In 1981, in an effort to be prepared for a national disaster,
then President Ronald Reagan created the Emergency Mobilization
Preparedness Board. Out of this board was born the National Disaster
Medical System (NDMS), which is currently made up of 75 local
Disaster Medical Assistant Teams (DMATs). The NDMS can be activated
by a presidential declaration of a disaster, by request for major
medical assistance from a state health official under provision
of the Public Health Service Act, or in a foreign military conflict
involving U.S. Armed Forces, where casualty levels are likely
to exceed the capacity of the Department of Defense Veterans Administration
(VA) Medical System.
The NDMS was designed to provide the following services in the event of a disaster:
Each DMAT team consists of 40 to 60 volunteers, physicians, nurses,
paramedics, EMT's and non-medical personnel such as clerks. In
an actual national disaster. at least 30 members from each team
are expected to relocate to the disaster site for a projected
one week stay. As an example, when Hurricane Hugo struck the
U.S. Virgin Islands in September 1989, a team from Albuquerque,
N.M., was flown into St. Croix by military transport with three
days of projected supplies. There they operated and staffed, on
a 24hour basis, the only inpatient and emergency facility on the
island. Approximately one week later they were relieved by a team
from Rockville and Bethesda, Md. Sixteen members of that team
were replaced one week after that by physicians, nurses and a
pharmacist from the Public Health Service.
Of the existing 75 DMATs, 74 are sponsored through veterans'
hospitals or U.S. military reserve units. The remaining DMAT,
however, is civilian sponsored. This team, which is located in
northwestern Ohio, is comprised of individuals from the Toledo
Hospital, St Charles Hospital, the Medical College of Ohio Hospital,
and from St. Vincent's Medical Center.
The force behind the northwest Ohio DMAT is Dr. Paul Rega, a
local emergency physician. After reading about NDMS, he contacted
the Public Health Service in Washington, D.C., regarding the prospect
of forming a local team. Curious about the possibilities of a
civilian team, the national NDMS agreed to meet with the area's
local disaster action committee, which had been formed to review
local disaster planning. They also met with the Regional Emergency
Medical Services of Northwest Ohio (REMSNO), the Lucas County
Academy of Medicine and the Hospital Council of Toledo.
After some discussion, it was decided that the four local hospitals
had enough interested individuals at all levels of medical expertise
to organize one DMAT unit each. It was also decided that they
had the resources to be an NDMS reception center. As a reception
center, the four hospitals would become part of a network of hospitals
nationwide to which evacuated patients could be transported.
To be considered as a suitable center, they had to first meet three criteria:
In addition to meeting these criteria. each DMAT must have a
sponsoring organization to recruit, organize and enroll members
with the federal organization; arrange for training sessions;
and coordinate and dispatch the unit Since REMSNO was already
the coordination center for the local EMS, it volunteered for
this task. A panel consisting of representatives from each of
the four units was also set up to guide the future progress of
the team.
Once the DMAT was established, each member had to be "federalized."
While considered a volunteer group during training and organization,
DMAT members become federal employees or paid members of the U.S.
Public Health Service during a national emergency. Once a member
is federalized and given a classification number and rating, the
problems of licensure across state lines and liability claims
are eliminated. The licensure aspect is the same as applies to
military personnel; registered nurses in the U.S. Navy, for example.
can practice anywhere they are sent without having to apply for
a license in each particular state.
Decisions regarding the team's training also had to be made.
Since each DMAT member has a different level of expertise, mandatory
training sessions are held each month. These sessions include
the ABCs of disaster medicine, proper immobilization techniques,
disaster triage. stress management and field living conditions.
To ensure that each member has an equal opportunity to receive
training, each session is presented in four different locations
at four different times, with the same presenter for a particular
subject matter. To help determine some of the areas of instruction,
coordinators spoke with leaders of other disaster teams that had
already been used in real disasters and who, therefore, had first-hand
knowledge.
So far, funding for this DMAT has come from private donations
and from local hospitals. The coordinators are looking at fund-raising
projects in the future and are relying on volunteer efforts to
help procure supplies.
To date, the four local units have been involved in two citywide
disaster drills, one involving a burning high-rise apartment building
downtown, and the other an airport plane crash. In October 1990,
the team, along with others from Detroit, Mich., and Birmingham,
Ala., will be participating in a national drill in Memphis, Tenn.
This area is expected to have a major earthquake in the next 15
years, resulting in an estimated 100,000 casualties.
Agencies interested in forming their own DMAT and becoming a
part of the NDMS can contact organizers through the U.S. Public
Health Service in Washington, D.C. Working with local hospital
councils, EMS providers, physicians, nurses and hospital representatives
will also aid in the organization of a DMAT.
No one knows where the teams will be needed next, but everyone
knows that being prepared is the key to success.
Jacqueline Hogan is a registered nurse and DMAT co-leader for
Toledo Hospital in Ohio.