Army Urban Augmentation Medical Task Forces for COVID-19: Part 1—Development

ABSTRACT

This article describes how the U.S. Army developed a new ad hoc medical formation, named Urban Augmentation Medical Task Force for the Department of Defense (DoD) in response to the Coronavirus Disease 2019 pandemic in the Continental United States during the spring of 2020. We review the role of the DoD support of the Federal Emergency Management Agency as a part of Defense Support of Civilian Authorities.

INTRODUCTION

In December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2, occurred in Wuhan, Hubei Province, China. On January 30, 2020, the World Health Organization declared this Coronavirus Disease 2019 (COVID-19) outbreak a Public Health Emergency of International Concern.¹ By the middle of February, there were 49,053 laboratory-confirmed cases of COVID-19 and 1,381 deaths reported globally.¹ The first patient to be diagnosed with COVID-19 in the USA was a Chinese national who traveled from Wuhan to Seattle, Washington, arriving on January 15, 2020.^2,3

By March 13, there were more than 2,000 confirmed COVID-19 cases in the USA. President Trump declared the ongoing COVID-19 pandemic of sufficient severity and magnitude to warrant an emergency declaration for all states, tribes, territories, and the District of Columbia pursuant to section 501 (b) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S. Code 5121-5207.⁴ The Stafford Act is a 1988 amended version of the Disaster Relief Act of 1974. Following a presidential disaster declaration, the Stafford Act triggers financial and physical assistance through the Federal Emergency Management Agency (FEMA) and it gives FEMA the responsibility for coordinating government-wide relief efforts.⁵

This article will review how the U.S. Army developed a new ad hoc medical formation, named Urban Augmentation Medical Task Force (UAMTF), for the Department of Defense (DoD) response to the COVID-19 pandemic in the Continental United States during the spring of 2020.

DEFENSE SUPPORT OF CIVILIAN AUTHORITIES

The National Response Framework (NRF) provides foundational emergency management doctrine for how the USA responds to all types of disasters. The NRF is composed of a base document, Essential Support Function (ESF) annexes, and support annexes. The annexes provide detailed information to assist with the implementation of the NRF.

Federal support during response operations focuses on the capabilities necessary to save lives; protect property and the environment; meet basic human needs; prioritize operations to stabilize community lifelines and restore basic services and community functionality; establish a safe, secure, and accessible environment for responders and response operations; and support the transition to recovery. The desired end-state for federal incident response is achieved when local, state, tribal, territorial, and insular area entities no longer require Federal Government assistance to provide life-saving or life-sustaining support, thereby allowing for the transition to recover.⁶

Essential Support Function (ESF) 6 (Mass Care, Emergency Assistance, Temporary Housing, and Human Assistance) provides for integrating voluntary agency and other partner support, including other federal agencies and the private sector, to resource health and medical services and supplies. Essential Support Function (ESF) 8 (Public Health and Medical Services) provides health and medical support to communities and coordinates across capabilities of partner agencies.⁶

Each of the 10 FEMA regional offices maintains a Regional Response Coordination Center. When activated, these multiagency coordination centers are generally staffed by regional FEMA personnel and augmented by ESFs and other federal agencies in anticipation of, or immediately following, an incident. Operating under the direction of the FEMA Regional Administrator, the staff within the Regional Response Coordination Center coordinates federal regional response efforts and maintains connectivity with FEMA Headquarters and state Emergency Operation Centers. Each FEMA Region has a Defense Coordinating Officer who serves as the FEMA Region’s single point of contact for DoD support. Each Defense Coordinating Officer has a Defense Coordinating Element consisting of a staff and military liaison officers to translate federal capabilities and facilitate coordination and support to activated ESFs.

