The National Disaster Medical System (NDMS) is a federally coordinated, interagency system designed to support the United States’ ability to respond to medical surges caused by domestic disasters and military events. NDMS is a partnership among the Departments of Health and Human Services (HHS), War (DoW), Veterans Affairs (VA) and Homeland Security (DHS). Its three core missions are medical response, patient movement and definitive medical care through a nationwide network of civilian partner hospitals.
Although originally developed to respond to large numbers of casualties returning from overseas conflicts, NDMS has been used primarily for domestic disaster response, including natural hazards and viral outbreaks.
NDMS Pilot Program
Launched in 2020, the NDMS Pilot Program is a congressionally directed initiative to assess the National Disaster Medical System’s capacity to meet the demands of a large-scale combat operation (LSCO). Congress tasked the DoW with enhancing NDMS surge capacity, capability and interoperability during medical surge events through regionally engaged research and partnerships. The Puget Sound Pilot Site, supported by the UW’s Center for Disaster Resilient Communities (CDRC), is one of eight pilot sites around the United States. These sites were strategically chosen to strengthen regional capacity, preparedness and planning efforts.
Puget Sound Pilot Site
The Puget Sound Pilot Site comprises King and Pierce counties in Washington state. The state and the Puget Sound region depend on various entities for coordinating the provision of healthcare, such as the Washington State Hospital Association and the Northwest Healthcare Response Network. The regional collaborative system comprises military and civilian hospitals, healthcare systems and coalitions, local, tribal, and state public health, transportation agencies, emergency management agencies, emergency medical services (EMS) and military partners.
Puget Sound Pilot Site: Active Research Projects
The NDMS Steering Committee, composed of regional partners from civilian and military partner organizations, informed the active projects of the Puget Sound Pilot Site by addressing high priority gaps in the region related to surge capacity, capability and interoperability. Read more about our active projects below.
Healthcare providers across the Puget Sound region hold additional professional commitments as members of the Reserve Components of the US Military. Previous research has yet to fully assess the proportion of these personnel who also hold civilian healthcare roles, making it challenging to measure the impact a LSCO scenario could have on current system capacity. This project seeks to quantify that impact, utilizing de-identified administrative data to fill this information gap. We are developing, piloting and refining a healthcare system-level process to assess healthcare personnel roles with overlapping military obligations that could impact civilian healthcare capacity in the event of a LSCO.
In this project, we are working with UW Medicine (UWM) to assess the feasibility of using hospital or healthcare system-level administrative data to identify personnel with competing military obligations and better understand unit-level impacts on hospitals and healthcare systems. Future applications of this project will inform region-wide understanding of workforce capacity to respond to medical surge during a LSCO scenario.
Military and civilian healthcare entities have different systems, policies, and procedures for information storage and sharing, which can impede coordination necessary in a LSCO scenario. This work builds on previous University of Washington research that developed a concept for a regional data ecosystem that would connect people, platforms, and processes for better public health emergency preparedness and response.
With input from a LSCO Data Task Force, this project will identify minimum essential elements of information (EEIs), barriers to data sharing, and minimum requirements for a data sharing platform to enhance information sharing between military and civilian healthcare systems. This project also explores lessons about data sharing for load balancing and patient movement from previous medical surge events (e.g., COVID-19) through interviews with local, regional, and national partners.
In the event of a LSCO, it is likely that hospitals will have some advance notice (e.g., days to weeks) that they will receive military patients, allowing for proactive decompression of facilities. This project evaluates regional and national strategies to reduce burden on healthcare systems during a medical surge event. We will work with regional healthcare partners to compile previously identified proactive decompression strategies and their barriers to implementation (e.g., those related to policy, voluntary participation of NDMS partner facilities). We will also identify additional strategies, including barriers and facilitators to their implementation, from publicly available medical surge plans in other pilot sites and other strategic regions/jurisdictions.
During the COVID-19 pandemic, the Washington Medical Operations Coordination Center (WMCC) was established to support load balancing and movement of COVID-19 patients across the state. The WMCC evolved to serve as a critical resource statewide to match patients with definitive care; however, absent an ongoing disaster or public health emergency, it has been a challenge to identify resources to sustain its operations.
Without this critical infrastructure, load balancing and patient movement needs during a LSCO scenario and other regional medical surge events, will be greatly hindered. Other states and regions have similarly struggled to sustain investment in medical operation coordination center (MOCC) capabilities. While significant effort has been made to conceptualize a MOCC and its functions, there has yet to be a consensus around outcomes that define their success.
This project leverages national interest and momentum around MOCCs to engage subject matter experts and leaders across the country to determine a set of key outcome measures for MOCCs in each of these scenarios. We will then use these outcome measures to retrospectively evaluate the WMCC’s impact during COVID-19 pandemic and other medical surge events. We will supplement our quantitative analysis through qualitative interviews with those who have engaged with the WMCC. Through our engagements, we will also explore financial models and opportunities to sustain the WMCC and other regional capabilities necessary for patient movement and load balancing during a LSCO. We will identify recommendations for improvement from the lens of enhancing capability to respond to a LSCO scenario. This work will provide an evidence-based foundation to advocate for sustained WMCC support to respond to diverse medical surge events in Washington state.