Reutershan, T. P. (1974). "CTHBP Views - the need for a citizen's organization." Journal of American Pharmacy Assoc. 14(4): 178.

Tomich, N. (1983). "VA Rejects current plans for NDMS." US Med 19(21): 17.

Mahoney, L. E., Swetonic, M. M., Bisgard, J. C., Reed, P. M., Reutershan, T. P. (1984). "Planning a National Disaster Medical System." Military Medicine 149(12): 657-660.

Brandt, E. N. J., Mayer, W. N; Mason, J. O., Brown, D. E. Jr., Mahoney, L. E. (1985). "Designing a National Disaster Medical System." Public Health Reports 100(5): 455-461.
The National Disaster Medical System (NDMS) is a partnership of private and public sectors to provide care to the victims of great disasters. The system is being developed as a voluntary cooperative effort of four major Federal agencies, State and local governments, and the American professional and hospital communities. A medical response component will include 150 disaster medical assistance units capable of clearing or staging operations in a disaster. Each unit will comprise three 29-person teams containing physicians, nurses, medical technicians, and support personnel and will include a 16-person unit command and support element. An evacuation component will be founded on the military aeromedical evacuation system, augmented by civilian aircraft and other transportation resources. A hospital component will enroll 100,000 pre-committed beds in hospitals throughout the nation. The system is designed to care for up to 100,000 casualties arising from a massive peacetime disaster or an overseas conventional military conflict. The National Disaster Medical System will be implemented over a period of 3 to 5 years. The authors recommend that all parts of the American health care community join in support of the system.

Orient, J. M. (1985). "Disaster preparedness. An international perspective." Annals of Internal Medicine 103(6): 937-940.
Establishing a national disaster medical system requires considering the goals and appropriate expenditure levels for emergency preparedness. The United States has placed a relatively low priority on national programs for disaster response. Such programs have been controversial because of their relationship to civil defense against nuclear attack. Switzerland and the Soviet Union have long-established, elaborate medical response systems that should be studied.

(1986). Journal Entries from the Olympic Diary of Dr. L. James Grold.

Mahoney, L. (1986). "Medical Preparedness for Disasters (editorial)." Annals of Internal Medicine 104(1): 114.
Editorial. Focuses on medical preparedness for disasters in the U.S. Effect of population increase; Risks faced by industries; Details of the establishment of the National Disaster Medical System.

Mahoney, L. E., Esch, V. H. (1986). "The national disaster medical system." Emergency Medical Services 1986(15): 5.

Mahoney, L. E., Brinley, F. J. (1986). "The National Disaster Medical System." Topics in Emergency Medicine 7(4): 75-85.

Moritsugu, K. P., Reutershan, T. P. (1986). "The National Disaster Medical System: a concept in large-scale emergency medical care." Annals of Emergency Medicine 15(12): 1496-1498.
The national disaster medical system is a new program established in 1981 to develop and implement a national policy to improve emergency preparedness for large-scale disasters. This article describes the background and purpose of this activity and delineates the elements of the system, which include a rapid medical response, patient evacuation, and definitive medical care. The program is designed to involve resources at the federal, state, and community levels. This article describes how local communities may participate in this initiative.

Mahoney, L. E., Reutershan, T. P. (1987). "Catastrophic disasters and the design of disaster medical care systems." Annals of Emergency Medicine 16(9): 1085-1091.
The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation.

Mahoney, L. E., Whiteside, D. F., Belue, H. E., Mortisugu, K. P., Esch, V. H. (1987). "Disaster medical assistance teams." Annals of Emergency Medicine 16(3): 354-358.
Five medical care functions are essential in disaster medical care--field rescue and first aid, casualty clearing, medical staging, field surgical intervention, and definitive care. Each of these functions requires substantial augmentation in response to disaster. Three functions, clearing, staging, and field surgical care, are complex functions requiring organized and skilled disaster medical units. We describe two kinds of disaster medical units designed to meet these needs. One unit is designed for casualty clearing and medical staging, the other for field surgical services. We describe how they can be created and used as part of a National Disaster Medical System.

Niemtzow, R. C., Taylor, A. R. Jr., Reutershan, T. P., Rebuck, H. I., Belford, W. B., Josuweit, R. A., Haacke, R. H.., Williams, K. D., Ball, T. P. Jr. (1987). "Amateur radio communications and the National Disaster Medical System." Military Medicine 152(12): 622-625.

(1988). "National Disaster Medical System; medical manpower component establishment--Health Resources and Services Administration, HHS. Notice." Federal Register 53(76): 12994-12995.
This notice announces the creation of the medical manpower component within the Health Resources and Services Administration (HRSA), Department of Health and Human Services/Public Health Service (HHS/PHS) as a part of the National Disaster Medical System (NDMS). The NDMS is an organized resource that may be activated to serve national needs in the event of disasters or other major emergencies requiring extraordinary medical services. The manpower component will contain volunteer medical response personnel and technical staff that will be made available in situations requiring substantial medical services from outside the area affected by the disaster or emergency. The manpower component of NDMS is being established by HRSA/HHS/PHS in cooperation with the Department of Defense (DoD), Federal Emergency Management Agency (FEMA), and the Veterans Administration (VA).

