VHA, DOD, & CIVILIAN COLLABORATION DURING MASS CASUALTY DISASTERS
The AVAS Trauma/Disaster and Emergency Management Preparedness “Committee” (See membership below) previously developed the following Missions and Goals:
MISSION: Engage VA surgeons by raising their awareness of and active involvement in VA-DoD National Disaster Preparedness activities.
GOALS:
VA ROLE IN TRAUMA AND DISASTER PREPAREDNESS
The presentation included underscores the importance of the VA in relationship to community and DoD response to mass casualty disasters.
While the authorization for the creation of the VA occurred at the end of the Civil War in 1865, a formal Department of Medicine and Surgery was not established until 1946. 1 During that time-period, Michael E. DeBakey, MD retired from the military service and undertook a mission caring for active duty servicemen and veterans. His early career was focused on military trauma surgery including development of Mobile Army Surgical Hospitals.2 In 1948 he moved to Houston and the Baylor University College of Medicine where he formalized the push to affiliate the VA with academic institutions and the creation of the Deans Committee.3-4 Since that time the VA has maintained a major role in research and care into our injured veterans.
The VA had no formal role during medical and civilian disaster response until a series of laws and Memorandums of Understanding (MOU) were created in the 1970’s and 80’s. The Disaster Relief Act / Public Law 93-288 (1974) followed by the FEMA act (1979) created the National Response Plan to manage major disasters. Public Law 97-174 (1982) executed between the Secretary of Defense and the Secretary Veterans Administration, established a VA/DoD Health Resources Sharing and Emergency Operation Act specifying each agency's responsibilities under the law. This MOU, gave the VA a new mission to serve as the principal health care backup to DoD in the event of war or national emergency that involves armed conflict. The VA agreed to serve as the primary medical backup systems for DoD and to furnish health services to armed forces on active duty on a higher priority than was done previously. Also in the 1980’s the American College of Surgeons Committee on Trauma recognized the need to partner with the military and VA and created the Military and VA Region-13.5
In 2004, The National Disaster Medical System (NDMS) was formalized as a method of supplementing State and local agencies during disasters and provide backup during oversees conflict. The NDMS is an interagency partnership between the Department of Health and Human Services, the Department of Homeland Security/FEMA, the Department of Defense, and the Department of Veteran’s Affairs. Within this plan the VA is predominately confined to patient reception and tracking. The VA also is responsible for the Strategic National Stockpile, the storage site for mass casualty response team equipment (VA All-Hazard Emergency Caches/ Strategic national Stockpile).6 The VA has been integral in disaster response through the provision of staff, supplies and equipment while utilizing its Disaster Emergency Medical Personnel System (most recently in response to several devastating hurricanes). Additionally, many VA’s are situated directly adjacent to Level I Trauma centers and while predominately theoretical, several have reported overflow of patients from overwhelmed emergency department to the VA (personal communication regarding the flow of patients diverted in the most recent Las Vegas Shooting incident).
The VA’s “Fourth Mission” (7) is to improve the Nation’s preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to veterans, as well as to support national, state, and local emergency management, public health, safety and homeland security efforts. In times of national crisis, such as the current Coronavirus pandemic, VA provides services to the nation based on requests from states, while being clear that Veterans are first. This is known as VA’s Fourth Mission. During the outset of the COVID-19 Pandemic, VA Secretary, Robert Wilke announced that the “VA is committed to helping the nation in this effort to combat COVID-19. Helping Veterans is our first mission, but in many locations across the country we’re helping states and local communities. VA is in this fight not only for the millions of Veterans we serve each day; we’re in the fight for the people of the United States.”
VA has determined to make 1,500 beds available for the Federal Emergency Management Agency (FEMA). These beds will be a combination of acute care and intensive care beds for non-Veteran patients available at various VA locations around the country.
MISSION: Engage VA surgeons by raising their awareness of and active involvement in VA-DoD National Disaster Preparedness activities.
GOALS:
- Education of Surgery Chiefs* regarding the VA-DoD roles during the NDMS-FCC plan activation, assuring that the Surgical Chiefs have the appropriate information to discuss their program’s role when the NDMS is activated or during other civilian or DoD Mass Casualty Disasters.
- Develop opportunities for collaboration with other stakeholders in the processes involved in the NDMS-FCC, (such as the Emergency Management Strategic Healthcare Group, facility leadership, etc), to assure that surgical program concerns are addressed in civilian or DoD mass disaster planning activities.
- Provide VA Surgery Program perspectives to American College Surgeons Committee on Trauma, Regional Committees on Trauma – Region 13 via information sharing from collaboration with VA and DoD Surgery Program Chiefs.
- Assess potential avenues of earlier integration of severe combat injured veterans including encouraging further surgical research areas via collaboration with current polytrauma programs, academic and DoD combat trauma research centers.
- Encourage participation of Surgical Program Trainees in conference presentations relating to DoD- COT Surgical meetings.
VA ROLE IN TRAUMA AND DISASTER PREPAREDNESS
The presentation included underscores the importance of the VA in relationship to community and DoD response to mass casualty disasters.
