This document outlines the need for a statewide mass fatality response strategy in Texas. It notes that the current system relies on informal agreements between jurisdictions that may not be adequate in a large-scale incident. The document reports that a workshop was held where Chief Medical Examiners agreed that Texas would benefit from a centralized state resource for mass fatality response that could support local jurisdictions. This proposed system would be housed at a state university, seek multiple funding sources, take a statewide rather than just regional approach, and include experts from various sectors.
The document discusses limitations in medical malpractice research due to issues with data availability and methodology. It notes that missing or inaccurate data from various sources like jury verdicts and insurance claims, as well as lack of standardized research methods, have led to inconsistent findings. The document describes efforts by researchers to address these weaknesses through improved data collection and more rigorous study designs in order to provide stronger evidence to guide policy solutions.
This document discusses the costs of medical errors and efforts to reduce preventable hospital-acquired conditions (HACs). It notes that medical errors may cause up to 98,000 deaths per year costing up to $29 billion annually. Hospitals have little incentive to improve safety due to externalizing most error costs. In response, policies began denying Medicare/Medicaid payments for treatments from certain HACs considered preventable. This policy was expanded in 2012/2015 and may reduce payments to hospitals with the highest rates of HACs. The goal is to incentivize greater patient safety.
The document analyzes quality indicators for emergency departments at five hospitals in Dallas, Texas. It finds that while the hospitals serve similar populations, there is variation in quality outcomes. Texas Health Presbyterian generally had the best outcomes compared to national and statewide averages. Factors like overcrowding, staffing levels, and communication can impact quality and efficiency of emergency care provided. Improving processes and structures in emergency departments may help hospitals achieve better results.
The document discusses several topics related to medical malpractice including:
- Medical error is estimated to occur at a rate equivalent to 3 jumbo jet crashes per day.
- Common reasons patients sue doctors include diagnostic errors, surgical errors, and improper medical treatment. The doctors most often sued are surgeons, anesthesiologists, and obstetricians.
- While a negligent doctor has a 3 in 100 chance of being sued, a non-negligent doctor has only a 13 in 10,000 chance - suggesting most malpractice claims are not frivolous.
- Medical malpractice is defined as when a doctor fails to act as a reasonable physician would under the circumstances. Proving malpractice
The CHRISTUS Spohn Cancer Network outsourced its cancer registry services to TrustHCS to address a backlog of cases and maintain an up-to-date registry. The cancer registry collects and analyzes patient data to evaluate outcomes, identify trends, and ensure the hospital meets state reporting requirements. TrustHCS helped eliminate an 18-month backlog within 4 months by performing remote cancer registry services. This allowed the hospital to submit accurate and timely data to state and national databases and better inform strategic planning and clinical practices.
The document discusses medical errors and their relationship to negligence and malpractice litigation. Some key points:
- Medical errors are estimated to cause between 44,000-98,000 deaths per year in the US, making it a leading cause of death. However, other studies estimate a lower number of around 5,000 deaths due to errors.
- Only a small percentage (around 1-2%) of medical errors result in negligent injuries. Of those negligent injuries, only 10-13% result in malpractice claims.
- Common reasons for malpractice litigation include needing money, believing there was a cover up, or wanting information or revenge. However, the system rarely identifies or holds providers accountable for substandard care
The document summarizes rationing strategies for Viagra adopted in four countries:
1) In the US, decisions were diffused with no national policy, so access depends on location and insurance. Some states excluded it while others allowed limited prescriptions.
2) In Germany, courts played a major role in shaping policy, ruling individual cases for reimbursement when ED causes health issues but not to enhance function. No clear guidelines resulted.
3) In the UK, the NHS excluded Viagra initially but later allowed exceptions for severe ED after assessment. Usage has remained low due to cultural norms and cost deterrents.
4) In Sweden, regional councils made independent decisions but generally allowed reimbursement after assessment, and
This study evaluated the risk of opioid abuse in 202 chronic pain patients by addiction psychiatry fellows in an academic pain center. Most consultations were requested by less experienced pain practitioners and focused on assessing risk of continued opioid therapy. Abnormal toxicology results were found in 63% of patients referred, and only 2% were ultimately recommended for continued opioid therapy. The addiction psychiatry fellows found this rotation valuable for their training in evaluating prescription opioid risk. The study suggests supervised addiction psychiatry fellows can effectively conduct opioid risk assessments.
The document discusses limitations in medical malpractice research due to issues with data availability and methodology. It notes that missing or inaccurate data from various sources like jury verdicts and insurance claims, as well as lack of standardized research methods, have led to inconsistent findings. The document describes efforts by researchers to address these weaknesses through improved data collection and more rigorous study designs in order to provide stronger evidence to guide policy solutions.
This document discusses the costs of medical errors and efforts to reduce preventable hospital-acquired conditions (HACs). It notes that medical errors may cause up to 98,000 deaths per year costing up to $29 billion annually. Hospitals have little incentive to improve safety due to externalizing most error costs. In response, policies began denying Medicare/Medicaid payments for treatments from certain HACs considered preventable. This policy was expanded in 2012/2015 and may reduce payments to hospitals with the highest rates of HACs. The goal is to incentivize greater patient safety.
The document analyzes quality indicators for emergency departments at five hospitals in Dallas, Texas. It finds that while the hospitals serve similar populations, there is variation in quality outcomes. Texas Health Presbyterian generally had the best outcomes compared to national and statewide averages. Factors like overcrowding, staffing levels, and communication can impact quality and efficiency of emergency care provided. Improving processes and structures in emergency departments may help hospitals achieve better results.
The document discusses several topics related to medical malpractice including:
- Medical error is estimated to occur at a rate equivalent to 3 jumbo jet crashes per day.
- Common reasons patients sue doctors include diagnostic errors, surgical errors, and improper medical treatment. The doctors most often sued are surgeons, anesthesiologists, and obstetricians.
- While a negligent doctor has a 3 in 100 chance of being sued, a non-negligent doctor has only a 13 in 10,000 chance - suggesting most malpractice claims are not frivolous.
- Medical malpractice is defined as when a doctor fails to act as a reasonable physician would under the circumstances. Proving malpractice
The CHRISTUS Spohn Cancer Network outsourced its cancer registry services to TrustHCS to address a backlog of cases and maintain an up-to-date registry. The cancer registry collects and analyzes patient data to evaluate outcomes, identify trends, and ensure the hospital meets state reporting requirements. TrustHCS helped eliminate an 18-month backlog within 4 months by performing remote cancer registry services. This allowed the hospital to submit accurate and timely data to state and national databases and better inform strategic planning and clinical practices.
The document discusses medical errors and their relationship to negligence and malpractice litigation. Some key points:
- Medical errors are estimated to cause between 44,000-98,000 deaths per year in the US, making it a leading cause of death. However, other studies estimate a lower number of around 5,000 deaths due to errors.
- Only a small percentage (around 1-2%) of medical errors result in negligent injuries. Of those negligent injuries, only 10-13% result in malpractice claims.
- Common reasons for malpractice litigation include needing money, believing there was a cover up, or wanting information or revenge. However, the system rarely identifies or holds providers accountable for substandard care
The document summarizes rationing strategies for Viagra adopted in four countries:
1) In the US, decisions were diffused with no national policy, so access depends on location and insurance. Some states excluded it while others allowed limited prescriptions.
2) In Germany, courts played a major role in shaping policy, ruling individual cases for reimbursement when ED causes health issues but not to enhance function. No clear guidelines resulted.
3) In the UK, the NHS excluded Viagra initially but later allowed exceptions for severe ED after assessment. Usage has remained low due to cultural norms and cost deterrents.
4) In Sweden, regional councils made independent decisions but generally allowed reimbursement after assessment, and
This study evaluated the risk of opioid abuse in 202 chronic pain patients by addiction psychiatry fellows in an academic pain center. Most consultations were requested by less experienced pain practitioners and focused on assessing risk of continued opioid therapy. Abnormal toxicology results were found in 63% of patients referred, and only 2% were ultimately recommended for continued opioid therapy. The addiction psychiatry fellows found this rotation valuable for their training in evaluating prescription opioid risk. The study suggests supervised addiction psychiatry fellows can effectively conduct opioid risk assessments.
This document outlines a presentation on state initiatives impacting physicians and patients related to controlled substances. It includes disclosures from presenters and planners, as well as learning objectives. The first presentation discusses Maryland's emergency preparedness plan for responding when a physician's license to prescribe controlled substances is suspended. The plan was developed after an incident where over 2,000 patients lost access to prescriptions. It involves coordinating state agencies, conducting surveys, developing response teams, and temporarily providing resources to mitigate public health impacts. Focus groups provided guidance on barriers, triaging patients, documenting for referrals, and estimating costs. The goal is to deploy temporary resources at the local level until normal care processes resume.
This presentation reviews the historical and prospective studies demonstrating the causation of carpel tunnel syndrome in non-workers, workers and individuals with trauma i.e. fractures. It utilizes evidence based information for the medical causation analysis
This document summarizes challenges in providing preventive care services to older adults in the United States. Fewer than half of those aged 65 and older are up-to-date on recommended preventive services like immunizations and cancer screenings. While some goals have been met, like mammogram rates, the US still falls short of goals for vaccinating older adults against herpes zoster and pneumococcal disease. Barriers include a healthcare system focused on sickness rather than prevention, time constraints in medical visits, lack of awareness among patients and doctors of available preventive services like annual visits and weight loss counseling, and off-putting topics like colon cancer screening that require more discussion.