Holohan, T. V., Babitz, M., Berry, D.N. (1989). "Clinical performance in a field exercise for the National Disaster Medical System." Military Medicine 154(12): 587-589.

Wachtel, T. L., Cowan, M. L., Reardon, J. D. (1989). "Developing a regional and national burn disaster response." Journal of Burn Care and Rehabilitation 10(6): 561-567.
The supplement on burns by the National Disaster Medical System (NDMS) requires an evaluation of burn centers' and burn hospitals' capabilities for treating seriously burned victims. The American Burn Association (ABA) and its members, as experts in burn care, should take the lead in working with local, state, and federal disaster planners. Proposals based on standards adopted by the ABA support classification of facilities (levels I, II, III), identify minimum and maximum bed availability, require minimum training for personnel (e.g., ABLS), and encourage enrollment of all burn centers and burn hospitals as contract hospitals in the National Disaster Medical System. Periodically, the ABA should verify that the burn care facilities identified in the disaster plan meet its standards. Once the burn disaster system is developed, drills should be held locally on a regular basis and nationally on an annual basis.

Hogan, J., Rega, P., Forkapa, B. (1990). "A Civilian-sponsord DMAT: A community's collaboration among hospitals." Journal of Emergency Nursing 16(4): 245-247.

Hogan, J. (1990). "Profile of a Disaster Team." Emergency 22(8): 41-43.

Rodenbeck, S. E. (1990). "The needs of a disaster medical assistance team for environmental support services." Military Medicine 155(1): 12-13.
The National Disaster Medical System (NDMS) was formed to provide medical assistance to civilian disaster areas. Disaster Medical Assistance Teams (DMAT) are subunits of NDMS and could be transported to the disaster area. For DMAT to function, a team must be able to provide for itself. The Bethesda DMAT established a Logistical Support Group within the team to provide these services. This paper identifies the mission and personnel of the Logistical Support Group.

Dolicker, G. J. (1991). "Preparing for the worst. The challenge facing NDMS (National Disaster Medical System)." Journal of Emergency Medical Services 16(8): 99-101.
Although mass-casualty disasters in the United States have been rare, as populations grow, so does the prospect of a full-scale emergency occurring in our midst. Federal agencies have been at work for nearly a decade developing the National Disaster Medical System to care for the victims of such disasters.

Lewis-Rakestraw, L. (1991). "Response of the New Mexico Disaster Medical Assistance Team in St. Croix after Hurricane Hugo." Journal of Emergency Nursing 17(3): 162-164.
Our DMAT pulled together with the energy, flexibility, and adaptability necessary to make things work. Sally Coan expressed it best, saying, "I was with a group of people who would do anything [that was] needed." Dedication and trust within the DMAT helped create lasting friendships. The islanders were appreciative and we formed attachments to them that made them too dear to leave without sadness. The DMAT did leave, but we left in place an established medical system that the island would not otherwise have had a standard of care of which we felt proud.

Pretto, E., Safar, P. (1991). "National Medical Response to Mass Disasters in the United States." JAMA 266(9): 1259.
Proposes that the National Disaster Medical System (NDMS) replace its civil defense model with an emergency medical service (EMS) model designed to mobilize rapid support for local emergency medical services systems from regional, state and national resources. Discussion of the present system; Suggested EMS models for the NDMS.

Roth, P. B. e. a. (1991). "The St. Croix Disaster and the National Disaster Medical System." Annals of Emergency Medicine 20: 391-395.
The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Roth, P. (1991). "Status of a National Disaster Medical Response." JAMA 266(9): 1266.
Comments on the status of the national disaster medical response in the U.S. as of September 1991. Revamp of the U.S. National Disaster Medical System (NDMS); National disasters that tested the preparedness of the NDMS; Discussion of articles on national disaster medical response.

Summers, G. M., Cowan, M. L. (1991). "Mental health issues related to the development of a national disaster response system." Military Medicine 156(1): 30-32.
With the creation of the National Disaster Medical System (NDMS), the federal government has moved to develop a national medical plan for responding to major mass casualty situations resulting from either a civilian disaster which overwhelms state and local resources or an overseas conventional conflict. To date, the mental health aspects of this plan have received little attention. This article discusses the rationale for adding a comprehensive mental health component to NDMS within the context of the complementary needs of disaster survivors and rescuers.

Gaffney, J. K., Schodorf, L., Jones, G. (1992). "DMATs Respond to Andrew and Iniki." Journal of Emergency Medical Services 17(11): 76-79.

Alison, R. A., Alexander, D., Leonard, R. B., Stringer, L. W. (1993). "Analysis of medical treatment at a field hopsital following Hurricane Andrew, 1992." Annals of Emergency Medicine 22(11): 1721-1728.
STUDY OBJECTIVE: To determine what medical care was required of a special operations response team by a community devastated by a major hurricane. STUDY DESIGN: Retrospective analysis of 1,544 patient encounter forms generated at a field hospital set up in Homestead, Florida, after Hurricane Andrew in August 1992 and staffed by the special operations response team from Forsyth County, North Carolina. TYPE OF PARTICIPANTS: All persons presenting for treatment. RESULTS: One thousand two hundred three adult patients and 336 pediatric patients were seen by the special operations response team. Only five of the injuries treated were due directly to the hurricane, whereas 285 of the treated injuries were sustained during clean-up activities. Most of the care provided was routine medical care denied the citizens due to the loss of their physicians' offices and clinics. Supplies of tetanus toxoid, antibiotics, and insulin were depleted in 24 hours. Resupplying these items and acquiring other medication to refill prescriptions constituted a pressing problem. CONCLUSION: The primary function of medical personnel responding to an area hit by a major hurricane will be to provide general medical care. Any trauma encountered will be primarily due to clean-up activities and not due to the hurricane itself. Responding medical personnel should plan on providing their own food and water for the first 72 hours and be well stocked with antibiotics, tetanus toxoid, and insulin.

