Command and Control Joseph A. Barone, Pharm.D., FCCP Professor and Chair Dept. of Pharmacy Practice & Administration Ernest Mario School of Pharmacy

Command and Control

Joseph A. Barone, Pharm.D., FCCPProfessor and Chair

Dept. of Pharmacy Practice & Administration

Ernest Mario School of Pharmacy


“Command and Control”

Acknowledgements

Mr. David Gruber, Sr. Deputy Commissioner NJ DHSS



Outline

• Command and Control Concepts• National Level• New Jersey Level• New Jersey Innovations• Future Challenges• Conclusion



Everybody’s Example

• Katrina



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



National Level

• National Incident Management System (NIMS)– Flexible– Standardized



National Incident Management System Components

• Command and Management• Preparedness• Resource Management• Communication and Information Management• Supporting Technologies• Ongoing Management and Maintenance



Command and Management

• Incident Command System• Multiagency Coordinating Systems• Public Information Systems



Preparedness

• Planning• Training • Exercises• Personnel qualification and certification• Equipment qualification and certification• Mutual aid• Publication management



Communications and Information Management

• Incident management communications• Information management



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



Incident Command System

• ICS emergency response functions– Command (incident commander/unified

command)– Operations– Planning– Logistics– Finance and administration



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



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



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



“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



“Network-Centric” Emergency Response

• Driven by technology• Rapid collection, transfer, and dissemination of

information• Arises from network-centric warfare



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



Network-Centric Challenges

• Figure out what information you need• Train the decision makers• Train emergency personnel• Train organizations• PRACTICE• ASSESS• PRACTICE SOME MORE



Network-Centric Challenges

• Information overload• Data masquerading as information• Unfiltered information• Conflict with CC hierarchy

– Excessive control from above – Uncontrolled improvisation below

• Unnecessary networking



National Level







New Jersey Level



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



Pharmacist Assets

• Staffing POD’s• Contribute to disaster response planning• Design medication prophylaxis and treatment

protocols



Health Infrastructure Preparedness & Emergency Response Program

Region Team

Public HealthPublic Health

EmergencyEmergencyManagementManagement

Healthcare DeliveryHealthcare DeliverySystemSystem



New Jersey’s Health System

• 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



Lab

Op

s

IT

Hu

man

Services

Hospitals/FQ

HC

/

LTC

Public Health

Logistic (SNS/SSS)

HA

N

Fed

eral

Cel

lE

MS

PIO

Ad

min

Lab Building

OIT

SRSS

Off si

te o

ps

CDRS

Epi Investig

ation

JICJOC

FB

I

OC

T

DH

SD

EP P

hone

Gov

offi

ce

EMS/General

OEM EOC

AG

HH

S

CD

C

Hospital

s

EMS Dispatch

EMS TF

Press

BENSPublic

PODSLINCSNJH

A

Me

dic

al

Co

mm

and

HCO&A

DHSSDHSS

Govt. AgenciesGovt. Agencies

Other

Other

Agenci

es/O

rgs

Agenci

es/O

rgs

Health System Command, Control and Communications



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



Federal and National CollaborationFederal 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)



Interstate CollaborationInterstate 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



Why:•Pre-event administration•State/local linkage•Event management

Focused operationsCoordination of resourcesIncreased surge capacity

How:•Population•Capability•Geography

Who:•DHSS Regional Coordination Teams•Emergency Management (MCCs)•Public Health•Health care delivery

REGIONALIZATIONREGIONALIZATION





Local OEM

County OEM

Local OEM

RegionalizatiRegionalizationon

PreparednessPreparednessLocal HealthCounty Health Local Health

Hospital

Hospital

Long TermCare

PrimaryCare

Region Teams

Regional CoordinatorMCCs

Health System LiaisonExercise Coordinator

EMS LiaisonLocal Planners

Public HealthPublic Health

EmergencyEmergencyManagementManagement

Healthcare DeliveryHealthcare DeliverySystemSystem



EMS Task ForceEMS Task ForceConceptConcept

EMS Task Force 1EMS Task Force 1Public Health Regions 1 & 2

UASI

EMS Task Force 2EMS Task Force 2Public Health Regions 3 & 4

ODP

EMS Task Force 3EMS Task Force 3Public Health Region 5

MEDPREP

•A DHSS/DSPTF Effort

•UASI, ODP and MEDPREP Funded

•DHSS asset/coordinated with OEM

NJ EMS Task ForceNJ EMS Task Force



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)

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

Federal •DHS, FBI, DHHS, CDC

State•Attorney General’s Office, NJDHSS, OEM

Local health departments

County OEMsAcute care hospitals

DHSS Command and Control– federal, state and local partners

Lo

cal

Sta

teF

eder

al/s

tate



New Jersey Developments



New Jersey Developments

• MEDPREP• HEPAC• HIPPOCRATES

HippocratesNew Jersey’s Health System Situational Awareness Application



New Jersey’s Health EmergencyResponse System

NJDHSS HCC

HACC

StatewideEmergency Management

SystemState Regional Team

Hospital

FQHC

Other Health Entities

MCCRegional Medical Coordination Center

MCC

MCC MCC

MCC

MCC



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



Preparedness and Hippocrates

HIPPOCRATESHIPPOCRATES

Health Infrastructure

Preparedness and

Emergency Response

Health Infrastructure

Preparedness and

Emergency Response



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



Post OfficesSchoolsRoads

MunicipalitiesCounties

Surrounding State Counties

BASE MAP LAYERS

IncidentsIncidents

Ambulance LocationsAmbulance Locations

EventsEvents

Weather/TrafficWeather/Traffic

Medical StockpileMedical Stockpile

SitStat SurveysSitStat Surveys

Hospital Divert StatusHospital Divert Status

REAL-TIME FEEDS

HIPPOCRATES

HEALTH LAYERS

Acute and Non-Acute

Care Hospitals

Advanced and Basic

Life Support

Blood Banks

Points of Distribution

Health Departments

RSS Medical

Stockpile Locations

Long Term Care

Hospitals from

Surrounding States

Command Centers

Dynamic Data Integration



Future Challenges



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



The Horizon

• CBRNE event• Influenza pandemic• SARS-like• GPS on/in individual users• Handling mass fatalities• Legal issues in community containment measures



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



TOPOFF-4

• 15,000 participants• Prevention exercise - law enforcement and

intelligence communities• HHS - radiologic emergency public health issues• DoD - global terror threat mitigation



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…”



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



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.



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



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

Documents

Command and Control Joseph A. Barone, Pharm.D., FCCP Professor and Chair Dept. of Pharmacy Practice & Administration Ernest Mario School of Pharmacy