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NBSB Report Suggests Improvements for NDMS

By Crystal Franco, September 29, 2008

On September 23, 2008, the National Biodefense Science Board (NBSB)—an advisory body to the HHS Assistant Secretary for Preparedness and Response (ASPR)—held a meeting to discuss a report titled Strategic Improvements to the National Disaster Medical System (NDMS), which was issued by the NBSB Disaster Medicine Working Group.^1,2

As mandated by the Pandemic and All Hazards Preparedness Act (PAHPA) and Homeland Security Presidential Directive (HSPD)-21, HHS has been conducting an ongoing review of NDMS and national medical surge capacity. NBSB was called upon by HHS to provide feedback on the ongoing review. To conduct its analysis, the NBSB Disaster Medicine Working Group formed an NDMS Assessment Panel composed of NDMS subject matter experts from the public and private sectors. This expert panel reviewed documents on NDMS, with specific focus on the “Joint Review of National Disaster Medical System, Consolidated Report of Recommendations, Stakeholder Review Draft, Version 3.0” authored by the MITRE Corporation (“the MITRE report”), which they concluded was an “inadequate and inaccurate…review of the NDMS and medical surge capacity.”²

The NBSB report contains recommendations for the future of the program based on the NDMS Assessment Panel’s evaluation of NDMS and the review process thus far:

Strategic Vision: A strategic vision for NDMS is needed that will “represent an overall system to provide for the medical needs of patients at a time of national need.” Integration of public/private sector partnerships should be part of this strategic vision.
Advisory Groups: Civilian NDMS advisory groups should be established and should meet regularly to assess and make recommendations for improving NDMS.
Monitor and Document NDMS Improvement: A system that tracks findings, after action reports, and improvements made during the NDMS review process would be helpful in understanding the program’s progress.
Medical Response Personnel: Enhancing the NDMS medical response teams is critical. Teams should be staffed fully, and there should be a streamlined application process. Issues regarding equipment, logistics, communication, and command and control should be addressed, and a “uniform, consistent training curriculum” should be created and implemented.
NDMS Personnel Capability and Gap Analysis: It is important to ensure that NDMS volunteers do not have “conflicting obligations and have time to respond” during a disaster. Also, given the current Department of Defense (DoD) commitments abroad, availability of DoD assets and staff for NDMS assistance should be evaluated.
Definition of NDMS Patient: The definition of an NDMS patient should be expanded. Reimbursement by the Centers for Medicare and Medicaid Services (CMS), for care provided to NDMS patients, should continue at 110% of the normal reimbursement rate. Reimbursement for NDMS patient care should be provided to all hospitals (whether or not they participate in NDMS), nursing homes, shelters, clinics, etc.
Refinement of Patient Movement Concept of Operations: The concept of operations for NDMS patient movement must be re-examined, and attention must be given to rapidly available patient transportation options and “continuity of medical records” during and after transport.
NDMS Electronic Medical Record: Electronic medical records for NDMS must be usable in the field, reflect real-time data, and should include a patient tracking function.
Improved Communication with State/Local Representatives: Better integration is needed between federal and state and local resources.
Development of Improved NDMS Standing Capacity: NDMS’s standing capacity could be improved by establishing closer alliances between NDMS and the private healthcare system. This would improve NDMS’s capacity for field care, patient transportation, and definitive patient care.
Federal Regulations: Criteria specifying which federal health-regulations will be suspended during a disaster response should be developed in advance of a disaster. These criteria should be widely communicated to the healthcare community so that they are taken into account in preparedness efforts.
NDMS Funding: Funding for NDMS is inadequate and requires at least a 15% increase over current levels. However, in order to truly accomplish its mission, NDMS will require a doubling of its current funding level.²

The NBSB submitted its recommendations to HHS, and HHS is to provide a written response to the report during the NBSB 2009 summer meeting.²

References

National Biodefense Science Board meeting. NBSB. September 23, 2008. http://www.hhs.gov/aspr/conferences/nbsb/20080923meeting.html. Accessed September 29, 2008.
Strategic improvements to the National Disaster Medical System (NDMS): report from the Disaster Medicine Working Group NDMS Assessment Panel. NBSB. September, 2008. http://www.hhs.gov/aspr/conferences/nbsb/ndms-rpt-0809.pdf. Accessed September 29, 2008.