Deployment Information Package
This package is designed to provide you with the information you need to have a successful deployment. It is recommended that you familiarize yourself with this information well in advance of any deployments. Those officers that are selected for the Emergency Medical Response Team (EMRT) must be in full compliance with all information in this package. The goal is to assure that you are thoroughly prepared for the deployment so you will have a successful and rewarding experience in the field.
Officers who are activated from outside the Division of Immigration Health Services (DIHS) should carefully read the information on the role the U. S. Public Health Service plays when working with the Immigration and Customs Enforcement. You will also need to familiarize yourself with and sign off on the security rules and regulations which are designed to maintain the safety of both us and the detained population.
ICE and DIHS
The DIHS works under a memorandum of understanding with the ICE to provide direct primary care, medical referrals, and managed care to the detained population. This relationship dates back to 1891 when the Immigration Act authorized the PHS to examine and quarantine aliens at Ellis Island. Since 1985, the ICE Detention and Deportation Branch has had an interagency agreement with the PHS (Health Resources Services Administration, Bureau of Primary Health Care).
- The DIHS is responsible for assuring that the provision of health care services to detained individuals is consistent with community standards
- The DIHS supports the ICE mission by providing or arranging for the most appropriate and cost effective health care services
The goals of DIHS are to maximize quality, cost effectiveness, and access to health care services
- Health services are provided by U.S. Public Health Service commissioned officer physicians, dentists, physician assistants, nurse practitioners, nurses, pharmacists, and health care administrators
In FY99, there are 135 federal FTEs and 70 contract staff supporting the DIHS
DIHS staff provided over 145,000 clinic visits in FY95; 180,000 visits in FY96; 220,000 visits in FY97; and over 230,000 visits in FY 98
- Primary care is provided at eleven Service Processing Centers (SPCs) through ICE medical facilities and one staging facility
If sub-specialty services are required, contract physicians are employed through agreements; secondary and tertiary care is arranged for through local hospitals
DIHS staff provide medical consultation and technical assistance to all ICE Regions, Districts, and Sectors on detainee health care
The DIHS management structure consists of a Director, Deputy Director, and the following branch chiefs:
- Clinical Services (based at SPC Krome--Miami, Fl)
- Integrated Health Services and Support
- Resource Management
Health Service Administrators (HSA) operate medical facilities at Aguadilla, PR; Buffalo, NY; El Centro, CA; El Paso, TX; Elizabeth, NJ; Florence, AZ; Los Angeles, CA; Miami, FL; New York, NY; Port Isabel, TX; Queens, NY; and San Pedro, CA
Infirmaries are located in the following locations: Miami, FL; and El Centro, CA.
In FY99, El Paso, TX infirmary will open.
- Jail Management System (JMS) initiated to manage the medical care and costs of detainees housed in non-service processing centers (non-SPCs). The JMS employs Managed are Coordinators (MCCs) who perform oversight functions and authorize offsite referral and onsite non-routine care.
- Quality health care is assured through achievement of Joint Commission on Accreditation of Healthcare Organizations (JCAHO), National Commission on Correctional Health Care (NCCHC), and American Correctional Association (ACA) accreditation at the SPC medical facilities.
Current initiatives of the DIHS are as follows:
- A Rapid Response Team (RRT) is established which will provide clinical services within 24 hours of a mass influx
- Expand information resources support via wide-area networks for all medical facilities
- Establish a tele-medicine program for TB screening at all sites
Security Rules and Regulations
The Immigration and Customs Enforcement (ICE) is a federal law enforcement agency and as such is concerned with security. The DIHS works with the Detention and Deportation Branch which is primarily concerned with detaining and removing illegal immigrants. The role of the DIHS is disease prevention through the provision of primary health care to the detained population. It is not our role to be actively involved with the security issues or to question the methods of ICE.
The items listed below are considered contraband and should not be brought into the facility. Additionally, no PHS officer should give any items to a detainee for other than medical use. Even then care should be taken to assure that potentially dangerous items are not issued. All items issued to detainees should be purchased by the DIHS Health Services Administrator or designee. Staff members are not permitted to use their personal funds to buy ANY item for a detainee.
- Knives (not even pen knives)
- Metal eating utensils
- Glass of any kind (bottles, mirrors, etc.)
- Tobacco products
- Illegal drugs
- Personal protection items (mace, pepper spray, etc.)