¿Se correlaciona el volumen de atención de pacientes VIH con calidad de cuidados, esquemas, seguimiento y atención en general de un paciente con infección VIH?
Improving Patient Safety - Five years after the IOM ReportISOB
Five years after an influential IOM report brought attention to medical errors, there have been some improvements in patient safety but also lingering concerns. Various public and private organizations have implemented new programs and policies focused on error reduction. However, over half of Americans remain dissatisfied with healthcare quality and 40% believe it has gotten worse. Reaching consensus on effective safety strategies, including reporting methods, remains challenging due to ideological differences. Continued progress will require further investment in information technology solutions and data sharing across the fragmented system.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document provides an overview of medical malpractice and tort reform. It discusses the extent of medical error and malpractice litigation, defines the elements of a negligence case including duty, breach, causation and damages. It covers the burden of proof through expert testimony and standards of care. Vicarious liability and defenses such as statutes of limitations are also outlined. The document then examines MICRA, the landmark tort reform legislation in California, and proposes additional reforms around apologies, expert panels and specialized medical courts.
Health Care Continuity in Jail, Prison and Community brighteyes
Health Care Continuity in Jail, Prison and Community Thomas.Lincoln@bhs.org
Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006
This study examined the relationship between risk of future crime/violence and mental health status/co-occurring disorders in 2,077 probationers in Tarrant County, Texas. Screening tools assessed substance use, mental health disorders, and risk levels. Probationers with co-occurring substance use and mental health disorders had significantly higher risk of future crime than those with only one disorder or no disorders. Treating both substance use and mental health issues is important for reducing recidivism in this population.
This document discusses the importance of disaster preparedness plans for healthcare institutions. It notes that disasters, both natural and man-made, are inevitable in every country. Hospitals will be on the front lines of responding to mass casualty events. Effective disaster preparedness plans are needed at the institutional level to efficiently manage large numbers of victims during an emergency situation. The plans should identify available local resources and coordinate with external support. Proper triage, treatment, and record-keeping of victims are essential components of institutional disaster response.
This document discusses behavioral health patient boarding in emergency departments. It defines boarding as patients staying in the ED after being admitted until an inpatient bed becomes available. Boarding can last over 24 hours and negatively impacts both patients and hospital resources. The document provides statistics on the increasing rates of psychiatric boarding in US EDs and safety concerns for healthcare workers from violent patients. It examines reasons for boarding like capacity constraints, limited outpatient services, lack of funding, and legal issues. The document also discusses the ill effects of boarding and factors exacerbating wait times. It concludes with recommendations to improve care and safety for psychiatric patients boarding in the ED.
Trauma Informed Primary Care for Women Living with HIV ANAC Webinar May 2014Carol Dawson-Rose
This document presents a conceptual model for a trauma-informed primary care environment. The three core components of the model are:
1. A trauma-informed environment that is safe, calm, and empowering for patients and staff. Providers are educated about trauma's impacts and the clinical flow reduces triggers to promote trust and healing.
2. Universal screening for current and lifelong trauma, including abuse, as well as consequences like complex PTSD, depression, and substance abuse. Screening is patient-led but routine.
3. Screening is directly linked to on-site and community interventions. For recent trauma, safety and autonomy are prioritized. For lifelong abuse, longer-term evidence-based group interventions address
Seeking patient feedback an important dimension of quality in cancer careAgility Metrics
1) A patient satisfaction survey was conducted with cancer outpatients to identify areas for improvement. Wait times and contacting healthcare providers by telephone received the lowest satisfaction ratings, despite prior interventions to address wait times.
2) Patients followed by a nurse navigator reported higher satisfaction with wait times than those without a nurse navigator.
3) The survey found overall high satisfaction rates, but identified wait times and telephone contact as ongoing priorities for enhancing the patient experience.
The Mental Health of Federal Offenders A SummativeReview of.docxoreo10
The Mental Health of Federal Offenders: A Summative
Review of the Prevalence Literature*
Philip R. Magaletta,1 Pamela M. Diamond,2,5 Erik Dietz,3 and Stephen Jahnke4
To date, only a small number of government and peer-reviewed studies have examined the
mental health of federal offenders. Although these studies provide isolated bits of
information they have yet to be organized into a coherent body of knowledge from which
clinicians, administrators and policy makers can inform their work. As a first step in
constructing this knowledge and understanding the possible mental health needs of this
population (currently America’s largest correctional population), this paper delineates the
available government and peer-reviewed studies on federal offenders, highlights their
convergent findings, and suggests opportunities for growth in research, administration and
policy.
KEY WORDS: offenders; federal prisons; service utilization; diagnoses.
There is an increasing demand for effective,
empirically informed, prison-based mental health
services in America. It is a demand driven by the
needs of the offender population, the clinicians who
serve them, and the public’s expectation of
accountability. It is the product of multiple factors:
courts mandating that mentally ill persons receive
treatment while in custody; national mental health
screening and treatment standards being rigorously
applied; and increasingly porous boundaries be-
tween the mental health and criminal justice systems
(Fisher et al., 2002; Jemelka, Trupin, & Chiles,
1989). Furthermore, growth in the offender popu-
lation has remained mostly constant (Harrison &
Beck, 2005) and little debate remains that the
prevalence of mental illness in prison populations is
higher than that of the general population (Dia-
mond, Wang, Holzer, Thomas, & Cruser, 2001;
Jemelka et al., 1989). Finally, among community
mental health providers there is an increasing rec-
ognition that many patients have histories of crimi-
nality, incarceration, and prison-based mental health
treatment (Jemelka et al., 1989; Manderschied,
Gravesande, & Goldstrom, 2004; Morgan, Beer,
Fitzgerald, & Mandracchia, in press).
Far beyond the application of mental health
principles to those who ‘‘simply’’ happen to be
incarcerated, the provision of mental health services
in corrections remains a complex enterprise. It re-
quires strong clinicians, administrators who have a
keen and sensitive understanding of the multiple
systems comprising the correctional environment,
and policy makers who can draw upon an empirical
understanding of the population’s needs. To inform
the effective deployment of mental health resources
to this growing population it is imperative that this
*The views expressed in this paper are those of the authors (Philip
R. Magaletta and Erik Dietz) only and do not necessarily rep-
resent the policy or opinions of the Federal Bureau of Prisons,
the Department of Justice, or their academic affiliates.
1
Psycholo ...
State medical boards are tasked with disciplining healthcare professionals to protect the public, but their regulatory behavior is influenced by various political and economic factors. Most complaints come from the public and are investigated through a multi-step process involving various medical experts. Common grounds for discipline include substance abuse, sexual misconduct, incompetence, and malpractice issues. However, boards struggle to fulfill their constitutional mandate due to budget constraints, biases in expert testimony, and lack of standardized measures for determining negligence or sanctioning physicians. The disciplinary process can negatively impact physicians and encourages defensive practices without ensuring meaningful public protection.
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
Suicide Prevention Training Policies for HealthCare Profess.docxfredr6
Suicide Prevention Training: Policies for Health
Care Professionals Across the United States
as of October 2017
Janessa M. Graves, PhD, MPH, Jessica L. Mackelprang, PhD, Sara E. Van Natta, RN, and Carrie Holliday, PhD, MN, ARNP
Objectives. To identify and compare state policies for suicide prevention training
among health care professionals across the United States and benchmark state plan
updates against national recommendations set by the surgeon general and the National
Action Alliance for Suicide Prevention in 2012.
Methods. We searched state legislation databases to identify policies, which we de-
scribed and characterized by date of adoption, target audience, and duration and fre-
quency of the training. We used descriptive statistics to summarize state-by-state
variation in suicide education policies.
Results. In the United States, as of October 9, 2017, 10 (20%) states had passed
legislation mandating health care professionals complete suicide prevention training,
and 7 (14%) had policies encouraging training. The content and scope of policies varied
substantially. Most states (n = 43) had a state suicide prevention plan that had been
revised since 2012, but 7 lacked an updated plan.
Conclusions. Considerable variation in suicide prevention training for health care pro-
fessionals exists across the United States. There is a need for consistent polices in suicide
prevention training across the nation to better equip health care providers to address
the needs of patients who may be at risk for suicide. (Am J Public Health. 2018;108:760–
768. doi:10.2105/AJPH.2018.304373)
See also Caine and Cross, p. 717.
The number of suicides annually in theUnited States exceeds that of traffic
crashes or homicide, rendering it the 10th
leading cause of death.1 In 2013, 42 826 in-
dividuals died by suicide in theUnited States.1
The mortality rate for suicide has increased
24% since 1999 and is currently 13 per
100 000 people,which equates to 115 suicides
every day.2 Because of its high incidence and
potential for prevention, determining how to
most effectively prevent suicide is a public
health imperative.3
Health care professionals regularly en-
counter patients at risk for suicide. In an
Australian study, 75% of individuals who died
by suicide had seen a health care professional
within 3 months preceding their death.4 This
suggests health care professionals may play
a critical role in identifying at-risk patients and
in preventing suicide. However, health care
professionals are often not equipped with the
training necessary to effectively identify and
manage patients at risk for suicide.3,5,6 Even
among mental health providers, training in
suicide assessment and intervention is not
ubiquitous, despite calls for increased training
since the late 1980s.7–9 Patients at risk for
suicide may, therefore, be inadequately
identified and not receive appropriate
treatment.
