Following the catastrophic 2005 hurricane season, the Federal Emergency Management Agency (FEMA) sought to implement a plan to establish a comprehensive all-hazards EMS response to federally declared disasters. FEMA selected American Medical Response (AMR) as the sole provider of a national ambulance contract that provides a full array of ground ambulance, air ambulance and para-transit services to supplement the federal and military response to disasters, acts of terrorism or other public health emergencies.
Maximum deployment for each of the four FEMA zones includes 300 ground ambulances, 25 air ambulances and enough para-transit vehicles to transport 3,500 people. AMR has established a robust network of subcontractors to assist in meeting these needs. Private, public, third-service and volunteer EMS agencies have joined forces with AMR to form an EMS disaster response network. In addition to its own surge capacity resources, AMR has subcontracted with 122 para-transit companies, 41 air ambulance companies and 230 ground ambulance companies to address the government's health surge capacity goals.
The services provided in AMR's agreement with the government include: patient triage; treatment; transport; hazard recognition; symptom surveillance and reporting; on-scene medical standby; transport and redistribution of patients to free up receiving hospital bed space, provide immunizations, ensure staffing for shelters and emergency departments; set up mobile medical clinics, medical liaison, tactical management functions; and oversight and management of federal EMS and para-transit resources.
There have been four deployments of the FEMA/AMR national EMS contract since its inception in August 2007:
- Hurricane Dean (Texas, August 2007): 300 ground ambulances, 25 air ambulances, 3,500 para-transit passenger seats, 30 states participated.
- Hurricane Gustav (Mississippi, Louisiana and Texas, August 2008): 600 ground ambulances, 27 air ambulances, 3,900 para-transit passenger seats, 41 states participated.
- Hurricane Ike (Louisiana and Texas, September 2008): 533 ground ambulances, 25 air ambulances, 3,000 para-transit seats, 34 states participated. Presidential Inauguration, Washington, D.C. (January 2009): 144 ground ambulances, 15 para-transit, wheelchair coach buses.
- Each deployment was evaluated by FEMA. The government's overall satisfaction with these major deployments has been extremely high.
The 2008 hurricanes resulted in the largest deployment of EMS resources in the history of the U.S.
"Deploying roughly 600 ambulances across three Gulf States is grossly equivalent to a U.S. Army armored division deployed across an area more than twice the size of Iraq," said Lt. Commander Bruce Dell, U.S. Dept. Health and Human Services, HHS liaison for Texas in Hurricane Ike.
The 2009 Presidential Inauguration was declared a National Security Special Event, which warranted activation of the FEMA/AMR National EMS contract.
"We have come to rely upon AMR during national disasters and once again [during the inauguration], they have done a great job," said Mark Snyder, FEMA, who was the contracting officer's technical representative for Presidential Inauguration. "The FEMA/AMR contract is an all-hazards agreement, and this deployment certainly demonstrates the diversity of AMR to respond to major events other than hurricanes."
The lessons learned and best practices identified in each deployment have resulted in expanded services, such as improved communications and pandemic flu planning, and enhanced ability to respond to federal disasters.
Rapid mass notification system: To improve operations effectiveness and safety during large-scale disasters, AMR has implemented a state-of-the-art rapid mass notification system. With this advanced communications system, the AMR Office of Emergency Preparedness (OEP) has the ability to quickly and easily share information and resources in critical situations. This system enables one person to contact thousands of people within minutes via a variety of devices -- cell phones, land lines, satellite phones, computers, handheld devices, pagers and more. The OEP mass notification system is a highly scalable communication tool able to match any size disaster and is capable of handling simultaneous incidents in multiple locations.
GPS navigation and emergency communications: Hurricanes Gustav and Ike damaged traditional communications systems in areas along the Louisiana and Texas coasts. FEMA acquired several thousand wireless push-to-talk radios equipped with GPS navigation to track federal assets deployed to disasters.
Because two-way radios are only effective if they are linked to a functioning telecommunications infrastructure, FEMA partnered with AMR and its telecommunications vendor to address this problem. Mobile communications infrastructure platforms were acquired and deployed for both Gustav and Ike. During disasters, these communications platforms are deployed with first responders to insure interoperable communications. Even though the communications infrastructure in Galveston (Texas) and surrounding areas was destroyed in Hurricane Ike, by quickly deploying its disaster communications equipment, AMR and FEMA never lost contact with their EMS incident management teams.
Ambulance equipment: Essential equipment for ambulances varies from state to state. The AMR/FEMA contract calls for ALS and BLS ambulances. Some states require AEDs on BLS ambulances, but not all. In an effort to standardize equipment on all ambulances responding to federally declared disasters, AMR assisted HHS in establishing minimum standards for ALS and BLS ambulances for disaster deployments.
Bariatric ambulances were not part of the FEMA national ambulance response plan, but because hurricanes Gustav and Ike underscored the need for these specialized services, FEMA and AMR modified the national response to include bariatric ambulances in the arsenal of EMS disaster services.
Scope of practice for federal disasters: Recognizing that EMS scope of practice may vary between states, it was determined that minimum requirements should be established for disaster response. AMR has established EMS Scope of Practice, Protocols and Medical Control and Direction for all EMS responders who participate in AMR/FEMA disaster deployments. The National EMS Scope of Practice Model and National EMS Core Content were used to develop this standard.
Pandemic Influenza Preparedness
In 2009, FEMA and the U.S. Department of Homeland Security (DHS) Office of Health Affairs (OHA) announced plans to address first responder surge capacity and to work with state and local partners to review and assess current plans to respond to significant medical emergencies, including pandemic influenza. AMR, FEMA, HHS and OHA have been working together to address these growing concerns.
Planning for pandemic influenza is critical to ensure a sustainable health-care response. AMR will be involved in the treatment and/or transportation of patients with known or suspected H1N1 influenza. In preparation, AMR has established a national pandemic influenza coordinating team (PICT) made up of various clinical, operations and technical experts. Members of the PICT interact regularly with FEMA, DHS-OHA and NHTSA, and serve on various national pandemic committees.
The National Ambulance Contract represents a dynamic private-public partnership that reflects the possibilities of such alliances within the disaster response environment. The existence of the contract itself represents a major step forward.
The contract has significantly matured since its inception, allowing for enhanced capabilities and services to citizens impacted by disasters. These transitions and changes have not come easily as compliance with strict government contract standards can be a formidable challenge. However, the commitment of AMR and FEMA to always "do it better the next time" continues to drive improvement within the enterprise. The national ambulance contract continues to be a model effort in merging the skills and talents of the private and public sectors to better serve the needs of the American people.
Steve Delahousey,RN, REMT-P, ADLS, is the national vice president of emergency preparedness for Emergency Medical Services Corporation (EMSC), which includes as one of its subsidiaries, American Medical Response (AMR), the nation's largest ambulance provider. He's the federal liaison and intelligence officer for AMR's national disaster team. In 2007 he was selected as the Project Director for the FEMA Federal National EMS contract. In that capacity he provided leadership for the 2007 and 2008 Atlantic hurricanes which prompted the argest mobilization of EMS resources in U.S. history.
Mark Snyder is director of transformation and initiatives for FEMA. He heads the Logistics Management Transformation Initiative (LMTI) focused on transforming FEMA's logistics operations through the use of commercial capabilities and best practices to increase efficiency, agility and scalability. He also manages FEMA's strategy and execution of public evacuation assets.
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Click herefor more on inauguration MCI planning.Click herefor more information on the FEMA/AMR Disaster Response Team.