CNN Chat transcript:
Gary Moore on national disaster medical teams

(CNN) -- Following is a transcript of a Friday, September 17, 1999, health chat with Gary Moore, director of the Division of Emergency Readiness and Operations, Office of Emergency Preparedness, U.S. Public Health Service, after a week of dealing with Hurricane Floyd.

In his role as director, he manages the National Disaster Medical System, a partnership of four federal departments and agencies: the U.S. Public Health Service, the Federal Emergency Management Agency (FEMA), Department of Defense (DoD) and Department of Veterans Affairs (VA).

During a disaster, Moore is the chief of field operations. In this role, Moore is responsible for providing on-ground direction and support to federal health and medical response operations during emergencies and disasters.

Previously, Moore was second in command in the Maryland State Police and commanded its aviation division for 18 years, working with the Maryland Institute for Emergency Medical Services System in developing and operating the statewide Emergency Medical Services system (EMS). Moore flew the first Medevac in Maryland and has received numerous awards including three governor's citations for his role in developing the Medevac system.

Gary Moore: Gary Moore is joining us today from the Office of Emergency Preparedness! Welcome, Gary Moore!

Chat Moderator: Tell us about your disaster teams. How many are there? How many people are on a team? Are they paid or volunteers? What are their areas of expertise?

Gary Moore: OK. Glad to be here. Our teams are made up of 35 personnel from the private sector as well as governmental agencies. These people volunteer their time to be able to respond to any kind of disaster, and they are a part of the national disaster medical system.

And that system is made up of four federal agencies. The agencies are the Department of Veterans Affairs, Department of Defense, Federal Emergency Management Agency (FEMA) and the U.S. Public Health Service. The U.S. Public Health Service has the management lead for the national disaster medical system. That system is commanded by Adm. Robert Knouss.

My job is director of operations and readiness. I am the one who deploys all the health and medical assets to a given disaster or event. It is my responsibility to see that all health and medical needs are met.

We have presently 26 LEVEL ONE Disaster Medical Assistance Teams (DMATs) strategically placed across the United States. There are 35 personnel on each team. These personnel are made up of doctors, nurses, EMTPs and EMTs.

Chat Moderator: What steps do teams take to deal with disasters?

Gary Moore: They are in the process of preparing for disaster such as hurricanes, weapons of mass destruction incidents, terrorist incidences, earthquakes, etc. During the entire year they participate in exercises, training, etc., to prepare themselves for these events.

Chat Moderator: What specifically do the different teams do? What did they do during Floyd?

Gary Moore: Presently for Floyd we have deployed 9 teams. These teams have been deployed from Ohio, Michigan, Florida 1, and a Public Health Service team to Fort Jackson, South Carolina, and stays with a management support team. Also we have deployed Georgia, Arkansas, Florida 2, and Florida 5 to Fort Gordon, Georgia, with a management support team.

These teams are there staged and ready for deployment to incidents that are requested by those states to respond to. Presently we are responding in North Carolina to meet the needs of flood victims who are stranded and also to assist hospitals who either surrounded by water and the public can't get to them, or setting up First Aid stations in areas flooded out.

Question from abby: Do you go in after the disaster has occurred? Or do you ever go in before, such as before a hurricane hits a given area?

Gary Moore: We send in an assessment team sometimes before a storm hits only if we can assure their safety and if they have sufficient housing such as a bunker underground or something of that nature for hurricanes. We never send our teams in before a storm hits as we don't want to put them in harm's way. So what we do is to stage our teams outside of the affected strike zone.

Chat Moderator: What should people NOT do in disasters? And what should they do?

Gary Moore: Most people wait too long to evacuate after an order has been given. What they should do is watch their local channels and TV weather channels so that they evacuate early and don't get caught up in a mass exit at the last moment causing them to be in a long drawn out traffic jam.

Chat Moderator: Describe the worst situation you ever encountered.

Gary Moore: The worst situation that I personally encountered was the Northridge, California, earthquake. Earthquakes are nowhere near predictable at all, as there is no notice to that type of disaster, whereas with a hurricane you have plenty of time to prepare and plan and stage your people. In the Northridge earthquake, we had to scramble very quickly (eight hours) to bring the full complement of federal health care providers to the scene. For me it's frustrating to not be able to respond quickly and immediately.

Chat Moderator: How/when does the U.S. Army get involved? U.S. Corps of Engineers?

Gary Moore: The U.S. Corps of Engineers is involved from the very beginning in what is known as the federal response plan. The U.S. Army is involved when the president so directs after a federal disaster has been declared and signed by the president for the affected state.

Question from Kester: Does the United Nations help in any way to help in disasters such as these hurricanes?