In 2001, the US surgeon general released
National Strategy for .
Mental Health Court in the United StatesIndependent studyCJS400Kelly Haag
This document provides an overview of mental health courts in the United States, including their history, policy, design, implementation, evidence-based practices, measurement of success, and recommendations. It discusses how a lack of community mental health treatment led to increased criminal justice involvement for those with mental illness. Mental health courts were developed as a post-booking diversion program to address this issue. The document outlines the key goals of mental health courts and the essential elements of effective court design and implementation, including cross-system collaboration, eligibility criteria, timely linkage to services, treatment supports, and ongoing performance assessment.
This document summarizes a paper on citizenship theory and the practice of psychiatric boarding in Washington state. It discusses a 2014 state supreme court ruling that found psychiatric boarding, where patients in need of involuntary treatment are detained in emergency rooms due to a lack of treatment facility space, violates the Involuntary Treatment Act. The ruling highlighted deficiencies in the mental health system due to inadequate funding and increasing demand for services. The document examines how psychiatric boarding marginalized and failed to uphold the rights and dignity of detained patients. It also discusses social work implications and the need for long-term solutions, funding, and advocacy to improve treatment and outcomes for this vulnerable population.
This document provides an overview of a research project conducted in Massachusetts to study how family courts handle cases involving intimate partner violence (IPV). Surveys were administered to litigants, judges, and probation officers over two phases from 2009-2010. 212 litigants, 44 probation officers, and 10 judges participated. The project aimed to identify how often IPV is a factor in family court cases and explore stakeholder perceptions to inform systemic improvements around safety and addressing IPV in family court proceedings. Key findings revealed gaps between litigants' and other stakeholders' experiences that, if addressed, could enhance outcomes and safety in high-risk family court cases.
This document outlines a presentation on state initiatives impacting physicians and patients related to controlled substances. It includes disclosures from presenters and planners, as well as learning objectives. The first presentation discusses Maryland's emergency preparedness plan for responding when a physician's license to prescribe controlled substances is suspended. The plan was developed after an incident where over 2,000 patients lost access to prescriptions. It involves coordinating state agencies, conducting surveys, developing response teams, and temporarily providing resources to mitigate public health impacts. Focus groups provided guidance on barriers, triaging patients, documenting for referrals, and estimating costs. The goal is to deploy temporary resources at the local level until normal care processes resume.
This presentation reviews the historical and prospective studies demonstrating the causation of carpel tunnel syndrome in non-workers, workers and individuals with trauma i.e. fractures. It utilizes evidence based information for the medical causation analysis
This document summarizes challenges in providing preventive care services to older adults in the United States. Fewer than half of those aged 65 and older are up-to-date on recommended preventive services like immunizations and cancer screenings. While some goals have been met, like mammogram rates, the US still falls short of goals for vaccinating older adults against herpes zoster and pneumococcal disease. Barriers include a healthcare system focused on sickness rather than prevention, time constraints in medical visits, lack of awareness among patients and doctors of available preventive services like annual visits and weight loss counseling, and off-putting topics like colon cancer screening that require more discussion.
¿Se correlaciona el volumen de atención de pacientes VIH con calidad de cuidados, esquemas, seguimiento y atención en general de un paciente con infección VIH?
Improving Patient Safety - Five years after the IOM ReportISOB
Five years after an influential IOM report brought attention to medical errors, there have been some improvements in patient safety but also lingering concerns. Various public and private organizations have implemented new programs and policies focused on error reduction. However, over half of Americans remain dissatisfied with healthcare quality and 40% believe it has gotten worse. Reaching consensus on effective safety strategies, including reporting methods, remains challenging due to ideological differences. Continued progress will require further investment in information technology solutions and data sharing across the fragmented system.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document provides an overview of medical malpractice and tort reform. It discusses the extent of medical error and malpractice litigation, defines the elements of a negligence case including duty, breach, causation and damages. It covers the burden of proof through expert testimony and standards of care. Vicarious liability and defenses such as statutes of limitations are also outlined. The document then examines MICRA, the landmark tort reform legislation in California, and proposes additional reforms around apologies, expert panels and specialized medical courts.
Health Care Continuity in Jail, Prison and Community brighteyes
Health Care Continuity in Jail, Prison and Community Thomas.Lincoln@bhs.org
Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006
This study examined the relationship between risk of future crime/violence and mental health status/co-occurring disorders in 2,077 probationers in Tarrant County, Texas. Screening tools assessed substance use, mental health disorders, and risk levels. Probationers with co-occurring substance use and mental health disorders had significantly higher risk of future crime than those with only one disorder or no disorders. Treating both substance use and mental health issues is important for reducing recidivism in this population.
This document discusses the importance of disaster preparedness plans for healthcare institutions. It notes that disasters, both natural and man-made, are inevitable in every country. Hospitals will be on the front lines of responding to mass casualty events. Effective disaster preparedness plans are needed at the institutional level to efficiently manage large numbers of victims during an emergency situation. The plans should identify available local resources and coordinate with external support. Proper triage, treatment, and record-keeping of victims are essential components of institutional disaster response.
This document discusses behavioral health patient boarding in emergency departments. It defines boarding as patients staying in the ED after being admitted until an inpatient bed becomes available. Boarding can last over 24 hours and negatively impacts both patients and hospital resources. The document provides statistics on the increasing rates of psychiatric boarding in US EDs and safety concerns for healthcare workers from violent patients. It examines reasons for boarding like capacity constraints, limited outpatient services, lack of funding, and legal issues. The document also discusses the ill effects of boarding and factors exacerbating wait times. It concludes with recommendations to improve care and safety for psychiatric patients boarding in the ED.
Trauma Informed Primary Care for Women Living with HIV ANAC Webinar May 2014Carol Dawson-Rose
This document presents a conceptual model for a trauma-informed primary care environment. The three core components of the model are:
1. A trauma-informed environment that is safe, calm, and empowering for patients and staff. Providers are educated about trauma's impacts and the clinical flow reduces triggers to promote trust and healing.
2. Universal screening for current and lifelong trauma, including abuse, as well as consequences like complex PTSD, depression, and substance abuse. Screening is patient-led but routine.
3. Screening is directly linked to on-site and community interventions. For recent trauma, safety and autonomy are prioritized. For lifelong abuse, longer-term evidence-based group interventions address
Seeking patient feedback an important dimension of quality in cancer careAgility Metrics
1) A patient satisfaction survey was conducted with cancer outpatients to identify areas for improvement. Wait times and contacting healthcare providers by telephone received the lowest satisfaction ratings, despite prior interventions to address wait times.
2) Patients followed by a nurse navigator reported higher satisfaction with wait times than those without a nurse navigator.
3) The survey found overall high satisfaction rates, but identified wait times and telephone contact as ongoing priorities for enhancing the patient experience.
The Mental Health of Federal Offenders A SummativeReview of.docxoreo10
The Mental Health of Federal Offenders: A Summative
Review of the Prevalence Literature*
Philip R. Magaletta,1 Pamela M. Diamond,2,5 Erik Dietz,3 and Stephen Jahnke4
To date, only a small number of government and peer-reviewed studies have examined the
mental health of federal offenders. Although these studies provide isolated bits of
information they have yet to be organized into a coherent body of knowledge from which
clinicians, administrators and policy makers can inform their work. As a first step in
constructing this knowledge and understanding the possible mental health needs of this
population (currently America’s largest correctional population), this paper delineates the
available government and peer-reviewed studies on federal offenders, highlights their
convergent findings, and suggests opportunities for growth in research, administration and
policy.
KEY WORDS: offenders; federal prisons; service utilization; diagnoses.
There is an increasing demand for effective,
empirically informed, prison-based mental health
services in America. It is a demand driven by the
needs of the offender population, the clinicians who
serve them, and the public’s expectation of
accountability. It is the product of multiple factors:
courts mandating that mentally ill persons receive
treatment while in custody; national mental health
screening and treatment standards being rigorously
applied; and increasingly porous boundaries be-
tween the mental health and criminal justice systems
(Fisher et al., 2002; Jemelka, Trupin, & Chiles,
1989). Furthermore, growth in the offender popu-
lation has remained mostly constant (Harrison &
Beck, 2005) and little debate remains that the
prevalence of mental illness in prison populations is
higher than that of the general population (Dia-
mond, Wang, Holzer, Thomas, & Cruser, 2001;
Jemelka et al., 1989). Finally, among community
mental health providers there is an increasing rec-
ognition that many patients have histories of crimi-
nality, incarceration, and prison-based mental health
treatment (Jemelka et al., 1989; Manderschied,
Gravesande, & Goldstrom, 2004; Morgan, Beer,
Fitzgerald, & Mandracchia, in press).