While the authorization for the creation of the VA occurred at the end of the Civil War in 1865, a formal Department of Medicine and Surgery was not established until 1946. 1 During that time-period, Michael E. DeBakey, MD retired from the military service and undertook a mission caring for active duty servicemen and veterans. His early career was focused on military trauma surgery including development of Mobile Army Surgical Hospitals.2 In 1948 he moved to Houston and the Baylor University College of Medicine where he formalized the push to affiliate the VA with academic institutions and the creation of the Deans Committee.3-4 Since that time the VA has maintained a major role in research and care into our injured veterans.
The VA had no formal role during medical and civilian disaster response until a series of laws and Memorandums of Understanding (MOU) were created in the 1970’s and 80’s. The Disaster Relief Act / Public Law 93-288 (1974) followed by the FEMA act (1979) created the National Response Plan to manage major disasters. Public Law 97-174 (1982) executed between the Secretary of Defense and the Secretary Veterans Administration, established a VA/DoD Health Resources Sharing and Emergency Operation Act specifying each agency's responsibilities under the law. This MOU, gave the VA a new mission to serve as the principal health care backup to DoD in the event of war or national emergency that involves armed conflict. The VA agreed to serve as the primary medical backup systems for DoD and to furnish health services to armed forces on active duty on a higher priority than was done previously. Also in the 1980’s the American College of Surgeons Committee on Trauma recognized the need to partner with the military and VA and created the Military and VA Region-13.5
In 2004, The National Disaster Medical System (NDMS) was formalized as a method of supplementing State and local agencies during disasters and provide backup during oversees conflict. The NDMS is an interagency partnership between the Department of Health and Human Services, the Department of Homeland Security/FEMA, the Department of Defense, and the Department of Veteran’s Affairs. Within this plan the VA is predominately confined to patient reception and tracking. The VA also is responsible for the Strategic National Stockpile, the storage site for mass casualty response team equipment (VA All-Hazard Emergency Caches/ Strategic national Stockpile).6 The VA has been integral in disaster response through the provision of staff, supplies and equipment while utilizing its Disaster Emergency Medical Personnel System (most recently in response to several devastating hurricanes). Additionally, many VA’s are situated directly adjacent to Level I Trauma centers and while predominately theoretical, several have reported overflow of patients from overwhelmed emergency department to the VA (personal communication regarding the flow of patients diverted in the most recent Las Vegas Shooting incident).
The VA’s “Fourth Mission” (7) is to improve the Nation’s preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to veterans, as well as to support national, state, and local emergency management, public health, safety and homeland security efforts. In times of national crisis, such as the current Coronavirus pandemic, VA provides services to the nation based on requests from states, while being clear that Veterans are first. This is known as VA’s Fourth Mission. During the outset of the COVID-19 Pandemic, VA Secretary, Robert Wilke announced that the “VA is committed to helping the nation in this effort to combat COVID-19. Helping Veterans is our first mission, but in many locations across the country we’re helping states and local communities. VA is in this fight not only for the millions of Veterans we serve each day; we’re in the fight for the people of the United States.”
VA has determined to make 1,500 beds available for the Federal Emergency Management Agency (FEMA). These beds will be a combination of acute care and intensive care beds for non-Veteran patients available at various VA locations around the country.
- For example, VA recently opened 35 beds between the Ann Arbor and Detroit VA Medical Centers to non-Veteran critical and non-critical COVID-19 patients.
- VA New York Harbor (New York: 80 patients, 30 discharges, 5 deaths.
- VA New Jersey: 24 patients, 6 discharges, 1 death.
- VA Ann Arbor, Michigan: 17 patients, 5 discharges, no deaths.
- VA Detroit, Michigan: 10 patients, 2 discharges, no deaths.
- VA Albuquerque, New Mexico: 4 patients, 1 discharge.
- In the last few days, VA has made 35 beds available for the community at three facilities in Illinois: the Edward Hines, Jr. VA Hospital, the Marion VA Medical Center, and the Jesse Brown VA Medical Center.
- Additionally, VA recently opened 18 beds at the Overton Brooks VA Medical Center in Louisiana.
- Our VA facility in Providence, Rhode Island has cared for 7 community nursing home patients. Six of the 7 were transferred back to the community nursing home; the remaining patient died.
- On April 4, 12 VA staffers were deployed to care for patients in two private nursing homes in Massachusetts: the Hunt Nursing Home in Danvers, and the Charlwell Nursing Home in Norwood.
- VA loaned a mobile pharmacy trailer and two VA staff members to the TCF Center in Detroit, Michigan, where the Army Corps of Engineers has set up a makeshift hospital for 1,000 beds. The state of Michigan will provide remaining staff and supplies.
- In New Haven, Connecticut, 3 VA clinicians were recently placed on assignment .to provide clinical support for disaster operations related to COVID-19 homeless population.
- https://www.va.gov/about_va/vahistory.asp. Assessed August 19 2017.
- http://www.annemergmed.com/article/S0196-0644(08)02006-4/pdf. Assessed August 19 2017.
- http://danbailes.com/wp-content/uploads/2012/11/VA-Debakey.pdf, Assessed August 19 2017.
- https://profiles.nlm.nih.gov/ps/retrieve/Narrative/FJ/p-nid/329. Assessed August 19 2017.
- https://www.facs.org/quality-programs/trauma/trauma-series/part-i. Assessed August 19 2017.
- http://www.cdc.gov/phpr/stockpile/stockpile.htm. Assessed August 19 2017.
- https://www.publichealth.va.gov/n-coronavirus/ Assessed Aug 12 2020