- Alcoholic beverages
- Personal Safety
When working with deployments it is important to remember that people being detained are under increased stress and may be living in uncomfortable and crowded conditions. When interacting with the detained persons and other staff it is highly important to practice extra patience and understanding.
As health care providers we must be vigilant to keep any personal feeling we have to ourselves ICE officers perceive PHS officers as viewing them as ICEensitive and uncaring. This perception can increase the stress level of the team.. The ICE officers are doing their jobs and enforcing the laws of the United States of America. Part of their job is to maintain discipline within the camp which may give the perception that they are not sympathetic with the condition of the detainees.
Each officer should familiarize themselves with their surroundings. Know the quickest exit and a secondary exit. You must always be aware of what is going on around you. Simple things may be an indication of trouble in the camp. For example, hoarding food, increased or decreased sick call, and not eating may be indications of pending problems. If you become aware of such situations you should immediately notify the Health Services Administrator. It is not our intent to frighten anyone, but we want all officers being deployed to understand that there is always the potential for dangerous situations in a camp. Be alert for your own personal safety and the safety of your team.
When on foreign travel the U. S. Embassy will usually provide a security briefing. It is mandatory that those instructions be followed. We are aware that many PHS Officers are experienced travels and feel confident about their ability to judge situations, however, while on deployment you must follow the instructions given by the embassy. This is important for you safety and the safety of the entire team.
Keep your PHS ID and your passport with you at all times. Do not leave them in your room.
Chain of Command
The Division of Immigration Health Services take the chain of command seriously. We do this to maintain a strict line of communication with ICE. This assures that we are speaking to them with one voice. If any ICE or other personnel approach you with a request for information you should refer them through the chain of command. The chain of command is diagramed below. All communication about any administrative issue should go through the HSA to the Headquarters Commander who will speak with ICE. All medical issues should be discussed with the Clinical Director who will inform the HSA and the Headquarters Commander. Clinical Supervision of all staff will the be the responsibility of Clinical Director. See Attachment 1 (Chain of Command Flow Chart).
Access to Command Center
The ICE Command Center is for the use of command personnel only. Access is strictly limited to those persons who have been designated by ICE or the PHS Headquarters Commander to be there. Staff should not take this personally. We have learned from previous experience that it prevents unintentional miscommunication. If you have a need to be there please go through the chain of command to obtain access.
What Should I Bring?
You should limit what you can personally carry. Some countries have weight limits that you can bring so be sure and check with the air carrier prior to travel. Be sure to keep a clean uniform in your carry-on and all of your personal equipment.
The following is a list of items we recommend that you bring on all deployments as a minimum.
- Field Utility Uniform
- Personal clothing
- Multipurpose knife (leatherman, swiss army)
- Ear plugs
- Sewing kit
- Drivers license
- Personal hygiene supplies
- Insect repellent
- Sun screen
- Enough money for the duration of the deployment
- Water bottle
- Water purification tablets
- Enough bottled water for 24 hours
- Enough nonperishable food to last 24-48 hours (in your carry-on)
- Rain poncho
- Travel alarm
- Personal first aid supplies (imodium, tylenol, antihistamines, bandaids, etc.)
- Enough personal medication to last 30 days
- Glasses (not contacts)
How Should I Prepare for Deployment?
See CCRF attachment
Many people now use the internet to pay bill on line. Remember that phone service is limited in some countries and access can be prohimitively expensive when available. Foreign travel only allows for $10 per day for phone calls.
A copy of the travel voucher is attached. It is recommended that you make several copies of this voucher and fill it out daily and keep all receipts with it. It takes time to process them so the sooner you turn it in the sooner you get your money. If you are on a long deployment (30 days) you may want to submit part of your voucher at two weeks. Please include all original receipts with your voucher and retain a copy for yourself. The vouchers should be mailed to:
Division of Immigration Health Services
801 I Street, N.W., 9th Floor
Washington, DC 20536
All travel arrangements for foreign travel will be made by the headquarters office. All travel arrangements must be made through SATO and may not be changed by the officer without the permission of the Resource Management Branch.
- Chain of Command Flow Chart
- Information on Overseas Duty: A Guide for Commissioned Officers of the Public Health Service
- Instructions for Field Utility Uniform
- CCRF: What should I bring on a deployment?
- CCRF: How should I prepare for deployment?
- Travel Voucher
- PHS Standards of Conduct
- Information on Temporary Duty Travel