Barbera, J. A., Lozano, M. Jr. (1993). "Urban search and rescue medical teams: FEMA Task Force System." Prehospital and Disaster Medicine 8(4): 349-355.
Recent national and international disasters involving collapsed structures and trapped casualties (Mexico City; Armenia; Iran; Philippines; Charleston, South Carolina; Loma Prieta, California; and others) have provoked a heightened national concern for the development of an adequate capability to respond quickly and effectively to this type of calamity. The Federal Emergency Management Agency (FEMA) has responded to this need by developing an Urban Search and Rescue (US&R) Response System, a national system of multi-disciplinary task forces for rapid deployment to the site of a collapsed structure incident. Each 56-person task force includes a medical team capable of providing advanced emergency medical care both for task force members and for victims located and reached by the sophisticated search, rescue, and technical components of the task force. This paper reviews the background and development of urban search and rescue, and describes the make-up and function of the Federal Emergency Management Agency (FEMA) Task Force medical teams.

Niemtzow, R. C., Yarbrough, G., Harwood, K. L., Jacobs, J. L., Burkett, S., Greaves, W. W., Reutershan, T. P., Rebuck, H. I., Posner, S., Clark, W. et al. (1993). "The amateur Radio Emergency Service (ARES) and the National Disaster Medical System (NDMS)." Military Medicine 158(4): 259-263.
The rescue, treatment, and evacuation of thousands of patients from a natural disaster or armed conflict that is coordinated by the National Disaster Medical System must be performed in accordance to health care standards recognized in this country. Without an effective communication system, morbidity and mortality will needlessly rise. A medical communication protocol that addresses this problem is proposed.

Roth, P. B. (1993). "Disaster medical assistance teams: a key role (editorial)." Annals of Emergency Medicine 22(11): 1750-1752.

Henderson, A. K., Lilibridge, S. R., Salinas, C., Graves, R. W., Roth, P. B., Noji, E. K. (1994). "DMATs: Providing health care to a community struck by Hurricane Iniki." Annals of Emergency Medicine 23(726-730).
STUDY OBJECTIVE: To describe the type of medical care that disaster medical assistance teams (DMATs) provided to a community struck by a major hurricane. STUDY DESIGN: A prospective study describing the use of DMAT field clinics by a population affected by a major hurricane. Data regarding the type of medical care provided to disaster victims and the acuity of each patient's medical condition were abstracted from medical charts at each field clinic. SETTING: Three DMAT field clinics that provided medical care to residents of Kauai, Hawaii, after Hurricane Iniki struck the island on September 11, 1992. RESULTS: From September 16 to 19, 1992, three DMATs provided medical care to 614 people. The patients' average age was 34 years, and 60% were male. The largest treatment categories were injury (40.4%), illness (38.6%), and preventive services (9.0%). Most illnesses and injuries were minor, and 99% of the patients were ambulatory. Only 33 patients (5.4%) were referred to another medical provider. Referrals were generally for procedures not available in DMAT field clinics rather than for life-threatening conditions. CONCLUSION: DMATs sent to assist with the medical needs of a US community struck by a major hurricane should be prepared to deliver basic medical services and primary health care. The need for these medical services will continue beyond the impact phase of a hurricane disaster.

Burkholder-Allen, K., Rega, P., Budd, C. (1995). "Analysis of patient satisfaction with One DMAT's performance during Hurricane Andrew Relief Efforts (abstract)." Prehospital and Disaster Medicine 10(1): 1995.

Leonard, R. B., Stringer, L. W., Alson, R. (1995). "Patient-data collection system used during medical operations after the 1994 San Fernando Valley-Northridge earthquake." Prehospital and Disaster Medicine 10(3): 178-183.
INTRODUCTION: In large disasters, such as earthquakes and hurricanes, rapid, adequate, and documented medical care and distribution of patients are essential. METHODS: After a major (magnitude 6.7 Richter scale) earthquake occurred in Southern California, nine disaster medical assistance teams and two Veterans Administration (VA) buses with VA personnel responded to staff four medical stations, 19 disaster-assistance centers, and two mobile vans. All were under the supervision of the medical support unit (MSU) and its supervising officer. This article describes the patient-data collection system used. All facilities used the same patient-encounter forms, log sheets, and medical treatment forms. Copies of these records accompanied the patients during every transfer. Centers for Disease Control and Prevention data classifications were used routinely. The MSU collected these forms twice each day so that all facilities had access to updated patient flow information. RESULTS: Through the use of these methods, more than 11,000 victims were treated, transferred, and their cases tracked during a 12-day period. CONCLUSIONS: Use of this system by all federal responders to a major disaster area led to organized care for a large number of victims. Factors enhancing this care were the simplicity of the forms, the use of the forms by all federal responders, a central data collection point, and accessibility of the data at a known site available to all agencies every 12 hours.

