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The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination. Bruce Clements, MPH Director, Community Preparedness Section Texas Dept of State Health Services Rick Bays Director, Response and Recovery Unit Texas Department of State Health Services Emily Kidd, MD

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the state of texas disaster medical system an overview of tdms and esf 8 coordination

The State of Texas Disaster Medical System – An Overview of TDMS and ESF-8 Coordination

Bruce Clements, MPH

Director, Community Preparedness Section

Texas Dept of State Health Services

Rick Bays

Director, Response and Recovery Unit

Texas Department of State Health Services

Emily Kidd, MD

Assistant Professor, UT Health Science Center San Antonio

Project Director – Texas Disaster Medical System

national preparedness strategies
National Preparedness Strategies
  • Public health and healthcare preparedness is part of a national preparedness strategy
  • Presidential Policy Directive 8: National Preparedness
    • “…aimed at strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber attacks, pandemics, and catastrophic natural disasters.”
    • “…aimed at facilitating an integrated, all-of-Nation, capabilities-based approach to preparedness.”


vision and strategy alignment
Vision and Strategy Alignment

Homeland Security Presidential Directives

OPHPR Strategic Plan

Pandemic and All-Hazards Preparedness Act


National Health Security Strategy


National Preparedness GoalCore Capability List

Public Health and Healthcare Preparedness Capability Development

Conceptualizing and

Defining Public Health

Emergency Preparedness

Trust for America’s Health

Ready or Not

Health Preparedness

Capability Prioritization Project

Project Public

Health Ready

* Note: Partner documents are not an exhaustive list, shown for representation purposes only

public health and healthcare preparedness capabilities
Public Health and Healthcare Preparedness Capabilities



Emergency Management

Public Health

Public Health and Healthcare Preparedness


10 Essential Services of Public Health

National Preparedness

Core Capabilities

ndms and tdms
HHS may activate the NDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency.

HHS is the lead federal agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services. 

DSHS may activate TDMS to provide aid to victims of a public health emergency or to be present at locations at risk of a public health emergency.

DSHS is the lead state agency for Emergency Support Function #8 (ESF#8): Public Health and Medical Services. 

healthcare and public health capabilities
Healthcare and Public Health Capabilities
  • Public Health Emergency Preparedness (PHEP) awardees address 15 public health preparedness capabilities
  • Hospital Preparedness Program (HPP)awardees address 8 healthcare preparedness capabilities
capabilities overview
Capabilities Overview
  • Fifteen (15) public health and eight (8) healthcare preparedness capabilities
    • Numerical designations cross PHEP and HPP
  • Based on NHSS, PPD-8, NRF, NIMS and CPG101
  • Intent:
    • Continuity of essential public health and healthcare services to the community post-disaster
    • Effective management ESF-8 challenges
    • Ensure ESF-8 priorities and resource needs are addressed during response and recovery
public health and healthcare preparedness capabilities1
Public Health and Healthcare Preparedness Capabilities
  • Consistent with national preparedness strategies
  • Capabilities-based planning and implementation
  • Provides national guidance with a “whole of community” and “all of nation” approach
  • Serve as the foundation for the 2012 HPP-PHEP cooperative agreements
illustrating and communicating esf 8 complexity
Illustrating and Communicating ESF-8 Complexity
  • Acute Healthcare and Public Health
  • Two sets of distinct functions that strongly influence each other
  • They can stand alone but are much stronger together
  • Can’t be too close
    • Complete integration is not possible (placing acute care in public health or vice versa)
  • Can’t be too far apart
    • They strongly influence each other
esf 8 coordination the keystone

ESF-8 Coordination: The Keystone

Collaboration of public health and acute medical care preparedness


Spectrum of Resources

  • Equipment (e.g. AMBUS)
  • Equipment with Crew (e.g. Mobile Medical Unit)
  • Teams with Equipment (e.g. Ambulance Strike Teams)
  • Persons with Skills (e.g. Physicians, Epidemiologists)
tdms resource typing and credentialing

External attributes that are obvious




Unlikely to change

Quantitative - Descriptive Definition

“Equipment” or “Teams”


Internal attributes that are not obvious




Can to be transitory

Vetted Identity

Badge to combine Identity and Attributes


TDMS Resource Typing and Credentialing
tdms process






TDMS Process
  • Collaborative planning
  • Response hierarchy coordination
  • Role and responsibility clarification
  • Sequencing response actions
  • Focusing resources on risks
  • Defining resources and support
  • Improvement processes

The TDMS process is a forum for collaborative planning for healthcare and public health stakeholders to refine preparedness and response

tdms texas disaster medical system
TDMS – Texas Disaster Medical System

The Texas Disaster Medical System is the collaboration of all public health and acute medical care preparedness initiatives within the State of Texas relating to the mitigation of, response to, and recovery from natural and manmade disasters and other significant events within any region in Texas, with respect to Emergency Service Function (ESF)-8 functions.

