National Disaster Medical System (NDMS) Partners: HHS DOD VA FEMA

1. National Disaster Medical System (NDMS)Partners: HHS DOD VA FEMA

2. NDMS Purpose A Nationwide Medical Response System to: • Supplement state and local medical resources during disasters or major emergencies • Provide backup medical support to the DOD/VA medical care systems during an overseas conventional conflict

3. NDMS Medical Response Disaster Medical Assistance Teams(DMATs) • Volunteer Groups Affiliated with NDMS • Roster approximately 100 Persons per Team (> 6,000 personnel) • Variety of Health/Medical Skills • Locally Sponsored • Community Based • Local/ State Asset

4. NDMS Definitive Medical Care • Network of approximately 2,000 non-Federal Hospitals • 63 Federal Coordinating Centers, which coordinate in excess of 80 receiving areas • Commit Hospital beds & support to NDMS • Provide Bed Availability Information to Local NDMS Federal Coordinating Center • Treat NDMS Patients • Participate in NDMS Exercises

5. Deploy as a 35 member team Carry $325,000 worth of medical equipment & Supplies Treat 250 patients / day Capable of 24 hour operations for 10-14 days Disaster Medical Assistance Team

6. Provide sophisticated medical care to victims of disaster in an austere environment DMAT Mission

7. Numerous jobs roles Volunteers during training When activated, become US Public Health Service employees DMAT Personnel • Federal claims tort act coverage • Licensure within Federal domain • Workers Comp • Disaster Medicine training

8. Level I Fully equipped with gear and personnel to provide 24 hour medical care and sustain team in field for 3 days Level II Most personnel and some equipment Level III Has some personnel and some gear DMAT Levels Seattle ME WA MT ND VT MN Worcester NH OR Boston NY MA WI SD MI CT ID Westland Providence WY PA NJ Toledo IA RI Fort Wayne OH MD DE NE NV PHS Denver IN WV MO IL UT VA CO CA Fort Thomas KY KS Winston-Salem San Bernadino TN Tulsa NC SC Los Angeles Area Albuquerque Little Rock Riverdale OK Birmingham AZ NM AR San Diego GA Maui AL MS TX El Paso LA HI FL Pensacola USVI Port Charlotte Miami PR 27 Level 1 teams, 72 teams in NDMS system

9. OMAT – Ohio Medical Assistance Teams Toledo: 419-383-5163 mediccom.org Churton.budd@mediccom.org jwfenn@buckeye-express.com Dayton: (937) 228-1000 www.daytondmat.com pbernitt@gdahin.org Youngstown: spartan@cisnet.com (Robert Demarco, MD)

10. Since 1989 Level I Team 120 members Deployments include Hurricane Andrew ‘92 Hurricane Marilyn ‘95 Atlanta Olympics ’96 North Dakota Floods ‘97 Kosovo Refugee’s ’98 NATO Summit ’99 Hurricane Floyd ’99 Presidential Inaug ‘01 Toledo DMAT

11. Typical DMAT Structure Approved 3/17/99

12. Toledo Area DMAT Composition • Non-Medical Personnel: • Admin / Clerical 3 • Communications 3 • Logistics 2 • Maintenance / Supply 1 • Medical Personnel: • Senior Medical Officer 1 • Staff Medical Officer 13 • PA / NP 3 • Supervisory RN 6 • RN / LPN 24 • Respiratory Therapist 2 • EMT Basic / Intermediate 13 • EMT Adv / Paramedic 5 • Veterinarian 1

13. The Disaster Cascade Local First Responders County Executive Disaster Occurs Alert Governor Requests Aid From FEMA Regional Director Informs Field Operations THE FEDERAL RESPONSE PLAN Declares Disaster Advises FEMA Director Requests Assistance Contacts 12 Emergency Support Functions (ESFs) President Declares Disaster Provides Sets Up Emergency Response Team Federal Coordinating Officer Disaster Field Office Appoints Joins State Coordinating Officer

14. Federal Response PlanEmergency Support Functions DOE USDA DOT Energy Food EPA NCS Transportation Hazardous Materials 12 11 1 Communication 10 2 Urban Search and Rescue ESF 9 Public Works (USACE) 3 FEMA DOD 8 4 7 Health and Medical 5 6 Firefighting HHS USDA & FS Resource Support Information & Planning Mass Care USDA AID DOJ ARC DVA EPA DOD FEMA DOT GSA USPS NCS GSA FEMA ARC

15. DMAT DMORT VMAT NMRT MMST Purpose Medical Response Patient Evacuation Definitive Medical Care Health and Medical (ESF 8)

16. Activation of the DMAT • Pre-Alert: Team leadership watching a developing disaster • Alert: NDMS indicateds they are mobilizing assets and the team may be utilized • Activation: The team has been activated for imminent deployment • Deployment: The team is actively working the disaster • Demobilization: The team is returning home, re-organizing equipment and re-supplying used items

17. The NDMS Push Package • May be pre-deployed to a disaster • Consists of a Management Support Unit (MSU) and three DMATs • Sets up at the Disaster Field Office or other location in or near the disaster site • DMAT assets are deployed within the disaster • May operate from a field site or mesh / supplement existing infrastructure

18. Past TADMAT Deployments

19. Hurricane Andrew South Florida (Dade County) Fall 1992

20. The track of Hurricane Andrew 1992

21. TADMAT - 65 members at Toledo Express Airport Deploying to Hurricane Andrew 1992

22. Equipment being loaded onto the C-141

23. Cutler Ridge Justice Center

24. The Cutler Ridge Justice Center treatment area

25. Community Health Clinic - Now a Field Hospital

26. Receiving briefing from NM-1 DMAT

27. Supplies being delivered to the CHI site

29. Office building - Now a Field Hospital

30. Patient treatment

32. Field Hospital set up at Cutler Ridge Elementary School

33. A group loads up to go on an outreach mission

34. Communications Officer at work

35. Marilyn 1995 St. Thomas, US Virgin Islands

36. 9 hour flight from Toledo to USVI on a C-130

37. Significant impact on the local infrastructure

38. Damage to many “transient” homes

39. And almost 80% of the permanent ones

40. Where most of the island health care is delivered

41. Labor intensive setup

43. DMAT Field Hospital on the back lawn of the hospital

44. Typical living conditions

45. Assistance from many Government branches / agencies

46. Patient care and field hospital operations

48. NATO DEPLOYMENT