key: cord-0845074-0qncxplj authors: Dire, Daniel J; Suter, Robert E; Robinson, Joe D; Lynn, W Scott title: Army Urban Augmentation Medical Task Forces for COVID-19: Part 1—Development date: 2021-07-23 journal: Mil Med DOI: 10.1093/milmed/usab309 sha: 7fbe8f3fbeb6858e6129cb4759b416a6e3035514 doc_id: 845074 cord_uid: 0qncxplj This article describes how the U.S. Army developed a new ad hoc medical formation, named Urban Augmentation Medical Task Force for the Department of Defense (DoD) in response to the Coronavirus Disease 2019 pandemic in the Continental United States during the spring of 2020. We review the role of the DoD support of the Federal Emergency Management Agency as a part of Defense Support of Civilian Authorities. gives FEMA the responsibility for coordinating governmentwide relief efforts. 5 This article will review how the U.S. Army developed a new ad hoc medical formation, named Urban Augmentation Medical Task Force (UAMTF), for the Department of Defense (DoD) response to the COVID-19 pandemic in the Continental United States during the spring of 2020. The National Response Framework (NRF) provides foundational emergency management doctrine for how the USA responds to all types of disasters. The NRF is composed of a base document, Essential Support Function (ESF) annexes, and support annexes. The annexes provide detailed information to assist with the implementation of the NRF. Federal support during response operations focuses on the capabilities necessary to save lives; protect property and the environment; meet basic human needs; prioritize operations to stabilize community lifelines and restore basic services and community functionality; establish a safe, secure, and accessible environment for responders and response operations; and support the transition to recovery. The desired end-state for federal incident response is achieved when local, state, tribal, territorial, and insular area entities no longer require Federal Government assistance to provide life-saving or life-sustaining support, thereby allowing for the transition to recover. 6 Essential Support Function (ESF) 6 (Mass Care, Emergency Assistance, Temporary Housing, and Human Assistance) provides for integrating voluntary agency and other partner support, including other federal agencies and the private sector, to resource health and medical services and supplies. Essential Support Function (ESF) 8 (Public Health and Medical Services) provides health and medical support to communities and coordinates across capabilities of partner agencies. 6 Each of the 10 FEMA regional offices maintains a Regional Response Coordination Center. When activated, these multiagency coordination centers are generally staffed by regional FEMA personnel and augmented by ESFs and other federal agencies in anticipation of, or immediately following, an incident. Operating under the direction of the FEMA Regional Administrator, the staff within the Regional Response Coordination Center coordinates federal regional response efforts and maintains connectivity with FEMA Headquarters and state Emergency Operation Centers. Each FEMA Region has a Defense Coordinating Officer who serves as the FEMA Region's single point of contact for DoD support. Each Defense Coordinating Officer has a Defense Coordinating Element consisting of a staff and military liaison officers to translate federal capabilities and facilitate coordination and support to activated ESFs. Requests for the President of the United States (POTUS) to declare an emergency typically come from the Governor of an affected state who deems that the situation is beyond the capability for the state to manage. 5 Under Title 10 U.S. Code §13, the Secretary of Defense (SECDEF) has authority, direction, and control over DoD capabilities. Department of Defense resources may be committed to a disaster response when requested by another federal agency (e.g., FEMA) and approved by the SECDEF or when directed by the POTUS. Department of Defense policy regarding Defense Support of Civil Authorities (DSCA) can be found in DoD Directive 3025.18, Defense Support to Civil Authorities. 7 When DoD resources are authorized to support civil authorities, command of those forces remains with the SECDEF under whom the operational coordination and employment of such resources are normally led by the designated Combatant Command. In the case of the COVID-19 response, United States Northern Command (USNORTH-COM) at Peterson Air Force Base in Colorado was the designated Combatant Command. The USNORTHCOM plans, organizes, and executes homeland defense and civil support missions, but has few permanently assigned forces. When necessary, the command is assigned forces to execute missions, as ordered by the POTUS or SECDEF. An FMS is a pre-packaged scalable, up to 250-bed facility, designed for low-acuity, non-acute, non-traumatic, and nonsurgical medical needs, including behavioral health support, that cannot be addressed in a general disaster shelter facility. 8 It is set up in a facility of opportunity with at least 44,000 square feet of space (e.g., school gyms/stadiums, convention center, warehouses, etc.), in close proximity to the disaster area and is usually pre-coordinated by HHS with regional and local emergency management offices. The FMS is led and operated by HHS, but the DoD support personnel remain under the command and control of an assigned DoD commander. 