(1996). "DMAT teams: there when disaster strikes." ED Management 8(9): 104-105.

Jacoby, I. (1996). "Lessons for hospitals from the Midwest Flood of 1993." Journal of Emergency Medicine 14(3): 379-380.

Roth, P. B., Gaffney, J. K. (1996). "The Federal Response Plan and Disaster Medical Assistance Teams in domestic disasters." Emergency Medical Clinics of North America 14: 371-382.
Through a variety of processes over the last 30 years, an organized federal plan has emerged for the response to domestic disasters. This plan incorporates several aspects of medical response into two areas: (1) health and medical and (2) urban search and rescue. This article discusses the development of the federal response plan with emphasis specifically on medicine. Highlighted are disaster medical assistance teams, urban search and rescue task forces, and roles and responsibilities of emergency physicians and other emergency health professionals in a federal disaster response.

Stratton, S. J., Hastings, V. P., Isb Ell, D., Celentano, J,; Ascarrunz, M., Gunter, C. S., Betance, J. (1996). "The 1994 Northridge Earthquake disaster response: the local emergency medical services agency experience." Prehospital and Disaster Medicine 11(3): 172-179.

Alson, R. L., Leonard, R. B., Stringer, L. W. (1997). "Disaster response in North Carolina." North Carolina Medical Journal 58(4): 248-252.

Damian, F., Atkinson, C. C., Bouchard, A. et al (1997). "Disaster relief efforts after Hurricane Marilyn: A pediatric team's experience in St. Thomas." Journal of Emergency Nursing 23: 545-549.

Hampl, P. (1997). "Forensic dentistry. Beyond recognition." Journal of Olahoma Dental Assoc. 88(2): 18-20.

Leonard, R. B., Spangler, H. M., Stringer, L. W. (1997). "Medical outreach after hurricane Marilyn." Prehospital and Disaster Medicine 12(3): 189-194.
INTRODUCTION: Many geographical areas are subject to devastating disasters that leave the citizens not only without homes, but also without their local medical systems. Now medical-aid stations consisting of personnel, supplies, and equipment quickly can be deployed when needed to such areas under the aegis of the National Disaster Medical System (NDMS). Such teams can provide emergent medical care as well as daily medical care. However, these aid stations are of no help for the home-bound or nursing home patients too infirm to reach them. Thus, these citizens only can obtain medical care if medical teams make planned outreach excursions to reach them. OBJECTIVE: To describe a planned outreach program that was implemented for such patients on St. Thomas Island after it was devastated by Hurricane Marilyn in 1995. RESULTS: Over a five-day period, the outreach team provided medical care for 67 patients ranging in age from 11 days to 90 years. Play and art therapy was provided for non-injured children. The most common needs in the elderly were anti-hypertensive medications and insulin-loaded syringes. CONCLUSIONS: For outreach efforts of this nature, membership of the team should include a registered nurse, a paramedic, a respiratory therapist, a public health specialist, and a local authority familiar both with the area and its inhabitants. A physician does not need to be assigned to the team, but should be available by radio.

Rega, P. (1997). "The disaster outreach concept (letter)." Prehospital and Disaster Medicine 12(4): 323-324.

Rega, P., Budd, C., Burkholder-Allen, K. (1998). "Outreach: Another DMAT's perspective (letter to the editor)." Prehospital and Disaster Medicine.

Sharp, T. W., Brennan, R. J., Keim, M. et al (1998). "Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Olympic Games." Annals of Emergency Medicine 32(2): 214-223.

Charbonneau, R. (1999). "Kosova relief efforts at Fort Dix, New Jersey: one DMAT nurse's experience." Journal of Emergency Nursing 25(5): 51a-52a.

Currance, P. (1999). "National medical response teams." Journal of Emergency Medical Services 24(1): 65.

Fairfield, S. R., Isakov, A. P., Volturo, G. A. et al (1999). "Northeastern North America ice storm tests Disaster Medical Assistance Team's preparedness (abstract)." Prehospital and Disaster Medicine 14(1): S87.

Fenn, J., Rega, P., Stavros, M., Buderer, N. F. (1999). "Assessment of U.S. helicopter emergency medical services' planning and preparedness for disaster response." AeroMedical Journal 18(1): 12-15.
INTRODUCTION: Helicopter emergency medical services (HEMS) roles in disaster response vary significantly from routine operation, and as reported in the literature, such responses have not been without difficulty. We identified nine criteria (written policy, triage and incident command training disaster drill participation, ground and air communications plan, critical incident stress management, annual review, policy sharing) that may significantly affected an air medical program's disaster preparedness, response, and recovery. Of these criteria, a written policy is considered of primary importance. METHODS: A written survey was developed and mailed in July 1995 to 187 U.S. rotor-wing members of the Association of Air Medical Services. The survey was designed to identify the programs that had a written policy and fulfilled the guideline criteria, had a written policy and partially fulfilled the criteria, or did not have a written policy. RESULTS: Surveys were returned from 104 (56%) programs. Of the 103 qualifying respondents, 16 (16%) meet the criteria, 55 (53%) partially met the criteria, and 32 (31%) did not have written policies. CONCLUSION: Most U.S. HEMS programs have not fully addressed disaster preparedness, response, and recovery. HEMS disaster response guidelines should be established, and these criteria should be incorporated.

