In 1981, President Reagan was concerned that the country would
not he prepared for a major catastrophic domestic disaster or
a foreign military conflict. He established the Emergency Mobilization
Prepared-ness Board, which led to the formation of the National
Disaster Medical System (NDMS). This system comprises 75 local
Disaster Medical Assistance Teams (DMATs) that can be activated
in three ways: (1) by a presidential declaration of a disaster,
(2) by request for major medical assistance from a state health
official under provisions of the Public Health Service Act, or
(3) 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 Ad ministration Medical System
National Disaster Medical System
The NDMS is designed to fulfill three main objectives
Fortunately, the United States has not yet experienced a disaster that has created thousands of casualties. But as areas become more densely populated, the likelihood of such an event increases. No single city or state can he prepared for such a catastrophic event. Thus NDMS has been created to provide assistance to such an area when existing local and state efforts are insufficient.
As an example, California has 67,112 general medical surgical
beds. Yet a disaster might produce 100,000 casualties. Similarly,
there might be shortages of beds in other areas of the country;
predictions are that within 15 years, there will be an earthquake
in the Midwest along the New Madrid fault line, in which 4000
persons will die and 100,000 will be injured.
THE DMAT SYSYEM
A DMAT consists of approximately 30 volunteers-physicians, nurses, technicians, and other allied personnel-who come together and train as a group. A DMAT can be used by local authorities for mass casualty search-and-rescue operations, by state authorities for medical response in their home state, and by national authorities to provide interstate aid.
There are several reasons for appointing DMAT members as federal employees. Although they organize and train as volunteers, on activation of the system for a national emergency, DMAT members be-come temporary paid employees of the U.S. Public Health Service.
When appointed as a federal employee, potential problems of state licensure are avoided. Federal employees can be sent across state lines without regard for that state's license requirements or certification. Individual medical personnel who cross state lines are protected from liability claims.
Each DMAT must have a sponsoring organization that organizes and recruits the team, pre-enrolled the members with the NDMS system to facilitate temporary appointment to federal status, arranges for the training of the team, and coordinates and dispatches the team.
In the event of a mass casualty disaster, victims might need to he evacuated to areas of the country that could accommodate a large patient influx. To he considered such an NDMS patient reception area, three criteria must be met:
Hurricane Hugo disaster relief
Recently DMATs participated in disaster relief following Hurricane
Hugo in the U.S. Virgin Islands. On September 29, 1989, the U.S.
Public Health Service dispatched a DMAT from Albuquerque, New
Mexico, to St. Croix. Team members were flown into the area in
military aircraft; 3 days of projected supplies and further sup-plies
were brought in by additional military transport. The team operated
the only inpatient and ED facility on the island on a 24-hour
basis. Fortunately this disaster did not warrant transport
of the victims and the team was relieved October 7, 1989, by a
34-member team from Rockville and Bethesda, Maryland. On October
14, 1989, 16 members of the Maryland DMAT were relieved by Public
Health Service physicians, nurses, and a pharmacist.
How our DMAT came to be
In 1986, a local emergency physician read a brochure about NDMS and DMATs from a disaster conference held in Indianapolis. He called Washington, D.C., and discussed the formation of a DMAT in Toledo, Ohio. He then brought this information to a local Disaster Action Committee that had been formed to review disaster planning in Lucas County, Ohio. This committee and the Regional Emergency Medical Services of Northwest Ohio (REMSNO), the coordination center for local EMS systems, obtained the endorsement of the Lucas County Academy of Medicine and the Hospital Council, which decided that three to four DMATs could be formed. This group met with the NDMS and initial educational topics for team members were established.
The training outline now includes ABCs of disaster medicine, cervical spine immobilization, disaster triage, stress management, and instruction on living in the field.
In 1988, REMSNO, now the coordination center for the DMAT, obtained signed Memoranda of Understanding from local hospitals to supply a minimum of 1000 beds for incoming casualties in the event of DMAT activation. The community could not provide 2500 beds and an exception was made. The local airport, Toledo Express, was contacted to ensure that they could accommodate the military transports that would be used during personnel or patient transport.
As a means of further training, during November of 1988, a citywide
disaster drill with a burning downtown high-rise office building
was held, coordinated by REMSNO and involving the three DMATs
and local EMS. An airport disaster drill was held in May of 1989.
Representatives from NDMS have observed these drills and have
offered both suggestions and praise
Present status of local DMAT
A quarterly newsletter developed by a team co-leader to keep each DMAT informed and to unify the three groups, has proved very beneficial. All three DMAT'S have the same curriculum. Each presenter provides the same program during the month and three different sites and times. In this way members' schedules can be better accommodated. Videotapes have been made and are shared by the three teams. General meetings are held to reinforce the ties with NDMS.
Presently we are preparing for a national drill to be held in October 1990, near Memphis, Tennessee, a site near the New Madrid fault, where a major earthquake is expected in the next few years. (See Journal Update, p. ??, for details.) The scenario selected involves an earthquake and will include teams from Detroit, Michigan; Fort Wayne, Indiana; and Toledo, Ohio. Teams from these three cities will be flown to the disaster site, where there will be an estimated 1000 moulaged victims. Victims also will be evacuated to these cities and taken to designated hospitals that are participating in the drill.
Currently we have three DMATs with a fourth team in formative stages. The sponsoring hospitals handle each team in an autonomous way.
One of the sponsoring hospitals provides a meeting place and refreshments for monthly meetings,
mailing services, paper supplies, videotaping equipment and supplies,
and personnel. Currently the Human Resources Department is striving
to create a situation in which members of the DMAT could be excused
from their jobs in the event of an actual emergency.
CONCLUSION
If a community can generate interest and meet the criteria, perhaps
a DMAT could be formed in your city. Contacting the NDMS is the
first step. The local hospital council, EMS providers, physicians,
nurses, hospital representatives, the local Academy of Medicine,
and existing teams can work together to aid organization of a
team. The nation has much to gain from such efforts. Any area
of the country may he the next to need these services. Preparation
is the key to overcoming major difficulties; such preparation
is the purpose of NDMS and their DMATs.
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