Far beyond the application of mental health
principles to those who ‘‘simply’’ happen to be
incarcerated, the provision of mental health services
in corrections remains a complex enterprise. It re-
quires strong clinicians, administrators who have a
keen and sensitive understanding of the multiple
systems comprising the correctional environment,
and policy makers who can draw upon an empirical
understanding of the population’s needs. To inform
the effective deployment of mental health resources
to this growing population it is imperative that this
*The views expressed in this paper are those of the authors (Philip
R. Magaletta and Erik Dietz) only and do not necessarily rep-
resent the policy or opinions of the Federal Bureau of Prisons,
the Department of Justice, or their academic affiliates.
1
Psycholo ...
State medical boards are tasked with disciplining healthcare professionals to protect the public, but their regulatory behavior is influenced by various political and economic factors. Most complaints come from the public and are investigated through a multi-step process involving various medical experts. Common grounds for discipline include substance abuse, sexual misconduct, incompetence, and malpractice issues. However, boards struggle to fulfill their constitutional mandate due to budget constraints, biases in expert testimony, and lack of standardized measures for determining negligence or sanctioning physicians. The disciplinary process can negatively impact physicians and encourages defensive practices without ensuring meaningful public protection.
This is an old article (2007) on the dangers of oversaturation of paramedics vs. EMTs. Well written, timely , and evidence based. Written by Matt Zavadsky. The original website, www.emsnetwork.org, is now defunct so I repost it so it doesn't get lost forever.
Suicide Prevention Training Policies for HealthCare Profess.docxfredr6
Suicide Prevention Training: Policies for Health
Care Professionals Across the United States
as of October 2017
Janessa M. Graves, PhD, MPH, Jessica L. Mackelprang, PhD, Sara E. Van Natta, RN, and Carrie Holliday, PhD, MN, ARNP
Objectives. To identify and compare state policies for suicide prevention training
among health care professionals across the United States and benchmark state plan
updates against national recommendations set by the surgeon general and the National
Action Alliance for Suicide Prevention in 2012.
Methods. We searched state legislation databases to identify policies, which we de-
scribed and characterized by date of adoption, target audience, and duration and fre-
quency of the training. We used descriptive statistics to summarize state-by-state
variation in suicide education policies.
Results. In the United States, as of October 9, 2017, 10 (20%) states had passed
legislation mandating health care professionals complete suicide prevention training,
and 7 (14%) had policies encouraging training. The content and scope of policies varied
substantially. Most states (n = 43) had a state suicide prevention plan that had been
revised since 2012, but 7 lacked an updated plan.
Conclusions. Considerable variation in suicide prevention training for health care pro-
fessionals exists across the United States. There is a need for consistent polices in suicide
prevention training across the nation to better equip health care providers to address
the needs of patients who may be at risk for suicide. (Am J Public Health. 2018;108:760–
768. doi:10.2105/AJPH.2018.304373)
See also Caine and Cross, p. 717.
The number of suicides annually in theUnited States exceeds that of traffic
crashes or homicide, rendering it the 10th
leading cause of death.1 In 2013, 42 826 in-
dividuals died by suicide in theUnited States.1
The mortality rate for suicide has increased
24% since 1999 and is currently 13 per
100 000 people,which equates to 115 suicides
every day.2 Because of its high incidence and
potential for prevention, determining how to
most effectively prevent suicide is a public
health imperative.3
Health care professionals regularly en-
counter patients at risk for suicide. In an
Australian study, 75% of individuals who died
by suicide had seen a health care professional
within 3 months preceding their death.4 This
suggests health care professionals may play
a critical role in identifying at-risk patients and
in preventing suicide. However, health care
professionals are often not equipped with the
training necessary to effectively identify and
manage patients at risk for suicide.3,5,6 Even
among mental health providers, training in
suicide assessment and intervention is not
ubiquitous, despite calls for increased training
since the late 1980s.7–9 Patients at risk for
suicide may, therefore, be inadequately
identified and not receive appropriate
treatment.
In 2001, the US surgeon general released
National Strategy for .
Mental Health Court in the United StatesIndependent studyCJS400Kelly Haag
This document provides an overview of mental health courts in the United States, including their history, policy, design, implementation, evidence-based practices, measurement of success, and recommendations. It discusses how a lack of community mental health treatment led to increased criminal justice involvement for those with mental illness. Mental health courts were developed as a post-booking diversion program to address this issue. The document outlines the key goals of mental health courts and the essential elements of effective court design and implementation, including cross-system collaboration, eligibility criteria, timely linkage to services, treatment supports, and ongoing performance assessment.
This document summarizes a paper on citizenship theory and the practice of psychiatric boarding in Washington state. It discusses a 2014 state supreme court ruling that found psychiatric boarding, where patients in need of involuntary treatment are detained in emergency rooms due to a lack of treatment facility space, violates the Involuntary Treatment Act. The ruling highlighted deficiencies in the mental health system due to inadequate funding and increasing demand for services. The document examines how psychiatric boarding marginalized and failed to uphold the rights and dignity of detained patients. It also discusses social work implications and the need for long-term solutions, funding, and advocacy to improve treatment and outcomes for this vulnerable population.
This document provides an overview of a research project conducted in Massachusetts to study how family courts handle cases involving intimate partner violence (IPV). Surveys were administered to litigants, judges, and probation officers over two phases from 2009-2010. 212 litigants, 44 probation officers, and 10 judges participated. The project aimed to identify how often IPV is a factor in family court cases and explore stakeholder perceptions to inform systemic improvements around safety and addressing IPV in family court proceedings. Key findings revealed gaps between litigants' and other stakeholders' experiences that, if addressed, could enhance outcomes and safety in high-risk family court cases.
THE EMERGENCY DEPARTMENT AND VICTIMS OF SEXUAL VIOLENCE AN .docxtodd701
THE EMERGENCY DEPARTMENT AND
VICTIMS OF SEXUAL VIOLENCE: AN
ASSESSMENT OF PREPAREDNESS TO HELP
STACEY BETH PLICHTA, SC.D.
TANCY VANDECAR-BURDIN, M.A.
Old Dominion University, Norfolk, VA
REBECCA K ODOR, M.S.W.
Virginia Department of Health, Richmond, VA
SHANI REAMS, A.A.S.
Virginia Sexual and Domestic Violence Action Alliance,
Richmond, VA
YAN ZHANG, M.S.
Old Dominion University, Norfolk, VA
ABSTRACT
The Emergency Department (ED) is a key source of care for
victims of sexual violence but there is little information available about
the extent to which EDs are prepared to provide this care. This study
examines the structural and process factors that the ED has in place to
assist victims. A survey of all 82 publicly accessible EDs in the
Commonwealth of Virginia was conducted (RR 76%). In general, the
EDs provide the recommended medical care to victims. However, at
least half do not have the needed resources in place to effectively assist
victims and most (80%) do not provide regular training to their medical
staff about sexual violence. Further, almost one-quarter do not have a
relationship with a local rape crisis center. It is recommended that each
ED partner with local rape crisis centers to provide training to their
staff and to ensure continuity of support for victims. It is also
suggested that the state government explore ways in which a forensic
(SANE) nurse be made available to every victim of sexual violence that
presents to the ED for medical assistance. Ideally, each ED would
become part of a community-wide Sexual Assault Response Team
286 JHHSA WINTER 2006
(SART) in order to provide comprehensive care to victims and
thorough evidence collection and information to law enforcement.
INTRODUCTION
This study seeks to examine the extent to which
Emergency Departments (EDs) in the Commonwealth of
Virginia are prepared to provide care for victims of sexual
violence through an examination of both structural and
process factors that are currently in place. Many studies
indicate that sexual violence victimization has both long-
term and short-term health consequences (Plichta and Falik,
2001; see also Rentoul and Applebloom 1997; Cloutier,
Martin and Poole, 2002; Bohn and Holz, 1996). The ED is
a key source of care for victims of sexual assault. It is one
of the first points of entry to care. Competent care by
professionals trained in treating sexual assault victims is
critical to the timely recovery of physical and mental
health. The ED also plays a critical role in the collection of
evidence that may lead to the conviction of the perpetrator
and a recent study found that specially trained (forensic)
nurses perform this function significantly better than do
other staff (Sievers, Murphy and Miller, 2003). Forensic
nurses are registered nurses (R.N.’s) who have advanced
training in the examination of sexual assault victims; this
includes training on legal aspe.
Basing on the present scenario, the tasks will be delegated by the m.docxgarnerangelika
Basing on the present scenario, the tasks will be delegated by the members of the hospital administration that involves the director, the chief medical officer and the two assistants in the above top administrative positions (Sasser.et.al.2009). For the sake of identity, these top leaders in the administration shall be labeled with their first and last names as they are delegated duties. In regard to their duties and responsibilities, the director will be in charge of supervising and checking the availability of resources basic needs like the food, water and shelter together with the health facilities to facilitate the first aid. The chief medical officer will be in charge of supervising all the processes that will facilitate the efficient operation of the first aid as well as the emergence response decisions. Wanda will be charged with the responsibility of helping the injured people with the medication that can ease the pain as well as other types of medication that can easily the control of the disinfections in case there is an excessive blood loss.
Further recruitment in the team is Geri that serves to help the orderly in the arrangement of the required items in the health unit as well as moving the dead. The choice of these people to take care of the plan was based on their individual brilliance in terms of the skills and the attributes(Rathore.et.al.2012). Wanda & Geri are chosen have a medical background that enables them have a deep understanding of the medical needs of the patients. Another reason that will guide the selection is that they must have a good experience in the administrative skills. The dedication towards their work also matters during the selection process. This fact will help to provide the sense of responsibility for the job.