Courtesy TDEM Website

where does tdms get its authority
Where does TDMS get its authority?

The Texas Disaster Medical System (TDMS) Steering Committee was established under the direction of the Texas Department of State Health Services (DSHS) in 2010. DSHS is the lead agency for Emergency Support Function (EDF)-8 (Public Health & Medical Services) per the state of Texas Emergency Management plan, Annex H, Texas Government Code §§ 418.042, 418.043(13), and 418.173(a).

tdms steering committee
TDMS Steering Committee

TDMS Steering Committee

Public Health

Acute Care

who is represented on the tdms steering committee
Who is represented on the TDMS Steering Committee?
  • Local Public Health Authorities
  • Local Health Departments
  • Regional Public Health Authorities
  • Regional Health Departments (HSRs)
  • Texas Department of State Health Services
  • Trauma Service Areas / Regional Advisory Councils
  • Hospitals and the Texas Hospital Association
  • Hospital Emergency Management
  • Academic Medicine
  • EMS Agencies – Rural, Urban, & Fire-based
  • Texas Division of Emergency Management
issues gaps identified so far
Issues / gaps identified (so far….)
  • Need for standardized training curricula and schedules for almost every response / resource group
  • Overlap of emergency response personnel on multiple team rosters
  • Coordination with Texas Military Forces resources
  • Funding responsibilities
  • Liability coverage of medical response personnel
  • Continuation of funding of teams/assets
  • Our role in medical component of mass-care sheltering
  • FNSS integration into plans and operations
  • Integration with federal response systems (timing, resource typing, availability, etc.)
  • Mass Fatality planning
issues gaps identified so far1
Issues / gaps identified (so far….)
  • Patient tracking issues
  • Standardized patient records
  • Patient records management
  • HIPAA compliance during a disaster
  • Use of MRCs / VOADs / volunteers
  • Integration of Medical Operations Centers into TDEM organizational chart
  • Medical Operations Centers functions and purpose
  • Integration of MOCs across the State
tdms overview document
TDMS Overview Document
  • Strategic framework and resource guide for P.H. and medical response and recovery
  • Guidelines, protocols, concepts, tasks, responsibilities, resource management information
  • Proposes MOC structure for ESF-8 coordination
  • Not intended to supplant local plans
tdms goals
TDMS Goals
  • Ensure highest level of readiness to respond
  • Ensure coordination, communication and collaboration among partners
  • Ensure understanding of roles and responsibilities of partners
  • Maintain updated list of ESF-8 resources
planning and coordination
Planning and Coordination
  • Bring together all partners from public health and acute care
    • Reveals gaps and overlaps
    • Facilitates better understanding of roles and responsibilities
    • Provides for continuous improvement
  • Partner workgroups at local jurisdiction, regional/multijurisdictional and state
planning and coordination functions
Planning and Coordination Functions
  • Access all current plans; de-conflict and coordinate
  • Compile list of available resources, assess gaps and overlaps
  • Establish mutual aid agreements
  • Develop organizational model for MOC and assign participants
  • Develop communications plan among partners
planning and coordination functions con t
Planning and Coordination Functions (con’t)
  • Determine how local and regional plans integrate with state plans
  • Develop written documents for plans and resources
  • Disseminate plans to all partners
  • Communicate gaps and capabilities to DSHS and TDMS Steering Committee
the moc medical operations center
The MOC(Medical Operations Center)
  • During response and recovery both acute care and public health must come together quickly
  • Single organization for ESF-8 coordination
  • MOC is not stand alone but is integrated into incident command
  • Flexible and scalable based upon the incident
moc development partners
MOC Development Partners
  • Single Jurisdiction
    • Local public health
    • EMS
    • Local EM
    • Local health authority
    • Hospitals/nursing homes
    • ME/JP
    • DME providers
    • Medical staffing agencies
    • Mental Health Centers
    • Disability community
  • Multi-jurisdictional
    • DDC/Regional coordinators
    • RAC
    • DADS
    • DARS
    • Community mental health centers
    • Disability community
    • ME/JP
esf 8 coordination primary functions

