Welcome to the Department of Defense, Force Health Protection and Readiness, National
Disaster Medical System (NDMS) Page!
This website serves to provide an educational resource for our interagency colleagues
involved in federal response to civilian authorities requesting federal medical
assistance to major disasters.
National Disaster Medical System (NDMS) combines Federal and non-Federal
medical resources into a unified response to meet natural and man-made disaster
needs, as well as support patient treatment requirements from military contingencies.
National Response Framework (NRF) utilizes the National Disaster Medical
System (NDMS), under Emergency Support Function #8 (ESF #8),
Health and Medical Services, to support Federal agencies in the management and coordination
of the Federal medical response to major emergencies and federally declared disasters
such as natural disasters, major transportation accidents, technological disasters,
and acts of terrorism including weapons of mass destruction events.
The NDMS is an interagency partnership between the Department of Health and Human Services (HHS),
of Homeland Security (HS), the
Department of Defense (DoD), and the
Department of Veteran’s Affairs (VA) and is based on the 2005 Memorandum
of Agreement (MOA)between these agencies.
Components of the National Disaster Medical System
I. Medical Response:
The first component of the NDMS
is medical response. This includes personnel, teams
and individuals, supplies, and equipment. The National Disaster Medical System (NDMS)
Response Teams can include
Definitive Medical Care
In the event that the local medical systems within a disaster area are overwhelmed,
there may be a need for a system to move patients out of the disaster area. When
this occurs, local authorities may operate Casualty Collection Points (CCPs) that
feed into State-operated Aerial Points of Embarkation (APOE). If State or local
authorities are unable to establish
Federal authorities may deploy
appropriate assets to assist (e.g., DMATs,
HHS Public Health Service,
assets). If State or local authorities determine that resources are inadequate to
transport or care for all patients, a request for Federal medical evacuation assistance
can be initiated.
Patient movement, within NDMS, includes patient evacuation, medical regulating,
en-route care, and patient tracking/in-transit visibility.
The DoD coordinates patient movement for the
NDMS in collaboration with other
ESF #8 partners, as required. The
DoD US Transportation Command (USTRANSCOM) Defense
Distribution Operations Center is the single manager for the movement of
who require en route medical care, to include accepting requests for movement of
NDMS patients out of the disaster area,
regulating patients to definitive medical
care, tracking patients between disaster area and definitive care reception sites,
and coordinating patient transportation.
Transportation by air may be accomplished through the
USTRANSCOM's Air Mobility Command (AMC).
Patient Regulating: If DoD assets (to include National Guard assets in Title
32 or Title 10 status) are utilized to transport patients by air, they will be tracked
by the Global Patient Movement Requirements Center (GPMRC). Evacuation that is performed
by DoD is generated by the completion and validation of patient movement requests
(PMR), and is coordinated through the GPMRC (intra or inter-state strategic
ESF #8 aeromedical evacuation (AE) from aerial port of embarkation (APOE) to aerial
port of debarkation (APOD) only). The responsible receiving agency will provide
in-transit visibility from the receiving airhead to the destination facility (e.g.,
National Disaster Medical System (NDMS) hospital). For example, the Federal Coordination
Centers (FCC), if activated within NDMS will provide in-transit visibility from
the APOD to the destination facility (e.g.,
Patient Tracking:The NDMS has developed a national patient tracking system
called Joint Patient Assessment and Tracking System (JPATS). The CONOPS for this
tool is currently in DRAFT.
You may request a JPATS Account
Patients moved via NDMS from a disaster area for definitive medical care arrive
at a Federal Coordinating Center’s (FCC) Patient Reception Area (PRA). The mission
of a FCC is to receive, triage, stage, track and transport inpatients, affected
by a disaster, to a participating National Disaster Medical System (NDMS) inpatient
hospital capable of providing the required definitive care. The PRA generally operates
from pre-identified airfield, bus station or railhead Patient Reception Sites (PRS).
More information about NDMS
FCCs can be found in the current FCC guide.
The following graphic shows the locations of the the current VA and
Definitive Care, according to the NDMS
CONOPS, dated July 2009, is defined as:
• To the extent authorized by
NDMS, in the particular public health emergency, medical
treatment or services beyond emergency medical care, initiated upon inpatient admission
to an NDMS hospital and provided for injuries or illnesses resulting
directly from a specified public health emergency, or for injuries, illnesses and conditions requiring
non-deferrable medical treatment or services to maintain health when such medical
treatment or services are temporarily not available as a result of the public health
emergency. NDMS payment will end when one of the following occurs, whichever comes
first: completion of medically indicated treatment (maximum of 30 days); exhaustion
of Diagnosis Related Group (DRG) payment schedule; voluntary refusal of care; return
home or to point of origin/fiscally comparable location or to destination of choice
for patient (whichever costs less). Definitive care is rendered by a nationwide
network of voluntarily participating, pre-identified, non-Federal and Federal hospital
services. The network includes an ability to track available beds by medical specialty.
In a public health emergency, these services provide definitive medical care for
victims. In a military health emergency, NDMS non-Federal hospitals provide backup
to the available military and VA medical services for military beneficiaries. In
the case of DoD and
hospital services, use in a public health emergency is contingent
on availability and appropriate approval. FCCs monitor the status of
treated at medical facilities associated with their FCC.