The spot administrative decisions will all be handled by the director apart from offering the meaningful assistance to the medical officer in the handling some of the matters that may sound critical and call for further intervention from the higher office which is the office the director. As a matter of fact, we shall have the medical officer taking care of the major injuries as a way of helping the orderly dispense his duties more effectively and evenly (Koenig & Schultz 2010). We shall have the orderly obtaining the medical supplies for his duties in the health clinic under the help of the chief medical officer. Wanda & Geri together with the orderly will work jointly to ensure there is provision of the basic necessities like the food, water and medicine to the injured persons and also facilitating the availability of shelter for the injured as part of the basic needs.
Since there is need for the authoritative representation, the National Disaster Management Authority has been working to govern the disasters in the region under the guidance of the central government (Wallace & De Balogh 1985). This body works to ensure there is a controlled emergence response to the occurrence of the di.
This article examines issues related to integrating drug treatment systems for criminal justice offenders. It discusses how the demand for treatment far exceeds availability for the large number of offenders who have substance use disorders. Most treatment provided in correctional settings is insufficient, such as self-help groups without clinical treatment. When offenders are released, continuity of treatment is often lacking. The article argues more needs to be done to apply lessons from research on effective community-based treatment to the criminal justice system. This includes providing clinically appropriate treatment matched to offenders' needs and integrating services as offenders transition between community supervision and incarceration.
National Surveillence Systems 2011 Report Briefbiopharmaguru
Surveillance systems are meant to inform public health and clinical practitioners, policy makers, and the general public of the scope, magnitude, and cost of a health problem in order to influence priority setting, program development, and evalu- ation of services or policies. The ultimate aim is to catalyze actions to reduce morbidity and mor- tality and improve health, within a framework of finite resources used in an efficient and cost-effec- tive way.
4 replies one for each claudiamajor disasters and emeAASTHA76
This document discusses health policies and their impact on nursing practice, particularly during disasters and emergencies. It notes that health policies provide guidelines for patient care during normal times and can act as a "guiding light" during abnormal situations like disasters. Nurses must be trained on protocols and have a general understanding of what to do in emergencies in order to respond rapidly and effectively. The document also emphasizes that nurses should feel confident in their actions during emergencies and that their experiences can help inform future health policies.
Barriers to Practice and Impact on CareAn Analysis of the P.docxrosemaryralphs52525
This document summarizes barriers to practice for psychiatric mental health nurse practitioners (PMHNPs) in New York State. It discusses how statutory collaborative agreements requiring oversight from psychiatrists disrupt continuity of care for patients and limit PMHNPs' autonomous practice. National statistics show a significant need for more mental healthcare providers. While PMHNPs are well-positioned to address this need, barriers like restrictive regulations prevent them from doing so. The document calls for reforms to expand PMHNPs' scope of practice and reduce barriers that impede access to mental healthcare.
This article summarizes a systematic review of published and unpublished evaluations of DWI Court programs released through April 2007. The review found that one evaluation exceeded 80% of recommended scientific criteria and was deemed "good", while four others exceeded 65% of criteria and were deemed "marginally acceptable". However, many evaluations had serious shortcomings like only reporting outcomes for graduates or failing to account for participant dropout. Overall, the state of the evaluation literature does not allow for scientifically defensible conclusions about the effects of DWI Courts due to inadequate methodological quality. The authors hope the criteria outlined can help improve future evaluations.
Pregnancy, Drug Use, and The Law Report and RecommendationsDana Asbury
In October of 2015, more than 250 participants from around the country came together in Nashville, TN for a series of events looking at the legal and medical responses to pregnant women and drug use. Today, we are releasing a report examining pregnancy and drug use and providing a comprehensive set of recommendations in a range of areas including state medical protocols, health coverage and the licensing of treatment facilities.
This study examined how well six different health data systems captured transgender identity information for 39 HIV-positive transgender individuals in Houston, Texas. The researchers found that transgender identity was only explicitly recorded in predefined fields in about half of the data systems. Notes sections contained transgender identity information 50% of the time but were unreliable. Without adequate fields to collect transgender data, manual record searches are needed but resource-intensive. The study concludes that health data systems need improvements to predefined gender identity fields and staff training to better capture transgender patient information.
Applying and Sharing Evidence Discussion.docxwrite22
This document discusses implementing routine distress screening for gynecologic cancer patients using the Distress Thermometer and Problem List. A study found that 66% of patients screened had moderate to high distress levels. The top problems identified were nervousness, worry, fatigue and sleep issues. Healthcare providers saw benefits for patients in validating their concerns and opening discussion. They also felt it enhanced holistic care. However, finding time for screening in busy clinics was challenging.
Biomedical Informatics project for implementing a state wide screening program for narcotic seeking patients. Project defined from abstract to specific implementation and measurement criteria.
Similar to Mass Fatality Response in Texas (Resources for research - late) (20)
The Veteran & Seniors Expo will be held on October 14, 2016 from 8 AM to 2 PM at the Humble Civic Center located at 8223 Will Clayton Pkwy, Humble, TX 77338. Seniors and veterans are invited to attend the expo and can RSVP by calling 832-605-3645 or emailing deeleal@aol.com.
Mr. Tam Nguyen interned for seven months at the Harris County Office of Homeland Security and Emergency Management. He showed strong academic ability and ambition by exceeding training requirements and successfully completing projects like a Threat and Hazard Identification and Risk Assessment and a white paper on methodology. His supervisor recommends him highly for another position, citing his dedication to education and community involvement.
This document is a shipper's export declaration form containing fields to provide information about an export shipment, including:
- Details about the U.S. principal party in interest exporting the goods and their address.
- Transportation and shipping details like date of export, port of export/unloading, carrier, and method of transportation.
- Information on the ultimate foreign consignee and country of destination.
- A description of the commodities being exported including quantity, value, and any required export licenses or authorizations.
- Certification by the exporter that the information provided is true and the exporter understands export laws and regulations.
This document lists 50 senior living communities in the Houston, Texas area including their addresses, phone numbers, and websites. It includes listings for Silverado Locations, Brookdale Locations, Belmont Village, Autumn Leaves of Riverstone, Loving Care Cottages, Elmcroft locations, Westbrae Court, The Forums at the Woodland, The Gardens of Bellaire, The Waterford at Deer Park, Enlivant, Pine Tree Assisted Living, Autumn Grove Cottages, and The Forum at Memorial Woods. Contact information is provided for each individual location.
Mr. Tam Nguyen interned for seven months at the Harris County Office of Homeland Security and Emergency Management. He showed strong academic aptitude by exceeding training requirements and successfully completing projects like a Threat and Hazard Identification and Risk Assessment for Harris County and a white paper on conducting the assessment. His supervisor recommends him highly for another position, praising his drive for education and relationship with his family and community.
This document provides information about marketing an event in Freeport, TX including objectives, positioning, SWOT analysis, marketing mix, tools, strategies and budget. The event will take place in Freeport on unspecified dates and aims to effectively promote itself through increased marketing to local and national audiences using its website, media partnerships, and a promotional plan targeting key markets. A budget will allocate funds across design, print, distribution, advertising, research and other expenses.
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Archbishop Joseph A. Fiorenza Park is managed by Harris County Precinct Three, whose commissioner is Steve Radack. Radack has been commissioner since 1988 and has expanded the number of parks in Precinct Three from 10 to over 62, totaling around 15,000 acres of parkland. He has also improved infrastructure, transportation, and quality of life for the precinct's residents.
The Ibn Sina Foundation was established in 2001 by local healthcare professionals to address the growing gap between healthcare needs and availability of services for underserved families. Its mission is to provide integrated preventative and primary care through clinical services and health education to improve quality of life. The foundation operates several community health centers offering free or low-cost primary care, cancer screenings, immunizations for children, and programs for diabetes prevention and community outreach.
LIFE SAVERS ER - Marketing Strategy PlanTam Nguyen
Life Savers ER is a free-standing emergency room located in Houston, Texas. It has state-of-the-art equipment like X-rays, CT scanners, and ultrasounds. Unlike hospital ERs which have long wait times, Life Savers ER has a no wait policy. It is staffed by board certified physicians, nurses, and a pharmacy to treat various medical conditions from injuries to infections. The facility aims to provide fast, affordable, and high-quality emergency care for both adults and children.
Tam Nguyen invites Chief Boyle to the Congressional Ceremony Award event on December 20th from 1-4 PM. The event will honor heroes from the military, police, firefighters, and EMTs with a certificate from Congresswomen Jackson Lee, Sanchez and their staff. Attendees are asked to donate an unwrapped $15 toy or cash for Toys for Tots. The ceremony and toy drive will be held at TAPS: House of Beer in Houston.
This document provides marketing information for companies called Thrive & MPower in the 77077 area code of Houston, Texas in 2015-2016. It includes a table of contents and sections on company services, types of marketing, area information on marketing firms and public/private schools, and reviews of the local market and target customers. The overall goal is to help Thrive & MPower create an effective marketing strategy and budget for the local area.
This document lists over 200 street names in and around Houston, Texas. Some of the major streets mentioned include TC Jester, Bellaire Blvd, Westheimer Rd, Gessner Rd, Bissonnet St, Kirby Dr, Fondren Rd, and Westpark Tollway. A wide range of street types are listed from major thoroughfares to small residential roads across various Houston neighborhoods.
