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Command and Control. Joseph A. Barone, Pharm.D., FCCP Professor and Chair Dept. of Pharmacy Practice & Administration Ernest Mario School of Pharmacy. Acknowledgements. Mr. David Gruber, Sr. Deputy Commissioner NJ DHSS. Outline. Command and Control Concepts National Level

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Command and Control

Joseph A. Barone, Pharm.D., FCCP

Professor and Chair

Dept. of Pharmacy Practice & Administration

Ernest Mario School of Pharmacy


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Acknowledgements

Mr. David Gruber,

Sr. Deputy Commissioner

NJ DHSS


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Outline

  • Command and Control Concepts

  • National Level

  • New Jersey Level

  • New Jersey Innovations

  • Future Challenges

  • Conclusion


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Everybody’s Example

  • Katrina


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Command and Control Concepts

  • There is no one concept that fits all

  • CC is a fluid state

  • Applications from the military don’t always fit non-military applications, but are pretty good

  • CC has exciting health care possibilities

  • CC offers opportunities for pharmacists


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National Level

  • National Incident Management System (NIMS)

    • Flexible

    • Standardized


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National Incident Management System Components

  • Command and Management

  • Preparedness

  • Resource Management

  • Communication and Information Management

  • Supporting Technologies

  • Ongoing Management and Maintenance


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Command and Management

  • Incident Command System

  • Multiagency Coordinating Systems

  • Public Information Systems


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Preparedness

  • Planning

  • Training

  • Exercises

  • Personnel qualification and certification

  • Equipment qualification and certification

  • Mutual aid

  • Publication management


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Communications and Information Management

  • Incident management communications

  • Information management


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Incident Command System

  • Standardized on-scene incident management concept

  • Allows responders to adopt an integrated organizational structure equal to the severity of single or multiple incidents

  • Not hindered by jurisdictional boundaries


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Incident Command System

  • ICS emergency response functions

    • Command (incident commander/unified command)

    • Operations

    • Planning

    • Logistics

    • Finance and administration


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Incident Commander

  • Responsible for all aspects of the response

  • Establish immediate priorities

  • Stabilize the incident

  • Determine objectives and strategy

  • Monitor incident organization

  • Ensure health and safety


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Joint Medical Command and Control (JMCC)

  • Natural disasters usually require DoD medical assistance

  • Command operations

  • Medical homeland defense planning and response

  • JMCC intended for natural disasters and CBRNE


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Joint Medical Command and Control (JMCC)

  • Technology is usually not most difficult aspect

  • Challenge is understanding agency-specific processes and needs of medical planners

  • “Air Force Portal” under development

  • Goal is to increase situational awareness of resources near the event


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“Air Force Portal”

  • Use existing infrastructure and technology

  • Assimilate information from various sources (people, supplies, civilian assets/hospitals)

  • Distribute information to medical planners in a virtual environment

  • Modifiable data links (ie. weather for evacuation)

  • Other military portals coming on line

  • Other commercial platforms available


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“Network-Centric” Emergency Response

  • Driven by technology

  • Rapid collection, transfer, and dissemination of information

  • Arises from network-centric warfare


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Emergency Response vs. Military CC

  • Differences in mission and training

  • Different skills sets and expertise between emergency responders and military personnel

  • Similar need to establish CC and build situational awareness in a changing and hostile environment


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Network-Centric Challenges

  • Figure out what information you need

  • Train the decision makers

  • Train emergency personnel

  • Train organizations

  • PRACTICE

  • ASSESS

  • PRACTICE SOME MORE


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Network-Centric Challenges

  • Information overload

  • Data masquerading as information

  • Unfiltered information

  • Conflict with CC hierarchy

    • Excessive control from above

    • Uncontrolled improvisation below

  • Unnecessary networking


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National Level


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New Jersey Level


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Pharmacist Assets

  • T3 model of pharmacist involvement

  • Planning, execution, and after action analysis

  • Participation in CC at many levels

  • Planning and participating in Strategic National (and local) Stockpile exercises

  • Identifying and designing processes for safe,effective, and efficient medication distribution