ESF – 8 CoordinationPrimary Functions

Assessment of Health & Medical Needs

- P. H. infrastructure

- Mental Health services

- hospital dialysis and LTC

facilities & Capacity


- home bound population

Health Surveillance

- general and medical shelters

- hospitals, dialysis and LTC facilities

- illness, injury, deaths

Medical Care Personnel

- coordinate and manage deployed staff and teams

- facilitate resources

- medical volunteer management

esf 8 coordination primary functions1

ESF – 8 CoordinationPrimary Functions

Health and Medical Supplies and Equipment

- general and medical shelters

- facilities


- Pharmacy and Oxygen


- coordinate medical ground and

air assets

- coordinate staging

- coordinate facility evacuations and destinations

- coordinate embarkation/reception triage/shelter


Patient Care

- facilitate management of medical surge

- hospital census and bed availability

esf 8 coordination primary functions2
ESF – 8 CoordinationPrimary Functions
  • Food Safety and Security

- food safety in shelters

- food safety during recovery

- food borne illness outbreak

  • Mental Health Services

- Disaster behavioral health

- Substance abuse services

  • Mortuary Services

- assist in Family Assistance Centers

- coordinate mortuary services/cemetery

esf 8 coordination primary functions3
ESF – 8 CoordinationPrimary Functions
  • Public Health / Medical information

- risk messaging to public

- public health policy and guidance

  • Recovery

- re-entry of evacuees

- infrastructure

- vector

incident scenarios
Incident Scenarios
  • Hurricane
  • Flooding
  • Wildfire
  • Catastrophic disease

(including pandemic)

  • Drought / Water Loss
  • Tornado
  • Radiologic Emergency
  • Food Contamination Attack /

Food Borne Illness

incident scenarios2
Incident Scenarios
  • Awareness of injury risks
  • Medical care for sheltered individuals
  • Evacuation
  • Stress Reactions
  • Preventing disease in congregate care settings
  • Mass Fatalities
  • Medical Surge
  • ESF-8 Coordination and Management

To name a few……..

tdms training levels
TDMS Training Levels
  • Basic knowledge related to an integrated TDMS emergency response and its key components
  • The target audience is all existing or potential participants of the TDMS
  • Core knowledge and skills that are common to most of the TDMS technical teams or activities
  • The target audience is individual TDMS members
  • Advanced TDMS team training
  • The target audience is individuals or entire units assigned to specialized TDMS teams (e.g., MMU, MIST, RAT, CAT, BHAT)
pilot courses
Pilot Courses
  • Not Throwing Caution to the Wind: 4/32:30 Deployment Safety
  • Exec. Overview of WebEOC in Texas 4/4 10:00
  • ESF8 Resource Roundup 1 4/4 2:30
  • ESF8 Resource Roundup 2 4/4 4:00
  • Going Down Range: Deployment Basics 4/5 10:00
ambulance strike teams
Ambulance Strike Teams

Currently 32 ASTs engaged, 150+ units

  • 5 Ambulances/AST (25 total)
  • Pre-identified teams
  • No-notice regional deployment
  • Statewide tasked missions
  • Common communications
mobile medical units
Mobile Medical Units

16-32 bed capacity

Provide emergency stabilizing care and transfer

Staffed with physicians, nurses, techs, logistics, clerical, etc

6-12 hr launch time for 72-96 hr deployment

Standardized cache of supplies, pharmaceuticals, and capabilities

ambus project
AMBUS Project

MPV = Multi-Patient Vehicle

Transport >12 litter patient at a time

Pre-plumbed for O2 and medical gases

No-notice regional and statewide taskings

4-6 paramedics/AMBUS


EMTF 2 –

North Central Texas

rn strike teams
RN Strike Teams

Nurses deployed into a “like” environment – standardized training

Must be qualified nurses with critical thinking skills during disaster situations

Understand NIMS and disaster response

Statewide tasking missions

Still being developed

esf 8 coordination in action
ESF-8 Coordination in Action
  • TDMS Components active during wildfire response
    • State medical operations center
    • DDC medical operations center
    • Ambulance Bus
    • CAT Team
    • Ambulance Strike Teams
    • Mobile Medical Team (MMT/MMU)
    • Pharmacy services
    • Disaster behavioral health
esf 8 coordination in action1
ESF-8 Coordination in Action
  • TDMS Components active during wildfire response, con’t
    • Medical support in general shelters
    • DME/ Medical supplies
    • Public Health
      • Shelter surveillance
      • Public health messaging
      • Epi surveillance
      • Infection control
      • Assessment