Theta Staffing Solutions LLC is throwing a community event on December 24, 2015 in the Acres Homes area of Houston to provide free food, hygiene packages, and toys to low income citizens. They are requesting Blake McMullin of Melange Catering & Special Events sponsor the event, which needs $3,000 total. Sponsorship levels include $250 for name/logo recognition and a speaking spot, $100 for name on materials, or $50 for name/logo on materials. The budget breakdown includes $800 for food, $100 for drinks, $100 for security, $2,000 for hygiene packages, and $100 for ziplock bags.
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The document provides information about the role and requirements for pharmacy technicians in Texas. It describes pharmacy technicians as individuals who work under the supervision of pharmacists to prepare and distribute drugs. Their main duties include filling prescriptions, assisting customers, and clerical tasks. To become a pharmacy technician trainee, one must be enrolled in an ASHP-accredited program and pass a certification exam within two years. To be a certified pharmacy technician, one must have a high school diploma, pass the PTCB exam, and register with the Texas State Board of Pharmacy. The career outlook is strong with an expected 31% increase in jobs by 2016 due to an aging population and increased medication use.
Students are expected to attend all classes and contact instructors if they must be absent. Students missing the first three days of class will be dropped from the roster. The student code of conduct prohibits disruptive behaviors like eating in class, cell phone use, monopolizing discussions, and disrespecting other students. Instructors can remove students from class for disruptive behaviors. Laptop and mobile device use is at the instructor's discretion, and devices should not be used for messaging, games, or other non-class activities unless permitted. Mobile phones must be silenced and only used outside of class unless an instructor grants an exception. Electronic devices cannot be used for academic dishonesty or illegal activities.
The summary provides an overview of the Houston Police Department's basic police officer training program:
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Mass Fatality Response in Texas (Resources for research - late)
1. MASS FATALITY RESPONSE IN TEXAS:
A STRATEGY FOR THE FUTURE
WHITE PAPER SPONSORED BY:
THE CHIEF MEDICAL EXAMINERS OF TEXAS
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TEXAS DIVISION OF EMERGENCY MANAGEMENT
SEPTEMBER 30, 2014
2. Mass Fatality Response in Texas: A Strategy for the Future 2
TABLE OF CONTENTS
Executive Summary 3
Contributors 4
Authors
Chief Medical Examiners of Texas
State of Texas
Statement of the Problem 5
Strategy 6
Components and Personnel
Framework
Management
Summary 13
3. Mass Fatality Response in Texas: A Strategy for the Future 3
EXECUTIVE SUMMARY
On April 17, 2014 the Chief Medical Examiners from across the state of Texas held a workshop at
the Harris County Institute of Forensic Sciences in Houston, Texas to discuss the potential for the
development of a statewide strategy for mass fatality incident response. The consensus among the
attendees was that there is indeed a need for a system that is capable of providing operational
medicolegal support to local jurisdictions, particularly those that do not have a medical examiner’s
office. The group developed consensus regarding the structure and components of the system. In
the opinion of the Chief Medical Examiners in Texas, a statewide mass fatality response system
should: 1) be a state health and medical function that is housed on the campus of a state public
university; 2) be eligible for and seek funding from multiple sources including the presiding state
agency, the housing university, and federal grant programs: 3) develop a statewide rather than a
regional or local response strategy; 4) incorporate subject matter experts from the public and
private sector, and; 5) have a mission that includes deployment, training, and research. This paper
provides a statement of the problem that has precipitated this effort and a summary of the solution
as envisioned by the Chief Medical Examiners from across the state.
4. Mass Fatality Response in Texas: A Strategy for the Future 4
CONTRIBUTORS
AUTHORS
Jason Wiersema PhD, DABFA, DABMDI, Forensic Anthropologist/Director of Forensic Emergency
Management, Harris County Institute of Forensic Sciences
Allison Woody MS, MEP, Preparedness Training and Exercise Coordinator, Harris County Institute of Forensic
Sciences
MEDICAL EXAMINER’S OFFICE REPRESENTATIVES
Luis Sanchez MD, Executive Director & Chief Medical Examiner, Harris County Institute of Forensic Sciences
Dwayne Wolf MD, PhD, Deputy Chief Medical Examiner, Harris County Institute of Forensic Sciences
Katie Rutherford, Assistant County Attorney, Harris County
Jeffrey Barnard MD, Chief Medical Examiner, Southwestern Institute of Forensic Sciences
Paul Boor MD, Interim Chief Medical Examiner, Galveston County Medical Examiner’s Office
David Dolinak MD, Chief Medical Examiner, Travis County Medical Examiner’s Office
Ray Fernandez MD, Chief Medical Examiner, Nueces County Medical Examiner’s Office
Randall Frost MD, Chief Medical Examiner, Bexar County Medical Examiner’s Office
Sridhar Natarajan MD, Chief Medical Examiner, Lubbock County Medical Examiner’s Office
Nizam Peerwani MD, Chief Medical Examiner, Tarrant County Medical Examiner’s Office
Mario Rascon MD, Deputy Chief Medical Examiner, El Paso County Medical Examiner’s Office
William Rohr MD, Chief Medical Examiner, Collin County Medical Examiner’s Office
Corinne Stern MD, Chief Medical Examiner, Webb County Medical Examiner’s Office
Amy Gruszecki DO, Medical Director, American Forensics
Danielo Perez MD, Forensic Pathologist, Central Texas Autopsy
John Ralston MD, Chief Forensic Pathologist, Forensic Medical Management Services of Texas
Lucile Tennant MD, Forensic Pathologist, Montgomery County Forensic Services Department
Casey Gould, Deputy Chief Medicolegal Death Investigator, Dallas County Medical Examiner’s Office
Ricardo Ortiz, Chief Investigator, Nueces County Medical Examiner’s Office
Cathy Self, Forensic Operations Administrator, Dallas County Medical Examiner’s Office
STATE OF TEXAS
Nim Kidd, Chief, Texas Division of Emergency Management
Bruce Clements, Community Preparedness Director, Texas Department of State Health Services
Emily Kidd MD, Interim Medical Director, San Antonio Fire Department & Chair, Texas Disaster Medical
System
Danielle Hesse, Mass Fatality Coordinator, Texas Department of State Health Services
Texas Disaster Medical System Mass Fatality Management Workgroup
5. Mass Fatality Response in Texas: A Strategy for the Future 5
STATEMENT OF THE PROBLEM
Medicolegal death investigation is an essential, statutorily regulated local government function.
However, both the United States and Texas death investigation systems have well-documented
structural shortcomings, one of which is the degree of disparity between individual jurisdictions in
their capabilities to manage various components of death investigation. 1 The potential
manifestation of this disparity in the management of a large mass fatality incident in Texas was the
impetus for the development of this paper.
The Texas Code of Criminal Procedure Article 49 details the responsibilities of the medicolegal
authority (Medical Examiner or Justice of the Peace) in the investigation of unexpected fatalities.
According to this statute the medicolegal authority is responsible to perform, or arrange and pay “a
reasonable fee” for the completion of the following for inquests that require them: death scene
response and investigation, decedent removal and transport, postmortem examination (including
analysis for the determination of cause and manner of death and for identification of the deceased),
and management of personal effects in the absence of next of kin. These responsibilities apply
whether a county fulfills its medicolegal responsibilities with a large medical examiner’s (ME) office
or a single Justice of the Peace (JP). Similarly, the responsibilities of the medicolegal authority
remain the same in the management of multiple fatalities (regardless of the number) as with the
management of a single fatality. The law requires that counties with more than one million
residents establish a medical examiner’s office, and defines a medical examiner’s office as an agency
within which postmortem exams are performed by a physician. There are currently only 14 medical
examiners offices in Texas, located in the larger population centers around the state. Thus,
medicolegal authority for the vast majority of the geographical area of the state of Texas is
maintained by Justices of the Peace, elected officials who have the responsibility to initiate and
perform inquests, but who do not necessarily have any medical or investigative training or
experience. The gap in the capabilities between Justice of the Peace and Medical Examiner
jurisdictions is manifest in highly variable approaches to death investigations. The infrastructure
within which Justices of the Peace operate is substantially less robust than their medical examiner
counterparts, often resulting in little to no access to decedent storage, transportation assets, scene
investigation expertise, or local autopsy capability. The statutory requirement of certain
medicolegal functions has resulted in dependence, by Justice of the Peace jurisdictions on
neighboring medical examiner’s offices or private pathology firms. This has resulted in an
intersecting network of informal arrangements by which medical examiners offices perform
autopsies for Justice of the Peace jurisdictions. These are generally non-binding agreements that do
not obligate the medical examiner’s office to accept remains for autopsy, an arrangement often
misunderstood by the Justice of the Peace jurisdiction which assumes that the medical examiner’s
office is under contract to perform autopsy services. Additionally, these arrangements usually only
include autopsy services and do not extend to scene response, transport, or storage. The Justice of
the Peace retains the responsibility to issue the official cause and manner of death regardless of
who completes the postmortem exam, and is not obligated to record the cause and manner of death
determined by the contract pathologist on the official death certificate.