8 The military commander is expected to coordinate with the FMS HHS-assigned leader to define the supervisory relationship. Typically, the DoD provides transportation for its deployed personnel to the FMS, but is not required to coordinate logistical support (e.g., local transportation vehicles, lodging, meals, and security) which is handled by HHS. The recommended DoD staffing of an FMS is shown in Table I . Medical specialties may be adjusted at execution to specific mission requirements or personnel availability. The preparation for use of U.S. Army Reserve (USAR) medical forces began on March 19, 2020, with a message from the Commanding General of the U.S. Army Reserve Command (CG, USARC) in anticipation that the DoD would call upon the medical capabilities of the USAR. That same On March 24, 2020, the CG, USARC queried the USAR operational medical divisions as to how long it would take to mobilize the personnel from two USAR combat support hospitals from the 807th MCDS and two hospital centers from the 3rd MCDS. 9 The response given by both MCDS commanders was 5 to 7 days. Three days later, these two commands received a new order to create these new ad hoc military formations, modeled by USARC in accordance with the DoD FMS CONOP, which became known as UAMTFs. 10 The decision to create this new ad hoc formation was in response to a request by FEMA to provide DoD personnel staffing for FMS in caring for non-COVID-19 patients that would be off-loaded from civilian hospitals which were overburdened with COVID-19 admissions. The CG, USARC order specifically directed that potential candidate army reserve soldiers for UAMTFs would not include personnel currently employed in local COVID-19 response efforts in a military or civilian capacity. The UAMTF is an 85-person unit consisting of physicians, nurses, dentists, environmental scientists, combat medics, behavioral health specialists, occupational therapists, pharmacists, dieticians, physician assistants, respiratory therapists, and administrative personnel (See Table II ). These UAMTFs consisted of personnel only without any equipment or supplies except their individual personal field draw. The initial mission for each of these UAMTFs was to prepare to support HHS 250-bed FMSs for non-acute, non-COVID-19 patient care. Several skill set substitutions were made to account for military operational needs: three positions were added to the command/administrative section (medical logistics, unit supply, and human resource specialists) and an infectious disease physician was added in the event the mission changed to include caring for COVID-19 patients. There was a reduction in the number of occupational and physical therapy personnel to keep the total number of personnel unchanged. The 3rd and 807th organized 5 and 10 UAMTFs each, respectively, and had them ready for movement by April 7, 2020. The 3rd MCDS assigned unit numerical designations named after their four medical brigades that assembled them (UAMTF 005-1, UAMTF 332-1, UAMTF 338-1, UAMTF 804-1, and UAMTF 804-2). The 807th MCDS assigned unit numerical designations named after the combat support hospital (UAMTF 94-1, UAMTF 352-1, UAMTF 352-2, UAMTF 452-1, UAMTF 452-2, UAMTF 801-1, UAMTF 801-2, and UAMTF 801-3) or hospital center that assembled them (UAMTF 811-1). An additional four UAMTFs were organized by the final USAR medical division, Army Reserve Medical Command (ARMEDCOM) which commands and controls the USAR garrison medical units, and were assigned numerical designations named after the Medical Backfill Battalion that assembled them (UAMTF 7452-1, UAMTF 7454-1, UAMTF 7457-1, and UAMTF 7458-1). Of these four ARMEDCOM units, one was fully assembled by April 20, 2020. Five of the 3rd and nine of the 807th UAMTFs were given mission assignments in the spring of 2020. None of the ARMEDCOM UAMTFs were given mission assignments during this time period; however, 134 ARMEDCOM soldiers were cross-leveled to fill personnel vacancies in the 3rd and 807th MCDS UAMTFs. The army utilized the USAR to rapidly prepare military medical personnel to augment HHS FMSs to help decompress civilian hospitals of their non-acute, non-COVID-19 patients in order to increase their capacity to admit and care for COVID-19 patients. The UAMTF was the military organization that was created to meet this need as a part of DSCA. In part 2 of this series, we will detail the various types of mission assignments that were completed by these ad hoc units and their limitations and we will make recommendations for the future utilization of military medical personnel for pandemic disasters. COVID-19): a literature review Washington state 2019-nCoV case investigation team, first case of 2019 Novel Coronavirus in the United States Army response to SARS-CoV-2-Coronavirus pandemic 2019 HQ-20-017-FactSheet United States Department of Homeland Security: Stafford Act, as amended, and related authorities, FEMA P-592 United State Department of Homeland Security: National response framework United States Department of Defense Directive 3025 Code) Health and Medical Staffing of a Department of Health and Human Services Federal Medical Station Fragmentary order 002 (assessment of PTDO for select 3 MCDS and 807 MCDS units) to operation order 20-048 [United States Army Reserve Command (USARC), Army Reserve COVID-19 Response] (unclassified) None declared. None declared. None declared.