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Pharmacist Assets

  • Staffing POD’s

  • Contribute to disaster response planning

  • Design medication prophylaxis and treatment protocols


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Public Health

Region Team

Healthcare Delivery

System

Emergency

Management

Health Infrastructure Preparedness & Emergency Response Program


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8.7 million people

566 municipalities

114 local health departments

21 counties

22 lead health agencies

5 planning regions

81 acute care hospitals

9 Medical Coordination Centers

1 Health Command Center

New Jersey’s Health System


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DHSS

Command

Medical

HAN

Admin

Federal Cell

EMS

HCO&A

Ops

Human Services

PIO

Hospitals/FQHC/

LTC

IT

OITS

RSS

Public Health

Off site ops

Logistic

(SNS/SSS)

CDRS

Lab

Epi Investigation

Lab Building

Press

BENS

Public

EMS Dispatch

EMS TF

DHS

DEP Phone

Gov office

PODS

LINCS

JIC

JOC

FBI

OCT

AG

HHS

CDC

Other

Agencies/Orgs

NJHA

Hospitals

EMS/General

OEM EOC

Govt. Agencies

Health System Command, Control and Communications


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Horizontal and Vertical Integration

  • Entities outside New Jersey

    • Federal DHHS (CDC)

    • DHS, FEMA

  • NJ State Agencies

    • Governor’s office

    • Domestic Security Preparedness Taskforce

  • Health Care Organizations

  • Local and County Public Health Agencies

  • Hospitals and Health Care Providers


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Federal and National Collaboration

  • Centers for Disease Control and Prevention (CDC)

  • Health Resource Services Administration (HRSA)

  • Federal Emergency Management Agency (FEMA)

  • United States Public Health Service (USPHS)

  • Department of Homeland Security (DHS)

  • Department of Justice (DOJ)

  • Association of State and Territorial Health Officials (ASTHO)

  • National Association of County City Health Officials (NACCHO)


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Interstate Collaboration

  • Mid-Atlantic Public Health Preparedness Conference (NJ, PA, MD, DE)

  • Metro Planning Workgroup (NJ, NYC, NY, CT)

  • Executive level preparedness and response meetings

Top areas of discussion:

Surge capacity

Communications

Credentialing


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REGIONALIZATION

  • Why:

    • Pre-event administration

    • State/local linkage

    • Event management

    • Focused operations

    • Coordination of resources

    • Increased surge capacity

  • Who:

    • DHSS Regional Coordination Teams

    • Emergency Management (MCCs)

    • Public Health

    • Health care delivery

  • How:

    • Population

    • Capability

    • Geography


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Local Health

Local Health

County Health

Primary

Care

Hospital

Hospital

Local OEM

Local OEM

Long Term

Care

County OEM

Regionalization

Preparedness

Public Health

Region Teams

Regional Coordinator

MCCs

Health System Liaison

Exercise Coordinator

EMS Liaison

Local Planners

Emergency

Management

Healthcare Delivery

System


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EMS Task Force

Concept

EMS Task Force 1

Public Health Regions 1 & 2

UASI

EMS Task Force 2

Public Health Regions 3 & 4

ODP

EMS Task Force 3

Public Health Region 5

MEDPREP

NJ EMS Task Force

  • A DHSS/DSPTF Effort

  • UASI, ODP and MEDPREP Funded

  • DHSS asset/coordinated with OEM


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DHSS Command and Control– federal, state and local partners

  • Joint Operations Center (JOC)/ Joint Field Office (JFO)

  • Federal

  • DHS, FBI, DHHS, CDC

  • State

  • Attorney General’s Office, NJDHSS, OEM

Federal/state

  • NJDHSS

  • Health Command Center (HCC)

  • Receipt/Stage/Storage Site (RSS)

  • Emergency Communication Center (ECC)

  • State Police Office of Emergency Management (OEM)

  • Emergency Operations Center (EOC)

State

Acute care hospitals

County OEMs

Local

Local health departments


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New Jersey Developments


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New Jersey Developments

  • MEDPREP

  • HEPAC

  • HIPPOCRATES


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HippocratesNew Jersey’s Health System Situational Awareness Application


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Regional Medical Coordination Center

MCC

Hospital

State Regional Team

FQHC

Other Health Entities

New Jersey’s Health EmergencyResponse System

NJDHSS HCC

HACC

Statewide

Emergency

Management

System

MCC

MCC

MCC

MCC

MCC


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What is Hippocrates ?