Development of a remedy for the systemic shortcomings of the medicolegal death investigation
system in Texas is outside of the scope of this paper. However it is relevant in that the deficiencies
1 Strengthening Forensic Science in the United States: A Path Forward, National Academy of Forensic Sciences, 2009
6. Mass Fatality Response in Texas: A Strategy for the Future 6
of the system for the management of fatalities on a daily basis become exponentially more
significant in the mass fatality context. There is no established state framework to support local
medicolegal operations following a mass fatality incident. In fact the current structure that
compromises mass fatality preparedness by operating on the assumption that these informal
arrangements between JP jurisdictions and neighboring medical examiners offices will apply in a
mass fatality context, thus creating the illusion of a mutual aid structure that can support mass
fatality incident response. The tenuous mutual aid strategy that currently characterizes mass
fatality preparedness in Texas is not a reasonable strategy for response to a large incident of the
variety that has occurred throughout the United States, and is also not well suited for the
comprehensive management of smaller incidents. Although the vast majority of mass fatality
incidents result in a relatively low number of fatalities, even these small incidents represent a
considerable and often insurmountable burden to rural Justice of the Peace jurisdictions. The
current system can absorb these incidents as the recent fertilizer plant explosion in West, Texas
illustrated, but the response is piecemeal and tenuous. The medicolegal responsibility in these
incident responses is often met by multiple otherwise unaffiliated entities including multiple
medicolegal jurisdictions, public health, funeral industry personnel, emergency management, and
aid agencies. Additionally, though medical examiners jurisdictions are not legally obligated to
provide mass fatality incident operational assistance to neighboring jurisdictions, it is likely that
these larger jurisdictions will inherit extralocal responsibilities in the absence of an existing
strategy for mutual aid. Thus it is of critical importance for the state of Texas to develop a strategy
for mass fatality incident response that provides assistance to the resource poor JP jurisdictions
while protecting the resource rich medical examiner jurisdictions.
STRATEGY
We insist that in spite of the current state of the medicolegal death investigation system, Texas is
well positioned to move quickly toward the development of an effective system for mass fatality
incident response. This position is based in part on the high degree of expertise that is scattered
throughout the state, the presence of mass fatality specific assets (in the form of equipment and
response teams) that already exist in the state, and the willingness for the appropriate parties on
the state level to invest in a strategy that will mutually benefit Justice of the Peace jurisdictions,
medical examiners offices, public officials, and the citizens of Texas. The state of Texas is replete
with highly specialized subject matter capabilities that are currently not connected for mass fatality
response and thus currently unavailable to assist local jurisdictions in an incident response. This
subject matter expertise is distributed around the state in medical examiners offices, private
pathology services, university departments, public health departments, health and human services
departments, hospitals, and private industry. Additionally there is a significant array of mass
fatality response assets already present across the state including public (Texas Task Force 1, Texas
Military Forces) and private (Texas Funeral Directors Association) response teams, refrigerated
storage assets, portable morgue facilities, human remains pouch caches, etc. It is now necessary to
identify and incorporate all of the personnel and equipment assets from around the state into a
single comprehensive network that can be leveraged in response to a mass fatality incident, and to
develop a comprehensive command and control strategy according to which a mass fatality
incident response system will operate. This will involve acquiring answers to questions regarding
funding, ownership, deployment, and maintenance of a mass fatality response system. The answers
to these questions may lie with an array of entities, but the primary contributors and recipients of
7. Mass Fatality Response in Texas: A Strategy for the Future 7
assistance via a mass fatality response system are the medicolegal jurisdictions across the state
(primarily the medical examiners offices).
For this reason, on April 17, 2014 a meeting of the Chief Medical Examiners from across the state of
Texas was held at the Harris County Institute of Forensic Sciences. The goal of meeting was twofold:
first, to determine whether the Chief Medical Examiners as a group agreed that there was a need for
a statewide mass fatality response system to deal with the above described problems, and if so, to
develop a consensus among the Chief Medical Examiners on the structure of such a program. There
was immediate agreement on the part of the Chief Medical Examiners that there does exist a need
for a mass fatality response strategy in Texas. During the course of the meeting consensus was
reached on the overall function and structure of the system as Chief Medical Examiners envision it.
Via facilitated discussion, including consideration of existing medicolegal and non-medicolegal
response system models, the group considered the: 1) framework, 2) components, and; 3)
personnel options to incorporate into the proposed system. A brief summary of the proposed
strategy follows. For the sake of clarity, the rest of this paper will refer to the system that is under
development as the Texas Mass Fatality Operations Response Team (TMORT).
COMPONENTS AND PERSONNEL
A detailed discussion of the operational components and the variety of personnel to include into the
TMORT structure was part of the April 17 meeting. In summary, the opinion of the medical
examiners in Texas is that TMORT should be inclusive of all medicolegal operational components,
but should not extend into mortuary (funerary) services and/or family assistance support
operations. In other words TMORT should include capabilities in victim accounting, incident site
operations, morgue operations, transport operations, storage operations, Victim Identification
Center operations, long term storage/release services, and fatality-specific data management
services.
The discussion of personnel expertise to include in the TMORT system reached similar consensus.
As with the components, the group consensus was that the system should include only fatality
management personnel and that the mission should not extend to mortuary services or family
assistance support operations. Table 1 lists the components and personnel to be included in the
TMORT structure.
Table 1. TMORT Capabilities and Personnel Consensus.
Capabilities Personnel Categories
Victim accounting Forensic
Site investigation and operations Scene investigators, pathologists, anthropologists
autopsy assistants, dentists, radiographers,
photographers, fingerprint technicians, DNA
technicians
Human remains transport
Human remains storage
Victim Identification Center operations
Data management Support
Long term storage/release services Victim Information Center personnel (family
interviews, briefings, public information support)
8. Mass Fatality Response in Texas: A Strategy for the Future 8
FRAMEWORK
The discussion of the preferred framework of the system addressed the following topics: 1) housing
agency, 2) funding source, 3) deployment strategy, 4) command and control, 5) multi-agency
cooperation, 6) training strategy, and 7) whether or not the system should include a research
component. Each of these structural considerations is considered in the following paragraphs, and a
summary of each is provided in table 2.
Housing
The consensus regarding housing is that TMORT would benefit from being housed on a university
campus. This solution would benefit TMORT because the vast majority of the time, TMORT will
essentially be a training entity. The anticipated university benefit comes in the form of student and
faculty access to an active response system as well as a research-focused facility and the associated
network of subject matter expertise.
There is precedent for a university-based mass fatality response framework in the United States.
The Florida Emergency Mortuary Operations Response System (FEMORS) is a partnership between
the state of Florida and the William R. Maples Center for Forensic Medicine at the University of
Florida that was created to develop and implement protocols for response to mass fatality incidents
within the state of Florida. FEMORS includes trained personnel from multiple state and local
agencies, and maintains an array of specialized mass fatality specific equipment and resources. The
FEMORS mission, “to assist and support the local District Medical Examiner’s Office, Florida
Department of Law Enforcement and other responding agencies, in the event of a mass fatality
incident as directed by the Florida Department of Health” represents a valuable and very successful
model for Texas to emulate.
Funding
The Chief Medical Examiners envision TMORT as a state entity funded in part by the state of Texas,
a housing university, and grant awards. FEMORS is co-funded by the University of Florida and the
Florida Department of Health and receives funding from federal grant programs including the CDC
Bioterrorism, National Hospital Preparedness (HPP) and Public Health Emergency (PHEP)
Programs. TMORT is eligible for the same, and additional grant funding programs.
Deployment strategy
FEMORS maintains a single team that deploys around the state. The Texas medical examiners were
unanimous in their opinion that TMORT should adopt a similar state team structure, the consensus
being that the alternative, a regional approach, would place an unreasonable burden on the larger
medical examiners offices in the state. Thus, similar to FEMORS, the proposed TMORT deployment
strategy is to roster and deploy pre-credentialed subject matter expertise from across the state
rather than from neighboring jurisdictions.
9. Mass Fatality Response in Texas: A Strategy for the Future 9
Command and control
The consensus among the Chief Medical Examiners regarding the command and control role of
TMORT in a mass fatality response is that TMORT will not seek or assume medicolegal authority in
any local jurisdiction. This responsibility will remain with the local medicolegal authority
regardless of the circumstances of a particular incident. However, upon request, TMORT could
provide operational command assistance to a local medicolegal authority. TMORT will operate
within the Incident Command Structure (ICS), to ensure compatibility of its command structure
with support agencies.
Multi-agency coordination
A number of agencies, including Texas Task Force 1, the Texas Funeral Directors Association, and
Texas Military Forces Joint Task Force 71 (Fatality Search and Recovery Team) maintain mass
fatality response capabilities that are valuable to the TMORT system. The consensus of the Chief
Medical Examiners was that TMORT will coordinate with these agencies as independent entities,
and incorporate them into TMORT’s training and exercise curriculum.
Training strategy
The Chief Medical Examiners envision TMORT as a training entity that is prepared for, and capable
of deployment following activation by the state of Texas. The training curriculum is to be based on
the assumption that TMORT will deploy responders to fill roles that are within their range of
expertise. This means that the trainings that TMORT provides will be operational trainings in
morgue, site, and victim information center operations rather than discipline-specific trainings.