Requests for the President of the United States (POTUS) to declare an emergency typically come from the Governor of an affected state who deems that the situation is beyond the capability for the state to manage.⁵

Under Title 10 U.S. Code §13, the Secretary of Defense (SECDEF) has authority, direction, and control over DoD capabilities. Department of Defense resources may be committed to a disaster response when requested by another federal agency (e.g., FEMA) and approved by the SECDEF or when directed by the POTUS. Department of Defense policy regarding Defense Support of Civil Authorities (DSCA) can be found in DoD Directive 3025.18, Defense Support to Civil Authorities.⁷ When DoD resources are authorized to support civil authorities, command of those forces remains with the SECDEF under whom the operational coordination and employment of such resources are normally led by the designated Combatant Command. In the case of the COVID-19 response, United States Northern Command (USNORTHCOM) at Peterson Air Force Base in Colorado was the designated Combatant Command. The USNORTHCOM plans, organizes, and executes homeland defense and civil support missions, but has few permanently assigned forces. When necessary, the command is assigned forces to execute missions, as ordered by the POTUS or SECDEF.

Subordinate headquarters under USNORTHCOM include U.S. Special Operations Command, North, U.S. Marine Forces Northern Command, U.S. Fleet Forces Command/U.S. Navy North, Air Forces Northern, U.S. Army North, Joint Task Force North, Joint Task Force Civil Support, Alaskan Command, and Joint Force Headquarters National Capital Region. For the COVID-19 response, USNORTHCOM utilized its Joint Force Land Component Command (JFLCC) at U.S. Army North headquarters, Fort Sam Houston, Texas, to command and control DoD medical units in support of DSCA for the whole-of-America COVID-19 response. The Army Reserve’s 807th Medical Command Deployment Support (MCDS), one of three MCDS units in the U.S. Army (one active and two reserve), provided its Operational Command Post to serve as the JFLCC’s medical command and control (C2) element and provided operational command of all of the DoD medical units and personnel that were provided to the JFLCC.

DEVELOPMENT OF THE UAMTF

In 2014, the Deputy Assistant SECDEF, Homeland Defense Integration and DSCA along with the Deputy Assistant SECDEF, Director Office of Preparedness and Emergency Operations and the Director, Defense Health Agency authorized and approved a Concept of Operations (CONOP) for Department of Defense (Title 10, U.S. Code) Health and Medical Staffing of a Department of Health and Human Services (HHS) Federal Medical Station (FMS).⁸ The DoD Office of Primary Responsibility for this FMS CONOP is the Joint Staff, J4, Health Service Support Division. The FMS CONOP describes the DoD and HHS/Office of the Assistant Secretary of Preparedness and Response FMS operations and roles and responsibilities undertaken when the DoD receives a request for ESF 8 assistance. The DoD would then provide available U.S. Code Title 10 military public health and medical providers for an HHS-operated FMS upon approval of the SECDEF. The cost of this assistance would be fully reimbursed to the DoD in accordance with the Stafford or Economy Acts. The scope of this FMS CONOP includes utilizing DoD personnel when a HHS FMS is deployed in response to natural or man-made disasters, infectious disease pandemics, and other public health emergencies.

An FMS is a pre-packaged scalable, up to 250-bed facility, designed for low-acuity, non-acute, non-traumatic, and non-surgical medical needs, including behavioral health support, that cannot be addressed in a general disaster shelter facility.⁸ It is set up in a facility of opportunity with at least 44,000 square feet of space (e.g., school gyms/stadiums, convention center, warehouses, etc.), in close proximity to the disaster area and is usually pre-coordinated by HHS with regional and local emergency management offices.

The FMS is led and operated by HHS, but the DoD support personnel remain under the command and control of an assigned DoD commander.⁸ The military commander is expected to coordinate with the FMS HHS–assigned leader to define the supervisory relationship. Typically, the DoD provides transportation for its deployed personnel to the FMS, but is not required to coordinate logistical support (e.g., local transportation vehicles, lodging, meals, and security) which is handled by HHS. The recommended DoD staffing of an FMS is shown in Table I. Medical specialties may be adjusted at execution to specific mission requirements or personnel availability.

TABLE I.