  • Situational awareness application (routine/emergent)

  • Integrated, web-based suite accessible anywhere, anytime

  • Health infrastructure preparedness and emergency response information

  • Displays real-time data for informed decision-making during a health emergency

  • Customized access so individuals or groups see only what they need

  • Developed and owned by NJ DHSS


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Health Infrastructure

Preparedness and

Emergency Response

HIPPOCRATES

Preparedness and Hippocrates


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Application Development

  • Initiated development in 2003

  • Piloted during TOPOFF 3 in April 2005

    • Identified additional requirements

      • Seamless integration of additional health applications

      • Increased map area

      • New functions such as search

      • Bi-directional Email communication and document sharing

      • Additional reporting and summary statistics

      • New opportunities for advanced analysis

  • Refined Version 1.0 requirements in Fall 2005

  • User Acceptance Testing in Summer 2006

  • Launched Version 1.0 in December 2006

  • More rollouts occurring now


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Incidents

Advanced and BasicLife Support

Acute and Non-Acute Care Hospitals

Events

Points of Distribution

Weather/Traffic

Blood Banks

Medical Stockpile

RSS MedicalStockpile Locations

Health Departments

SitStat Surveys

Post Offices

Schools

Roads

Municipalities

Counties

Surrounding State Counties

Hospitals fromSurrounding States

Hospital Divert Status

Long Term Care

Ambulance Locations

Command Centers

BASE MAP LAYERS

REAL-TIME FEEDS

Dynamic Data Integration

HIPPOCRATES

HEALTH LAYERS


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Future Challenges


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Overarching Goals

  • Allow planners and responders to work together to prepare and respond

  • Activities should occur without regard to agency or geography

  • Various platforms and portals will need to work together


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The Horizon

  • CBRNE event

  • Influenza pandemic

  • SARS-like

  • GPS on/in individual users

  • Handling mass fatalities

  • Legal issues in community containment measures


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Exercise Vigilant Shield ‘08

  • Part of TOPOFF 4

  • United States Northern Command

  • NORAD

  • Aerospace detection and defense events across the venues of Oregon, Arizona, and Guam

  • Will exercise aerospace defense, aerospace control, maritime warning, and coordination of air operations in a disaster


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TOPOFF-4

  • 15,000 participants

  • Prevention exercise - law enforcement and intelligence communities

  • HHS - radiologic emergency public health issues

  • DoD - global terror threat mitigation


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TOPOFF-4 Scenario

  • Coordinated “dirty bomb” detonations

  • Guam, first, near a power plant

  • Portland and Phoenix

  • Will stress rescue, health, and long-term decontamination

  • N.B. - “Real weapons will not be used in the scenario…”


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Conclusion

  • CC is constantly evolving

  • Coordination among national, state, and local assets is a daunting task

  • New Jersey is at the forefront of many preparedness initiatives

  • Pharmacists can provide value at many levels

  • Future challenges will involve the event and coordination of information and assets


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Remember

  • It has been 6 years since 9/11

  • There is still a need to continually stress and exercise the medical response systems.

  • Pharmacists should involve themselves in the many aspects of readiness training and thereby contribute to overall preparedness.


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Resources

  • www.dhs.gov - TOPOFF 4, National Incident Management System

  • www.osha.gov - incident command

  • www.northcom.mil - Exercise Vigilant Shield

  • LtCol Mark Stanovich,USMCR. “Network-Centric” Emergency Response: The Challenges of Training for a New Command and Control Paradigm, Institute for Security Technology Studies, Dartmouth College


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Resources

  • www.cdc.gov

  • www.state.nj.us/health - New Jersey preparedness activities

  • http://integrator.hanscom.af.mil/2006/Feb

    • Joint Medical Command and Control


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