Exercises will also be an important component of the TMORT training curriculum, and the Chief
Medical Examiners envision a rotating schedule of mass fatality site, morgue, and family assistance
center exercises. These exercises will require significant cooperation between local, state. federal,
private, and university agencies and TMORT will manage these relationships. A substantial just-in-
time training curriculum will also be important to the success of TMORT and will require the
development and maintenance of field operating guides and job action sheets. The training focus of
the TMORT program is another reason that a university affiliation is important.
Research
TMORT will maintain a valuable research focus. Currently, mass fatality preparedness is largely
informed by anecdotes and the experience of its participants, and there is a need for research to
support progress for future initiatives. Specifically, scientific support is needed to bolster
commonly held opinions regarding the reality of mass fatality incident characteristics. Broad
research questions that TMORT may address include: what is the historical reality of mass fatality
incidents in the United States and how has this changed? Are our preparations meeting this reality?
How does the risk of particular types of mass fatality incidents vary across the state/
country/world? How does fragmentation of human remains impact the duration of an incident
response and how should this impact which technologies are utilized? What is the financial and
logistical impact of a large scale mass fatality incident response on a local jurisdiction? What
impact have/will recent legal and government opinions regarding the forensic scienceshad/have
on mass fatality response? These are questions that require answers supported by research, and a
10. Mass Fatality Response in Texas: A Strategy for the Future 10
university-based system is uniquely suited to address them because of access to students and
faculty in a research environment.
Table 2. TMORT Framework Consensus.
Structural Consideration Proposed Solution
Housing Agency Public State University
Funding Source Combination of state, university, and grant funding
Deployment Strategy Single team with members from across the state (no
regional teams)
Command and Control No transfer of medicolegal authority. Optional
transfer of operational control
Multi-agency Cooperation Coordinate with outside agencies as independent
agents
Training Strategy TMORT will primarily exist as a training and research
entity that can be deployed as a response agency.
Operational, rather than discipline-specific training
focus that leverages university, SME expertise
Research Component TMORT will conduct practical, theoretical, and survey
research to answer questions that complicate mass
fatality preparedness
MANAGEMENT
TMORT is a proposed training and response entity that coordinates with numerous outside
agencies and a variety of subject matter experts to ensure that the state has a rapidly deployable
medicolegal response support capability that can provide assistance to local jurisdictions following
mass fatality scenarios that overwhelm local capabilities. The development and maintenance of the
TMORT program requires a dedicated staff of personnel with specific roles related to management,
training, logistics, and scientific research. The FEMORS model again provides precedent for a core
management strategy. FEMORS is currently managed by five full-time personnel, and maintains a
team of approximately 180 pre-credentialed and trained subject matter experts in anthropology,
pathology, odontology, radiology, fingerprint analysis, DNA and mortuary analysis. TMORT will not
include a mortuary operations component, as the existing state capability is robust. Table 3 lists the
subject matter personnel classifications that the proposed TMORT structure would incorporate, as
well as the associated responsibilities and qualifications.
Table 3. Proposed TMORT Subject Matter Positions.
Proposed
Position Title
Duties Required Qualifications
Rapid
Assessment
Team
Performs Go Team Duties as Back-up to TMORT
Commander
Mass fatality disaster response
experience, management and
administrative experience
TMORT
Commander
Provides leadership and direction under the
authority of the local medicolegal authority for
all aspects of mass fatality management
Mass fatality disaster response
experience; management AND
administrative experience
11. Mass Fatality Response in Texas: A Strategy for the Future 11
TMORT Deputy
Commander
Support TMORT commander in operational
coordination, acting commander in TMORT
Commander absence
Mass fatality disaster response
experience; management AND
administrative experience
Incident Site
Team Leader
Supervises human remains search and recovery,
personal effects, storage, and transport
Mass fatality disaster response
experience; management AND
administrative experience
Morgue Team
Leader
Supervises disaster morgue operations Mass fatality disaster response
experience; management AND
administrative experience
Victim
Information
Center Team
Leader
Supervises Victim Information Center Mass fatality disaster response
experience; management AND
administrative experience
Pathologist,
Forensic
Examines recovered remains, details anatomic
observations; May serve as section leader for
Pathology
Forensic Pathology M.D. or D.O.,
ABP certified in anatomical and
forensic pathology
Pathologist, M.D.,
or D.O.
Examines recovered remains and details
anatomic observations under the supervision of
a forensic pathologist
M.D. or D.O. without ABP
certification
Anthropologist,
Forensic
Search or examination of bone or fragments;
May serve as section leader for scene or morgue
Anthropology
Ph.D., ABFA certification with
forensic/postmortem experience
Anthropology
specialist
Search or examination of bone or fragments
under the supervision of a forensic
anthropologist
M.A. or Ph.D. without
forensic/postmortem experience
Odontologist,
Forensic
Examines dental remains, processes antemortem
dental records for ID; May serve as section
leader for ante or postmortem Odontology
Licensed Dentist with
forensic/postmortem experience
Odontologist,
Non-Forensic
Examines dental remains, processes antemortem
dental records for ID under the supervision of a
forensic odontologist
Licensed Dentist without
forensic/postmortem experience
Administrative
Officer
Coordinates Administrative and Financial
documentation duties
Administrative and Financial
Experience
Data
Management
specialist
Established and troubleshoots network
operation and database modifications; assists
command staff
Programming, IT or MIS
Experience, MS Excel power user
Medicolegal
death
investigator
Identification coordinator; postmortem data
entry and VIP searching for possible ID linkages;
May perform VIC interviews or contact families
for information; May serve as section leader for
Victim Information Center, Medical
Investigations, Admitting, Photography, Personal
Effects, Remains Inventory Management; May
assist with pathology, anthropology, odontology,
DNA, or scene search sections
Medicolegal Death Investigator, or
Law Enforcement Death
Investigation Detective
12. Mass Fatality Response in Texas: A Strategy for the Future 12
Morgue Officer May fill the following roles: admitting, personal
effects, radiography, remains inventory, VIC
interviewer. Provide training to Morgue Officer
candidates
Medical examiner personnel,
credentialed graduate students
Safety and Health
Officer
Monitors proper PPE usage and safety factors in
the morgue environment. Manage well-being of
scientists
Chemistry/bloodborne precaution
background
DNA Specialist May serve as Section Leader for postmortem
DNA collection and VIC DNA Section for
specimen collection from families
Laboratory level forensic DNA
experience
Fingerprint
Specialist
Obtains print impressions from remains or
antemortem specimens; Compares ante and
postmortem prints for ID
Postmortem Fingerprint
Experience or Latent Print Analyst
Forensic
Specialist
Assists DNA, pathology, anthropology,
odontology, photography, or personal effects
sections
Laboratory level Forensic
Experience: Toxicology, Chemistry,
Firearms, Anthropology etc.
DPMU Team Equipment managers and logistics coordinators Administrative and/or logistics
experience
Evidence
Specialist
Scene search and recovery; Assists photography,
personal effects, pathology (as scribe),
anthropology (as scribe), odontology (as scribe),
or DNA sections
Crime scene technician experience
Photographer Scene and morgue photography. Death scene, morgue photography
training/experience
Autopsy
Technician
Assists pathology, anthropology, odontology, or
DNA sections; May serve as section leader for
radiography
Medical examiner morgue autopsy
or radiography experience
Data Entry Performs data entry; Helps in any other clerical
capacity. Provide training to Data Entry
candidates
Data entry, Windows, and MS office
proficiency
VIC Specialist Interviews families in Victim Information Center
for gathering information on missing persons;
Performs data entry of ante mortem information.
Provide training to VIC Specialist candidates
Training in VIC
Administrative
Specialist
Helps in any clerical capacity including data
entry, records clerk, or morgue scribe. Provide
training to Administrative Specialist candidates
Clerical/basic computer skills
Dental Assistant Assist odontologists at table or in clerical
capacity, or serve as body escort or scribe
Dental Hygienist or Assistant
Morgue Assistant Human remains escort, scribe, storage inventory.
Provide training to Morgue Assistant candidates
Pre-credentialed personnel with
just-in-time training
13. Mass Fatality Response in Texas: A Strategy for the Future 13
SUMMARY
In summary, the State of Texas is in the process of developing a statewide mass fatality response
system that is capable of providing operational assistance to local medicolegal authorities following
incidents that overwhelm local resources. Much of what is required to build this system, including
subject matter expertise, assets and equipment, already exists in Texas. This paper describes the
medical examiners vision of how to connect these disjointed pieces and incorporate them into a
structure that is simultaneously nimble enough to provide rapid deployable support, and robust
enough to remain valuable to its sponsors between deployments. A university affiliation is
particularly important to the latter. TMORT will require constant and varied training of its
personnel to ensure its readiness and capabilities when needed, and it is this training that ensures
the value of the system to its sponsoring agencies. In addition to being required of and available to
TMORT membership, these trainings can benefit non-TMORT personnel including students and
external agencies. In addition, scientific, rather than anecdotal research is needed to support future
mass fatality preparedness initiatives, and a university environment is conducive to both. In
summary, the Chief Medical Examiners in the state of Texas have expressed their vision for
coordinated mass fatality response in Texas. This vision includes the development of the Texas
Mass Fatality Operations Response System (TMORT) that is a permanent, university-affiliated
entity with core personnel that leverages existing personnel and equipment.