Gary Moore: The U.N. does help in typhoons and hurricanes that take place overseas, and they do offer some assistance in the United States depending where the hurricane may be.

Question from Allen: Mr. Moore, how is the function of your group coordinated with local (state, county, etc.,) agencies?

Gary Moore: Our group responds to local authority in a bottoms-up approach, not a top-down approach. What I mean is we come in and assist and take our direction from the local governments. We do not come in and take over the jurisdiction. We provide assistance to local and state governments when they determine that their capacity has been overwhelmed.

Question from TomP: Do the USPHS medical teams respond to international incidents? (e.g., Turkey?)

Gary Moore: We did not respond with our teams to Turkey, although we have the capability. But we did send individuals from the Centers of Disease Control to assist the government.

Chat Moderator: Since Northridge, has anything been done to make emergency response faster? What have you learned from this experience?

Gary Moore: We have learned that pre-staging earthquake equipment and training teams in high-risk earthquake areas is one of our sure ways to improve our response to earthquakes. As an example, we have assisted the city of San Francisco and the counties surrounding the city in building a level 1 DMAT team capable of responding much quicker to an earthquake in the Bay region.

Chat Moderator: How can people volunteer to help in disaster situations?

Gary Moore: They can report to their local governments and offer whatever assistance they have that can be brought to bear in any given situation. That assistance will be evaluated, and those volunteering will be advised if their services will be needed.

Chat Moderator: What qualities in a person do you think would make them a successful EMS operator?

Gary Moore: To have the medical training that a person receives, such as an EMT, doctor, nurse, or any of the health professions.

Chat Moderator: When in your life did you realize that this line of work was for you?

Gary Moore: I started my career in the Maryland State Police and rose to commander of the Maryland State Police Medevac Helicopter program and worked first responders from the local fire departments. As a result of this, I really found it rewarding to help the number of folks we were able to help by Medevacing people who were injured in auto accidents to a place to be seen by the right person at the right time at the right place to save their lives.

Gary Moore: From there I went on to the federal government after retirement to manage the operations and readiness divisions of the U.S. Public Health Service DMAT teams.

Chat Moderator: Did you coordinate operations dealing with Floyd from Washington, or did you go on-site?

Gary Moore: From my operations office in Rockville, we have an emergency operations center. And all of the health and medical assets are managed from that location. I did not go to the scene during Floyd, but many others do.

Chat Moderator: What kind of injuries are your nine teams seeing from Floyd?

Gary Moore: Mostly minor injuries. Mostly from debris, from wind picking up the debris and possibly striking someone; trees down ... actually very few injuries, a number of deaths, less than 10 from Florida to Maine. Some of these deaths were from heart attacks from the pressure of individuals dealing with this type of destruction.

Chat Moderator: I'm sure that in your line of work you see people with the worst possible medical conditions. How do you keep calm during these extremely tense situations, and how do you deal with the memories of seeing these people horribly hurt?

Gary Moore: I don't think you ever forget the possibility of being a victim yourself after seeing what so many people have to endure. But you do learn to cope after many years of experience. Because if you don't, you are not effective in helping others in need.

Chat Moderator: Did you play a role in the mass evacuation of the eastern seaboard during hurricane Floyd? What role?

Gary Moore: We did not play a role in the evacuation. That was the local and state governments' responsibility.

Chat Moderator: How long will your teams operate after a hurricane?

Gary Moore: It depends on the damage. It usually amounts to how much destruction, how many hospitals, nursing homes and medical facilities come under the wrath of a storm. In some incidents the injuries are low. Other incidents where a lot of buildings collapse, there are a lot of injuries.

Question from abby: The county that I work in is attempting to require public health employees to man shelters during a hurricane. Do you feel that this is the place of public health or more of a safety issue?

Gary Moore: They need, in my opinion, to have public health service providers to monitor shelters. But they don't need to be totally managed by these type of individuals.

Question from Allen: In your opinion, is the nation prepared enough to provide sufficient and timely medical aid in the event of an earthquake similar to Turkey?

Gary Moore: Yes, I think we are prepared with all of the state and local and federal assets this country has worked for years to put in place. Should such an event happen, all local governments, states and other countries would provide assistance as we do for others.

Chat Moderator: What are your plans for the Y2K bug?

Gary Moore: We are presently going to place all of our management support teams, our disaster medical assistance teams, and all federal health providers on alert from December 27 to January 14. During that period of time, we'll be operating 24 hours a day and prepared to respond should we have a failure that would involve health and medical across this country.

Chat Moderator: Do you have plans in place to respond to biological or chemical attacks?