Rega, P. P. (1999). "Acupuncture in disaster medicine (letter)." Annals of Emergency Medicine 34(4): 568.

Rega, P., Burkholder-Allen, K. (1999). "Cllinwood: an anatomy of a disaster." Prehospital and Disaster Medicine 14(4): 265-269.

Sullivan, F. M., Kleinman, G., Suner, S., St Jean, J. (1999). "Development of an equipment and supply list for emergency medical services delivery at an annual air show." Prehospital and Disaster Medicine 14(2): 100-103.
INTRODUCTION: Reports of medical care at mass gatherings reflect variability in mission and delivery models. Equipment recommendations are similarly varied. Thoughtful pre-planning and experience-based analysis are the best mechanisms for defining general and specific equipment recommendations. OBJECTIVE: This report presents a suggested supply and equipment list developed over a six-year period of medical coverage at an air show, with an emphasis on the usage and cost of expendable supplies. METHODS: The authors were involved in the planning for and execution of emergency medical care for a large, local, military air show on an annual basis, including provision of expendable medical supplies. A list of such supplies was developed over the initial two to three years, formalized and refined over the subsequent two years, and analyzed in the final, highest patient volume year of coverage. Detailed usage and cost was tracked over the final year for expendable supplies. RESULTS: The results of this analysis indicate that comprehensive emergency medical care from first aid to mass casualty care can be offered at reasonable equipment and supply costs, if existing equipment resources can be supplemented by expendable supplies from a pre-determined list. Given the need for large quantities of supplies for a mass casualty contingency and the low likelihood of occurrence, a loan arrangement with a supplier, with return of unused supplies, is particularly convenient and economical. The approach used in this study should be appreciable in other similar settings. In concurrent scheduled events, the iterative process described can lead to greater specificity of needs for expendable supplies.

Lovern, C. S. (2000). "Veterinary Medical Assistance Teams rise and shine." Journal of the American Veterinary Medical Assoc. 217(11): 1613.

Rega, P. (2000). "Disaster medical education for all physicians and physician extenders (comment letter)." Annals of Emergency Medicine 35(3): 314-316.

Streger, M. R. (2000). "The structure and role of DMAT teams." Journal of Emergency Medical Services 29(4): 57-58, 60, 70.

(2001). "AMSUS Heroes: Revisiting the 9-11 Disaster." Military Medicine Spring 2004 Supplemental: 4.
Focuses on the experience of Rodney P. Leibowitz, an active officer of the National Disaster Medical Service, during the September 11, 2001 terrorist attacks in the U.S. Immediate reaction of Leibowitz after the crash of the first plane; Aid provided by Leibowitz during the incident; Impact of the experience of Leibowitz on his life.

Brown, S. (2001). "Hospitals' awarness of their NDMS roles crucial to system's operation." AHA News 37(38): 5.
Reports on the creation of the National Disaster Medical System (NDMS) in the United States in response to the September 2001 terrorist attacks in the country. Purpose of NDMS; Components of NDMS; Information on hospitals contracted with NDMS.

Jacoby, I. (2001). "Mitigating medical maladies in disasters (editorial)." Journal of Emergency Medicine 21(3): 285-287.

Knouss, R. F. (2001). "National Disaster Medical System... The 2nd National Symposium on Medical and Public Health Response to Bioterrorism Public Health Emergency & National Security Threat, Washington, DC, November 2000." Public Health Reports 116(2): 49-52.
Focuses on the functions of the Office of Emergency Preparedness within the U.S. Department of Health and Human Services. Role of the office in federal responses to disasters; Details of the National Disaster Medical System.

Maniscalco, P. M. (2001). "Domestic preparedness: the grand illusion." Journal of Emergency Medical Services 30(4): 46-51, 55.

McCarthy, M. (2001). "Attacks provide first major test of USA's national antiterrorist medical response plans." Lancet 358(9286): 941.
Focuses on the role of the United States antiterrorist medical response plans in the aftermath of the terrorist attacks on the U.S. which occurred on September 11, 2001. Preparations made by New York City hospitals to receive thousands of victims from the collapsed World Trade Center; Deployment of Disaster Medical Assistance Teams (DMAT) and Disaster Mortuary Operation Response Teams (DMORT) in the first nationwide activation of the National Disaster Medical System.

Morrissey, J. (2001). "Disaster teams mobilize." Modern Healthcare 31(38): 6.
Reports on the actions taken by the disaster medical teams following the September 11, 2001 terrorist attacks in the United States. Factors which influence the selection of the teams to mobilize; Help extended by the disaster teams; Information on the disaster team from North Carolina.

Santandrea, L. (2001). "Nurses making a difference." American Journal of Nursing 101(11): 94-95.

Bissell, R., Walz, B. J., Droneburg, J. (2002). "Training of National Disaster Medical System responders via the internet (abstract)." Prehospital and Disaster Medicine 17(4): S31.