Department of Defense (DoD)–Recommended Medical Personnel Staffing of a Department of Health and Human Services (HHS) Federal Medical Station (FMS; From Reference 8)

Concept of Operations DoD (Title 10, U.S. Code) Health and Medical Staffing of a HHS FMS
Recommended DoD FMS Health and Medical Staffing
					Recommended skill codes
Billet type	Preferred services	FTE required	Suggested grade	Any source (Y/N)	USAF	USA	USN
Command Staff
DoD Commander	Any	1	O6	Y	4XX	60A	0109
DoD Deputy Commander	Any	1	O5	Y	41AX
Administrative Section
Admin Section Officer	Any	1	E8	Y	41AX	42B	0000
Administrative Staff	Any	2	E6 and below	Y	4A0XX	42A	0000
Clinical Operations Section
Clinical Operations Chief	Any	1	O5	Y	44XX	60A	2100
Family Practitioner Physician	Any	8	Any	Y	44XX	61H	0108
Physician Assistant/Nurse Practitioner	Any	8	Any	Y	42G3/46XX	65D	0113
Dentist	Any	2	Any	Y	47GX	63A	0335
Nurse	Any	8	Any	Y	46NX	66N	0944
Medics/Hospital Corpsman	Any	16	Any	Y	4N0XX	68W/C	0000
Pharmacists	Any	4	Any	Y	43PX	67E	0887
Pharmacy Technicians	Any	4	Any	Y	4P0XX	68Q
Psychiatrist	Any	1	O3	Y	44PX	60W	0115
Psychologist	Any	2	O3	Y	42PX	73B	0115
Psych Nurse Practitioner	Any	2	Any	Y	46PX	66R
Psych Technicians	Any	2	E4-E5	Y	4C0XX	68X	8485
Occupational Therapist	Any	2	O3	Y	42TX	65A	0166
Occupational Therapy Tech	Any	2	Any	Y		68L
Physical Therapist	Any	2	Any	Y	42BX	65B
Physical Therapy Tech	Any	2	Any	Y	4J0XX	68F
Respiratory Tech	Any	4	Any	Y	4H0XX	68V	8541
Food Safety/Nutrition/Dieticians	Any	4	Any	Y	43DX	65C
Epidemiologist	Any	1	Any	Y	43HX	61G
Environmental Science Officer	Any	2	Any	Y	43EX	72D	0845
Preventative Medicine Officer	Any	1	Any	Y	44BX	60C	0343
Preventative Medicine Technician	Any	2	Any	Y	4E0XX	68S
Total: 83—Clinical total: 78
Summary of staffing
Command Staff							2
Administrative Staff							3
Clinical Operations Staff							80
Total FMS staff required							85

The preparation for use of U.S. Army Reserve (USAR) medical forces began on March 19, 2020, with a message from the Commanding General of the U.S. Army Reserve Command (CG, USARC) in anticipation that the DoD would call upon the medical capabilities of the USAR. That same day, the highest priority mission of the USAR became the COVID-19 response. Before mobilizing reserve soldiers, the Department of the Army utilized three active duty brigades (1st, 44th, and 62nd) and subordinate medical units for the DoD COVID-19 response.

On March 24, 2020, the CG, USARC queried the USAR operational medical divisions as to how long it would take to mobilize the personnel from two USAR combat support hospitals from the 807th MCDS and two hospital centers from the 3rd MCDS.⁹ The response given by both MCDS commanders was 5 to 7 days. Three days later, these two commands received a new order to create these new ad hoc military formations, modeled by USARC in accordance with the DoD FMS CONOP, which became known as UAMTFs.¹⁰ The decision to create this new ad hoc formation was in response to a request by FEMA to provide DoD personnel staffing for FMS in caring for non-COVID-19 patients that would be off-loaded from civilian hospitals which were overburdened with COVID-19 admissions. The CG, USARC order specifically directed that potential candidate army reserve soldiers for UAMTFs would not include personnel currently employed in local COVID-19 response efforts in a military or civilian capacity.

The UAMTF is an 85-person unit consisting of physicians, nurses, dentists, environmental scientists, combat medics, behavioral health specialists, occupational therapists, pharmacists, dieticians, physician assistants, respiratory therapists, and administrative personnel (See Table II). These UAMTFs consisted of personnel only without any equipment or supplies except their individual personal field draw. The initial mission for each of these UAMTFs was to prepare to support HHS 250-bed FMSs for non-acute, non-COVID-19 patient care. Several skill set substitutions were made to account for military operational needs: three positions were added to the command/administrative section (medical logistics, unit supply, and human resource specialists) and an infectious disease physician was added in the event the mission changed to include caring for COVID-19 patients. There was a reduction in the number of occupational and physical therapy personnel to keep the total number of personnel unchanged.