Gary Moore: Yes, we do. We have four national medical response teams that are across the United States in four locations from the East Coast to the West -- plus our disaster medical assistance teams, our mortuary teams, used for victim identification (DMORTs) to assist in weapons of mass destruction events.

Question from DCarp: Are you going to activate in advance any teams for Y2K, or just have them on alert?

Gary Moore: They are all placed on alert for that time period starting December 27 to January 14, 2000.

Question from DCarp: How long do you expect DMATs to be deployed (overall, including replacement teams) for Floyd?

Gary Moore: Overall, we will probably be deployed for approximately 10 days. We have started today to release some of our teams.

Chat Moderator: Where did you get the inspiration for your Medevac program, and how did you go about implementing this program on a statewide level?

Gary Moore: When I was a young trooper working the highway, I was concerned about the number of fatalities that were happening. At about the same time frame, Dr. R. Adams Cowley from the University of Maryland in Baltimore was working with the effects of shock on victims due to automobile accidents. I was able to work with him, and my contribution was to find a transportation system that would place automobile accident victims in a hospital within one hour of their accident to reduce death due to shock.

Question from Kester: What will you do if an epidemic breaks loose in the country?

Gary Moore: It depends on what kind of epidemic. Some of this is classified, and I can't mention it, but we are well prepared to respond to whichever it may be.

Chat Moderator: Did you help after the Oklahoma City bombing?

Gary Moore: I was at Oklahoma within five hours of that disaster. Our role was to provide victim ID with our DMORT teams.

Chat Moderator: What should people do after an earthquake?

Gary Moore: After an earthquake, our disaster teams return to their home bases after being released by the local or state governments. They then spend literally weeks replenishing and repairing their earthquake equipment to be ready for the next event.

Chat Moderator: What is the first step in responding to a disaster such as a hurricane?

Gary Moore: The first step for my department is to be requested by a local government through FEMA for our assistance. That assistance will be given after federal disaster declaration has been signed by the president. Federal assistance will then be brought to bear very quickly.

Chat Moderator: What kind of medical assistance for a hurricane is usually needed?

Gary Moore: It ranges from disaster medical assistance teams to provide help at hospitals, also to go through the community and assist after people have been extracted from collapsed buildings, to providing medical care for those responders who are participating in this event.

Question from abby: Regarding hurricanes, do you find that most areas have good medical systems in place?

Gary Moore: They do. In the United States we are fortunate in that our local governments and all 50 states are well prepared and are participating daily in preparedness events to better their response.

Question from abby: Are there any mental health people on your teams?

Gary Moore: All of our teams have a mental health component with them to provide stress debriefings for that team.

Chat Moderator: Do you respond differently to natural disasters than to a bombing?

Gary Moore: The health and medical response is somewhat the same in any disaster,as we are there to treat the injured no matter what the event is.

Chat Moderator: Is mental stress a big problem? For victims, or for teams?

Gary Moore: It is a problem for both. However, teams are trained for this type of stress. Therefore I would say victims suffer more than responders, generally. There are times when this is reversed, such as the Oklahoma City bombing. That event was the most stressful situation for teams that I have seen in my entire life.

Chat Moderator: Are your volunteers paid by their agencies, or unpaid?

Gary Moore: They are paid by the federal government whenever they are deployed as federal assets.

Chat Moderator: What kind of training goes into flying disaster situations?

Gary Moore: They would have to avoid flying in conditions close to a hurricane as soon noted by the FAA. They would be restricted from that airspace.

Chat Moderator: Describe the most exciting rescue situation you've ever been involved in.

Gary Moore: When I was in the state police, I had a 17-year-old girl who needed to be rescued from a river where she fell out of a boat and was being washed downstream in heavy rain. Just before going over a very large falls, she had grabbed a rock and was hanging on. I flew a helicopter in 50 mph winds in hard rain and set one skid on the rock, and she was pulled into the helicopter after being there for about seven hours. It was so rewarding to save her life, because had she gone over the falls, she would not be here today. I have received a Christmas card from her yearly for the past 12 years.

Chat Moderator: Do you ever have any correspondence with the people that you rescue after the event?

Gary Moore: Yes, we receive correspondence. It comes through our office. Now they send e-mails, phone calls, to show their appreciation.

Chat Moderator: Do you have any final thoughts or words of advice for our chatters?

Gary Moore: I would just say be aware of the disasters where notice is given. Pay attention, listen to the local authorities, follow their directions, and they will do a lot to save your lives as well as the lives of your loved ones.

Chat Moderator: Thanks, Gary Moore, for joining us!

Gary Moore: Thank you very much for permitting me this opportunity to chat with you all today. You need to know that I also had to do my duties for the disaster we are presently in while talking with you, and it has been most enjoyable.