Chaffee, M. (2002). "Disaster Response, Bioterrorism, and Weapons of Mass Destruction Resources." Policy, Politics & Nursing Practice 3(1): 81.
: Focuses on Web sites that offer information on disaster response, bioterrorism and weapons of mass destruction. International Nursing Coalition on Mass Casualty Education; John Hopkins Center for Civilian Biodefense; National Disaster Medical System; Association for Professionals in Infection Control and Epidemiology Inc.

Gallanter, T., Bozeman, W. P. (2002). "Firefighter illnesses and injuries at a major fire disaster." Prehospital Emergency Care 6(1): 22-26.
INTRODUCTION: In the summer of 1998, a series of wildfires swept across Florida. Firefighters and support personnel were imported and based in a central camp in Flagler County, Florida. Local residents were evacuated. Disaster medical assistance teams (DMATs) were deployed to provide medical support. Similar large-scale fire disasters occur frequently, but the illnesses and injuries seen have not been described. OBJECTIVES: To report the descriptive epidemiology of illnesses and injuries seen in firefighters and support personnel engaged in control and suppression of a series of wildfires. METHODS: Review of DMAT treatment records to determine the nature of illnesses and injuries seen during a 19-day deployment. RESULTS: Approximately 1,600 firefighters and support personnel were present in the camp. There were 3,404 patients seen with 3,841 complaints. An average of 179 patients was seen per day (range 47-414). A prominent bimodal pattern of presentations was noted during the course of each day. Reasons for seeking medical care included: preventive/hygiene and environmental, 33%; foot-related, 15%; rashes, 14%; ear, nose, and throat (ENT)/allergies, 9%; headache, 4%; eye irritation, 4%; gastrointestinal/abdominal complaints, 3%; cuts and penetrating injuries, 3%; strains/sprains, 2%; bites/stings, 2%; others, 1%. Eight patients (0.2%) were transferred to an emergency department for further care; 99.8% were treated on site. CONCLUSIONS: In this setting the majority of illnesses and injuries are minor. Visits related to preventive care and hygiene are common. This information can help in planning medical support operations in similar situations.

Gaudette, R., Schnitzer, J., George, E., Briggs, S. M. (2002). "Lessons learned from the september 11th World Trade Center disaster: pharmacy preparedness and participation in an international medical and surgical response team." Pharmacotherapy 22(3): 271-281.

Pinkson, R. G. (2002). Chapter 12: The United States Federal Response Plan. Disaster Medicine. H. D. a. B. JL. New York, Lippincott Williams & Wilkins: 123-132.

Rose, D. E., Williams, J. M. (2002). "Walking humbly. Minnesota's DMORT team members remember 9-11." Northwest Dentist 81(5): 29-32.

Terriquez-Kasey, L. (2002). "Guest Column - What it was like down there." Online Journal of Rural Nursing and Health 3(1).
Reflections from a nurse that responded to the 9/11 incident

Wallace, A. C. (2002). Chapter 13: National Disaster Medical System: Disaster Medical Assistance Teams. Disaster Medicine. H. D. a. B. JL. New York, Lippencott Williams & Wilkins: 132-142.

Berrios-Torres, S. I., Greenko, J. A., Phillips, M., Miller, J. R., Treadwell, T., Ikeda, R. M. (2003). "World Trade Center rescue worker injury and illness surveillance, New York, 2001." American Journal of Preventative Medicine 25(2): 79-87.
BACKGROUND: The September 11, 2001, terrorist attacks on the World Trade Center in New York City, New York, prompted an unprecedented rescue and recovery response. Operations were conducted around the clock, involved over 5000 workers per day, and extended into months following the attacks. The City of New York Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention implemented prospective surveillance to characterize rescue worker-related injury and illness and to help guide public health interventions. METHODS: From September 11 to October 11, 2001, personnel reviewed medical records at four Manhattan hospital emergency departments (EDs), and healthcare providers completed data collection forms at five temporary Disaster Medical Assistance Team (DMAT) facilities located at the site. Rescue workers included construction workers, police officers, firefighters, emergency medical service technicians, or Urban Search and Rescue workers. Data collected included demographic characteristics, injury type, illness, and disposition. RESULTS: Of 5222 rescue worker visits, 89% were to DMAT facilities and 12% to EDs. Musculoskeletal conditions were the leading cause of visits (19%), followed by respiratory (16%) and eye (13%) disorders. Incidence rates were estimated based on total injuries and/or illnesses reported times 200,000 (100 equivalent full-time workers in 1 year at 40 hours per week x 50 weeks per year), then divided by the total number of hours worked. Eye disorders (59.7) accounted for the highest estimated injury and illness rate, followed by headache (46.8). One death, 52 hospital admissions, and 55 transports were reported. Findings underscored the need to coordinate distribution and enforcement of personal protective equipment use, purchase of diagnostic equipment to diagnose corneal abrasions, and distribution of health advisories. CONCLUSIONS: This system provided objective, timely information that helped guide public health interventions in the immediate aftermath of the attacks and during the prolonged rescue and recovery operations. Lessons learned can be used to guide future surveillance efforts.

Forgione, T., Owens, P. J., Lopes, J. P., Briggs, S. M. (2003). "New horizons for OR nurses--lessons learned from the World Trade Center attack." AORN 78(2): 240-245.
The terrorist attacks of Sept 11, 2001, we a horrifying wake-up call for the United States and the rest of the world. The attacks led to the deployment of the disaster medical assistance team (DMAT) from Massachusetts General Hospital in Boston. In this article, members of the team outline what they did during the days after Sept 11 and the lessons they brought back to better prepare their DMAT for the next disaster.