TABLE II.

Urban Augmentation Medical Task Force Personnel Structure by Military Occupational Specialty (MOS)

	MOS	No.	Substitutes in Priority of Fill
Administrative Cell
Health Care Administrator	70A	2	70H or 70K
Human Resources Specialist	42A	2
Patient Admin Specialist	68G	2	70E, 68W, any 70 Series
Med Supply Log Specialist	68J	1	92Y
Unit Supply Specialist	92Y	1
Subtotal		8
Clinical Cell
Operational Medicine Physician	60A	2	Any 60-62 Series (Commander)
Family Medicine Physician	61H	8	61 F, 62B, 62A, 60P, 60 H, 60 N, 60 J, 60K, 65D, 66P (2 must be 60-62 series)
Med-Surg Nursing	66H	8	66 Series (except 66F), 68C, 66S
Combat Medic	68W	16	68B, 68C, 68F, 68U, 68Y
Respiratory Specialist	68V	4	No substitutions
General Dentist	63A	2
Physical Therapist	65B	1
Physical Therapy Specialist	68F	1
Occupational Therapist	65A	1
Occupational Therapy Specialist	68L	1
Nurse Practitioner	66P	3
Physician Assistant	65D	5
Infectious Dis Physician	61G	1
Subtotal		53
Behavioral Health Cell
Psychiatrist	60W	1	73B, 66R, 73A
Clinical Psychologist	73B	2	73A, 66R
Mental Health Nurse	66C	2	66R, 67D, 73A, 73B, 68X
Mental Health Specialist	68X	2	68W, 68C, 66C, 66R, 73A, 73B, 67D
Subtotal		7
Ancillary Cell
Pharmacist	67E	4	68Q
Pharmacy Specialist	68Q	4	68W
Dietician	65C	4	68M
Preventative Medicine Physician	60C	1
Preventative Medicine Specialist	68S	2	No substitutions
Environmental Science	72D	2
Subtotal		17
Total personnel required		85

The 3rd and 807th organized 5 and 10 UAMTFs each, respectively, and had them ready for movement by April 7, 2020. The 3rd MCDS assigned unit numerical designations named after their four medical brigades that assembled them (UAMTF 005-1, UAMTF 332-1, UAMTF 338-1, UAMTF 804-1, and UAMTF 804-2). The 807th MCDS assigned unit numerical designations named after the combat support hospital (UAMTF 94-1, UAMTF 352-1, UAMTF 352-2, UAMTF 452-1, UAMTF 452-2, UAMTF 801-1, UAMTF 801-2, and UAMTF 801-3) or hospital center that assembled them (UAMTF 811-1). An additional four UAMTFs were organized by the final USAR medical division, Army Reserve Medical Command (ARMEDCOM) which commands and controls the USAR garrison medical units, and were assigned numerical designations named after the Medical Backfill Battalion that assembled them (UAMTF 7452-1, UAMTF 7454-1, UAMTF 7457-1, and UAMTF 7458-1). Of these four ARMEDCOM units, one was fully assembled by April 20, 2020.

Five of the 3rd and nine of the 807th UAMTFs were given mission assignments in the spring of 2020. None of the ARMEDCOM UAMTFs were given mission assignments during this time period; however, 134 ARMEDCOM soldiers were cross-leveled to fill personnel vacancies in the 3rd and 807th MCDS UAMTFs.

SUMMARY

The army utilized the USAR to rapidly prepare military medical personnel to augment HHS FMSs to help decompress civilian hospitals of their non-acute, non-COVID-19 patients in order to increase their capacity to admit and care for COVID-19 patients. The UAMTF was the military organization that was created to meet this need as a part of DSCA. In part 2 of this series, we will detail the various types of mission assignments that were completed by these ad hoc units and their limitations and we will make recommendations for the future utilization of military medical personnel for pandemic disasters.

FUNDING

None declared.

CONFLICT OF INTEREST STATEMENT

None declared.