tangent
06-08-02, 00:06
A Civilian-sponsored DMAT: A community's collaboration among three
hospitals
Journal of Emergency Nursing, Vol 16, #4: July/Aug 1990. pp 245-247
Jacqueline Hogan, RN, BSN, Paul Rega, MD, FACEP, and Budd Forkapa,
Toledo, Ohio
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
To provide medical assistance to a disaster area in the form of
medical assistance teams and medical supplies and
equipment
To evacuate patients that cannot be cared for in the affected
area to designated locations elsewhere in the nation
To provide hospitalization in a national network of hospitals
that have agreed to accept patients in the event of a national
emergency
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:
1.Available beds-There should be a minimum of 2500 acute care beds
as promised by local hospitals. Some exceptions
can be arranged, depending on available beds and willingness to
join the federal system.
2.Coordination center-The area must have a federal or nonfederal
organization capable of acting as a coordinating center
to link hospital beds with transportation, communication, and
other resources, and to establish patient administration
procedures. Established Emergency Medical Services (EMS) are a
good resource for this expertise.
3.Air access-The area must possess an airport capable of
accommodating aeromedical evacuation aircraft.
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.
SUGGESTED READINGS
1.National Disaster Medical System Task Force, Department of
Defense, Department of Health and Human Services',
Federal Emergency Management Agency, and Veterans Administration.
The National Disaster Medical System
Coordination Center Guide, March, 1985.
2.National Disaster Medical System response to Hurricane Hugo and
San Francisco earthquake. Department of Health
and Human Services Situation Report No.17, October 13, 1989.
hospitals
Journal of Emergency Nursing, Vol 16, #4: July/Aug 1990. pp 245-247
Jacqueline Hogan, RN, BSN, Paul Rega, MD, FACEP, and Budd Forkapa,
Toledo, Ohio
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
To provide medical assistance to a disaster area in the form of
medical assistance teams and medical supplies and
equipment
To evacuate patients that cannot be cared for in the affected
area to designated locations elsewhere in the nation
To provide hospitalization in a national network of hospitals
that have agreed to accept patients in the event of a national
emergency
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:
1.Available beds-There should be a minimum of 2500 acute care beds
as promised by local hospitals. Some exceptions
can be arranged, depending on available beds and willingness to
join the federal system.
2.Coordination center-The area must have a federal or nonfederal
organization capable of acting as a coordinating center
to link hospital beds with transportation, communication, and
other resources, and to establish patient administration
procedures. Established Emergency Medical Services (EMS) are a
good resource for this expertise.
3.Air access-The area must possess an airport capable of
accommodating aeromedical evacuation aircraft.
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.
SUGGESTED READINGS
1.National Disaster Medical System Task Force, Department of
Defense, Department of Health and Human Services',
Federal Emergency Management Agency, and Veterans Administration.
The National Disaster Medical System
Coordination Center Guide, March, 1985.
2.National Disaster Medical System response to Hurricane Hugo and
San Francisco earthquake. Department of Health
and Human Services Situation Report No.17, October 13, 1989.