Nufer, K. E., Wilson-Ramirez, G., Crandall, C. S. (2003). "Different medical needs between hurricane and flood victims." Wilderness Environmental Medicine 14(2): 89-93.
OBJECTIVE: Through the review of patient records seen by the New Mexico-1 Disaster Medical Assistance Team (NM-1DMAT) after various disasters, we hoped to find patterns that might help in disaster planning. Our hypothesis was that flood and hurricane victims have different medical conditions and needs. METHODS: We conducted a retrospective review of patient records for NM-1DMAT deployments to Hurricane Andrew in Florida (August 1992) and the Houston, TX flood caused by Tropical Storm Allison (June 2001). We compared age, gender, chief complaint, medical history, diagnosis, diagnostic testing, treatment rendered, triage category, and patient disposition. RESULTS: We found several differences between the patients presenting after Hurricane Andrew and those presenting after Tropical Storm Allison. The chief complaint, diagnosis, presence of medical history, diagnostic testing, treatment rendered, triage category, and disposition all differed between the 2 disasters. The mean ages in both groups were similar. CONCLUSIONS: The needs of the patients differed in several areas between Hurricane Andrew and the Houston flood. This information should be tested in a future hurricane or flood and taken into account when planning for deployments.

Riley, J. M. (2003). "Providing nursing care with federal disaster-relief teams." Disaster Manag Response 1(3): 76-79.

Rollins, G. (2003). "Disaster on-call." Hositals & Health Networks 77(12): 24.
Reports on the participation of hospitals in Boston, Miami and Seattle in the International Medical Surgical Response Teams of the National Disaster Medical System of the U.S. government. Function of the response team; Reason for creating the response team; Deployments of the response team of the Massachusetts General Hospital.

Suner, S. (2003). "On-site medical care during the September 11th WTC terrorist attack rescue and recovery effort and the National Disaster Medical System (NDMS)." Med Health R.I. 86(11): 354-356.

Tsai, M. C., Chuang, C. C., Arnold, J., Lee, M. H., Hsu, S. C., Chi, C. H. (2003). "Terrorism in Daiwan, Republic of China." Prehospital and Disaster Medicine 18(2): 127-132.
The Republic of China on the island of Taiwan has experienced at least 20 terrorist events since 1979, including 13 aircraft hijackings and five bombings. Factors responsible for the relatively small burden of terrorism on Taiwan in the past include tight military control over political dissent until 1987, a warming relationship with the People's Republic of China in the 1990s, political inclusion of major internal cultural groups, geographic isolation, and a lack of other significant international enemies. Nevertheless, today Taiwan faces a new prospect of terrorism by adversaries of the United States and its allies and by an international paradigm shift in the types of weapons used by terrorists. National emergency management has been enhanced significantly since the Ji Ji earthquake in 1999, including the assignment of lead government agencies to the planning and preparedness for specific types of terrorist events involving nuclear, biological, and/or chemical releases. Other significant improvements at the operations level, include the establishment of two national disaster medical assistance teams, four urban search and rescue teams, 13 local disaster medical assistance teams, and eight chemical emergency response hospitals. Future challenges include improving the coordination of inter-agency response at the national level and the quantity and quality of local disaster response assets.

(2004). "CE Test - Disaster Nursing." Critical Care Nurse 24(3): 23.
Presents a continuing education (CE) test form about disaster nursing as provided by American Association of Critical-Care Nurses. Main goal of the disaster medical assistance teams; Reason behind the qualifications of critical care nursing for disaster nursing; Training mandatory for participation on a national disaster medical system team.

(2004). "Homeland Security formalizes pharmacist response teams." American Journal of Health-System Pharmacy 61(3): 222.
Reports that the U.S. Department of Homeland Security and six national pharmacy organizations have agreed to establish national pharmacist response teams involving pharmacists, pharmacy students and pharmacy technicians as federal volunteers. Management of the National Disaster Medical System by the Response Division of the Federal Emergency Management Agency which is headed by Eric Tolbert.

Kahler, S. C. (2004). "VMAT deployments to New York involved dual role." Journal of the American Veterinary Medical Assoc. 225(8): 1162-1164.

Lhowe, D. W., Briggs, S. M. (2004). "Planning for mass civilian casualties overseas: IMSuRT-International Medical/Surgical Response Teams." Clinical orthopaedics and related research 422: 109-113.
The increased likelihood of mass casualties involving Americans living abroad has prompted the development of a mobile, civilian medical and surgical unit available for rapid deployment overseas. Using past experience derived from the National Disaster Medical Service, and from recent rescue efforts following the African embassy bombings in 1998, an International Medical-Surgical Response Team was developed. Organized under the Department of Homeland Security, it is staffed by civilian professionals from medical and bioengineering fields. Initial deployments to the World Trade Center (2001) and Guam (2002) have shown the ability to rapidly mobilize appropriate manpower and equipment to a mass casualty site, whether domestic or international. The goals of this organization are to work in cooperation with local authorities at the mass casualty site to provide rapid assessment and medical stabilization of injured persons. When the mass casualty is overseas, rapid evacuation of casualties is accomplished by the responding military air evacuation service.