Hospitals are reimbursed for the care they provide in accordance with the signed
NDMS Memorandum of Agreement.
is responsible for coordinating the discharge and transportation
of patients returning to their point of origin, or other destinations, as authorized.
Patients requiring continuing care are returned as soon as appropriate care is available
in the area from which they were evacuated and the patient can be transported safely.
The Assistant Secretary of Defense for Homeland Defense and Americas Security Affairs
(ASD(HD&ASA)), under the authority, direction, and control of the Under Secretary
of Defense for Policy USD(P), exercises overall supervision of homeland defense
activities of the Department of Defense. Under this authority, the ASD(HD&ASA)
The principal civilian advisor to the Secretary of Defense and the USD(P)
on DSCA, serves as the Defense Domestic Crisis Manager
Approval authority for requests for assistance from civil authorities sent to the Secretary of Defense, except for
those Item retained in paragraphs 4.h., 4.i., and 4.j. of DoD
Directive 3025.dd, or delegated to other officials. The Secretary of Defense shall be notified immediately of the use of
this authority. Such matters shall be coordinated with the Chairman of the Joint Chiefs of Staff and/or the Joint Staff
The ASD(HD&ASA) also develops, coordinates, and oversees the implementation
of DoD policy for DSCA and:
Through the Chairman of the Joint Chiefs of Staff as it pertains to DSCA
matters, monitors the activation, deployment, and employment of Federal military forces (including Reserve Component forces),
the National Guard, DoD civilian personnel, and all facilities, equipment,
fiscal accounts, supplies, and services owned by, controlled by, or under the jurisdiction of a
DoD Component in response to requests for
DSCA and for DoD
support to special events
The Assistant Secretary of Defense for Health Affairs (ASD(HA)), under the authority,
direction, and control of the Under Secretary of Defense for Personnel and Readiness
USD(P&R), and as the principal advisor to the Secretary of Defense for all DoD
health policy, provides guidance and support for all domestic crisis situations
or emergencies that require health or medical-related DSCA to
exercises authority, in accordance with section 300hh-11 of title 42, United States
Code, and according to DoD policy, for participation in the
Request for DoD Assistance to support Civil Authorities The following outlines the
key steps in the formal processing of Mission Assignments (MAs) and Requests for
Assistance (RFAs) for support to the NDMS
under 42 USC, Section 5121, Robert T. Stafford Act, as amended:
1. The Governor of an affected State may request Federal assistance under the provisions
of the Stafford Act. The State Coordinating Officer requests Federal assistance
from the FEMA Regional Director or Federal Coordinating Officer (FCO), as applicable.
2. The FEMA Regional Director or FCO
coordinates the request with the appropriate
Regional ESF-8 representative and forwards the request through the Regional Response
Coordination Office (RRCC) or the Joint Field Office (JFO) to the DHS
Response Coordination Center (NRCC).
3. To obtain support from NDMS Partners, the
DHS FEMA Federal Approving Official
in the NRCC issues a FEMA
Form 90-129 "Mission Assignment" in accordance with the
NRF Financial Management Support Annex.
4. The NRCC forwards approved MAs/
RFAs for Federal health and medical assets to
the HHS Secretary's Operations Center (SOC). (
MAs/RFAs for assets that are solely
provided by the DoD are forwarded directly to
DoD (Secretary of Defense, Executive
Secretary) via the DoD
Liaison in the NRCC.
5. The HHS Emergency Management Group (EMG) of the Secretary’s Operations Center
(SOC) convenes an NDMS Patient Movement Coordination Group (PMCG) [formerly known
as the Medical Inter-agency Coordination Group (MIACG)] to communicate mission requirements
and establish an integrated concept of NDMS operations. The
PMCG is comprised of
a representative(s) from each of the partner agencies (HHS,
DoD, VA, and
when patient movement and definitive care are needed. The HHS
SOC coordinates the
completion of "ESF Mission Assignment Subtasking Request Form(s)", as needed, in
accordance with the NRF Financial Management Support Annex.
6. The HHS SOC
forwards mission assignment Subtaskings to the VA Readiness Operations
Center (ROC) as applicable. The HHS
SOC will also request that DHS/
FEMA issue an
RFA through and approved and funded
MA directly to the Secretary of Defense, Executive
Secretary. The HHS SOC
coordinates with the HHS NDMS
Operations Branch as applicable.
The HHS SOC/Operations Division will notify the
NDMS Operations Branch when to alert,
activate and deploy response teams as applicable.
7. The Secretary of Defense's Executive Secretary forwards the RFAs (
FEMA MAs) to
the Office of the Assistant Secretary of Defense for Homeland Defense & America's
Security Affairs (OASD(HD&ASA)) and the Joint Director of Military Support (JDOMS).
The RFA (FEMA
MA) is forwarded to the Secretary of Defense for approval.
8. Upon Secretary of Defense approval, JDOMS coordinates and forwards Execute Orders
(EXORDs) and/or Operations Orders (OPORDs) to the applicable Combatant Commands
(e.g., U.S. Northern, Pacific, or Southern Command) and/or to the military Services
(i.e., Army, Navy and Air Force) as applicable, to direct activation of DoD assets,
such as USTRANSCOM AE patient assets and
9. The VA ROC forwards approved
MA subtaskings for VA
medical assets to the Office
of the VA Under Secretary for Health (USH). The
alerts or activates VA FCCs,
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Last Modified: April 29, 2010