Lord, E. J., Cieslak, T. J. (2004). "Joint Regional Exercise ("JREX") 2000." Disaster Manag Response 2(1): 24-27.
Joint Regional Exercise, 2000 (J-REX 2000) was an ambitious, multi-functional, multi-agency exercise conducted October 12-14, 2000. While the main focus of the exercise was centered in Minneapolis MN, and adjacent Fort Snelling, the exercise also involved National Disaster Medical System (NDMS) participating hospitals in Cleveland, Detroit, Duluth, Indianapolis, Omaha, and Tulsa. As such, the exercise presented a unique opportunity to simultaneously and somewhat realistically examine the response capabilities of multiple agencies and institutions within the NDMS and to 'game' several aspects of the Federal Response Plan's Emergency Support Function 8.

Mace, S. E., Jones, J. (2004). "An analysis of Disaster Medical Assistance Team deployments in the United States (abstract)." Annals of Emergency Medicine 44(4): S35.

Mace, S. E., Bern, A. (2004). "Needs assessment of current pediatric guidelines for use by Disaster Assistance Teams members in response to disasters and shelter care (abstract)." Annals of Emergency Medicine 44(4): S35.

Nufer, K. E., Richards, M. E. (2004). "Different medical needs between hurricane and earthquake victims (abstract)." Annals of Emergency Medicine 44(4): S34.

Nufer, K. E., Wilson-Ramirez, G. (2004). "A comparison of patient needs following two hurricanes." Prehospital and Disaster Medicine 19(2): 146-149.
OBJECTIVES: The New Mexico-1 Disaster Medical Assistance Team (NM-1 DMAT) has responded to more disasters due to hurricanes than disasters from any other type of event. To assess whether defined patient needs may be applied to future hurricanes, the patient needs after Hurricanes Andrew and Iniki were compared. The study question was, "Did patient medical needs differ after these hurricanes?" METHODS: DESIGN: Retrospective cohort review. SUBJECTS: All patients evaluated by NM-1 DMAT following Hurricanes Andrew and Iniki. OBSERVATIONS: Age, past medical history, chief complaint, diagnosis, diagnostic tests, treatments, triage level, and disposition. Age was analyzed using Student's t-test, other data were analyzed using the chi-square test. RESULTS: A total of 1,056 patients were evaluated. Age distributions did not differ between events. More patients had co-morbidities after Hurricane Andrew. The only difference in chief complaint was that more patients complained of "cold" symptoms following Hurricane Iniki. The only differences in diagnoses were for upper respiratory infections, which were diagnosed more often after Hurricane Iniki. There were no differences in the administration of tetanus toxoid, antibiotics, or analgesics. Patients evaluated after Hurricane Andrew had more diagnostic tests performed and a higher illness/injury acuity. The proportion of the total number of patients conveyed to a hospital did not differ. CONCLUSION: Patient needs were similar after Hurricane Andrew and Hurricane Iniki and may be applicable for predicting the needs of patients for future hurricanes.

O'Rourke, K. (2004). "Veterinary response teams proliferate. Veterinarians train for disease outbreaks and disasters." Journal of the American Veterinary Medical Assoc. 225(8): 1173.

Richards, M. E., Nufer, K. E. (2004). "Simple triage and rapid treatment: does it predict transportation referral needs in patients evaluated by Disaster Medical Assistance Teams (abstract)." Annals of Emergency Medicine 44(4): S33-34.

Schnitzer, J. J., Briggs, S. M. (2004). "Earthquake relief--the U.S. medical response in Bam, Iran." New England Journal of Medicine 350(12): 1174-1176.

Sparks, B., Pontus, C. (2004). "National Disaster Medical Assistance Teams: An MNA member shares her DMAT training experience." Massachusetts Nurse 75(1): 13.
Relates the educational experience of the author in emergency preparedness training. Development of Disaster Medical Assistance Teams (DMAT); Background information about the training; Number of individuals consisting the DMAT-deployable unit.

Cohen, S. S., Mulvaney, K. (2005). "Field observations: Disaster Medical Assistance Team response for Hurricane Charley, Punta Gorda, Florida, August 2004." Disaster Manag Response 3(1): 22-27.
The South Florida Disaster Medical Assistance Team was deployed to work with victims of Hurricane Charley in Charlotte County, Fla. Charlotte County was unique because of the higher than average number of elderly residents and the fact that all 4 local hospitals had been damaged. The Disaster Medical Assistance Team was required to modify their response, and the lessons learned from this experience are presented.

Owens, P. J., Forgione, A. Jr., Briggs, S. (2005). "Challenges of international disaster relief: use of a deployable rapid assembly shelter and surgical hospital." Disaster Manag Response 3(1): 11-6.
Surgical care is an important service to provide to victims of a disaster. A specialized response team has been created by the National Disaster Medical Treatment division of the Federal Emergency Management Agency to respond when local hospital facilities are either unavailable or unusable. When a major earthquake destroyed Bam, Iran, in December 2003, the US Government mobilized the International Medical Surgical Response Team-East and deployed a team of 57 health care providers to aid in rescue and response efforts. The challenges of designing, maintaining, and keeping a Deployable Rapid Assembly Shelter/Surgical Hospital are described.