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APPENDIX F

Excerpts from the National Disaster Medical System Home Page *

*Source: National Disaster Medical System home page, http://mediccom.org/public/tadmat/ndms/ndms.html , accessed November 6, 1997.



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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities APPENDIX F Excerpts from the National Disaster Medical System Home Page * *Source: National Disaster Medical System home page, http://mediccom.org/public/tadmat/ndms/ndms.html , accessed November 6, 1997.

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities NDMS Purpose NDMS Lead Federal Organizations What is a Disaster Medical Assistance Team? Partial list of endorsements for NDMS NDMS Statistics Official Fact Sheets from NDMS The NDMS Web page is at: http://www.oep ndms.dhhs.gov Frequently Asked Questions about NDMS What is a DMAT What is a DMORT What is a VMAT How does an agency sponsor a DMAT DMAT / NDMS / other related links Click here to go to the Disaster Resources list on MedicCom.Org which has the updated list NDMS Partners: DefenseLink: Department of Defense Veterans Administration Federal Emergency Management Agency US Public Health Service: Dept of Health and Human Services

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities The purpose of the National Disaster Medical System A nationwide medical response system that supplements state and local emergency resources during disasters or major emergencies. NDMS also provides backup medical support to the military / VA medical care systems during an overseas conventional conflict. Circumstances for which NDMS may be activated include 1) a military contingency or overseas conventional armed conflict involving US forces, 2) a presidential declaration of a disaster, 3) a request for major medical assistance. Major Components of NDMS include Medical Response The lead responsiblity of Health and Human Services (HHS), medical response includes an assessment of health & medical needs, provides medical care personnel including health / medical equipment and supplies by deployment of Disaster Medical Assistance Teams (DMAT). Other services include victim identification / mortuary services utilizing Disaster Mortuary teams (DMORT) Patient Evacuation The lead responsiblity of the Department of Defense (DOD) which utilizes all types of transportation and primarily relies on aeromedical evacuation to accomplish this task. Other functions during the medical evacuation include patient reporting, regulating and movement from staging areas or casualty clearing points utilizing assets of the US Air Force and Civil Reserve Air Fleed (CRAF). Definative Medical Care By concentrating on major metropolitan areas which have available air access, an NDMS Federal Coordinating Center (FCC), hospital support and patient reception and distribution capabilities, patients are provided definative medical care. Developed from the Civilian Military Contingency Hospital System (CMCHS), NDMS exists as a key role in coordinating a nationwide medical mutual aid network utilizing both public and private sector assets.

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities NDMS Lead Organizations U.S. Public Health Service Department of Veterans Affairs Federal Emergency Management Agency Department of Defense

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities The NDMS Disaster Medical Assistance Teams DMATs are the responsilibty of the Federal Government as prearranged sources of support. A DMAT consists of a volunteer group affiliated with NDMS. Although a DMAT consists of approximately 35 individuals in each deployable unit, each particular team may consist of more than three times that number to provide some redundancy for each job role on the DMAT in the event a key person is unavailable at the time of deployment. Each DMAT is composed of members with a variety of health or medical skills. Included among the ranks of a team are many support personnel such as communications, logistics, maintenance and security. Many teams also maintain a Critical Incident Stress Management sub-unit. Teams within 500 miles of a disaster usually travel by ground, whereas those greater than 500 miles from the site travel by air (usually military aircraft. DMATs are categorized according to their ability to respond. A Level-1 DMAT can be ready to deploy within 8 hours of notification and then remain self-sufficient for 72 hours with enough food, water, shelter and medical supplies to treat about 250 patients per day. Level-2 DMATs lack enough equipment to make them self-sufficient but are able to deploy and replace a Level-1 team utilizing and supplementing their equipment which is left on site. Level-3 DMATs consist of teams in various stages of development. DMATs are usually Locally sponsored and community based. Many are local or state assets prior to being a Federal asset. They maintain a Memorandum of Understanding (MOU) with the U.S. Public Health Service so they can be called upon for federal service when necessary. Team members are enrolled in a federal system and thus can be “Federalized” upon activation of the team. This is accomplished through the Special Needs Authority and the Accepted Volunteer Service Authority. This federalization is important because it provides the team members with Licensure and certification anywhere in the federal domain, as well solves liability and workers compensation issues. Some of the DMAT Functions include triage of victims at the disaster site. Providing sophisticated medical care in austere conditions and maintaining casualty clearing or staging locations just outside the site of the disaster. DMATs can also provide care at a reception area when the patient evacuation part of NDMS is activated. They can recieve victims of the disaster in areas across the country that were unaffected and thus can handle the large quantity of injured. In order to be ready to respond to a disaster, DMATs undergo specialized training both at the team level and during local and national level exercises. Along with this training and exercise, DMAT members provide medical care at special events and attend annual training conferences. Each team develops and maintains plans for deployment to various disasters. Supplies and equipment are provided through DOD excess property sources, federal budget requests, local donations and funding and other sources. When deployed, the DMAT functions under a Management Support Unit (MSU). This unit responds rapidly to the disaster area. It provides management support to deployed DMATs. By utilizing the Incident Command System areas of logistics, communications, operations, finance / procurement and planning are orchestrated by the MSU. The MSU interfaces, rather than takes over from the local disaster management system or Emergency Medical Services. DMAT Special Teams include pediatirc, burn, Disaster Morturary Service Teams (DMORTs), Urban Search and Rescue (USAR) and Mental Health Teams.

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities NDMS Statistics NDMS Coordinating Centers 72 Geographic Areas 107 Participating Hospitals 1,818 Precommitted beds 110,605 Individuals federally enrolled in DMATs 5,000

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities WHAT IS A DISASTER MORTUARY TEAM (DMORT)? The Federal Response Plan tasks the National Disaster Medical System (NDMS) under Emergency Support Function #8 (ESF #8) to provide victim identification and mortuary services. These responsibilities include: temporary morgue facilities victim identification using latent fingerprint, forensic dental, pathology, and forensic anthropology methods processing preparation and disposition of remains In order to accomplish this mission, NDMS entered into a Memorandum of Agreement with the National Foundation for Mortuary Care (NFMC), a nonprofit organization, to develop Disaster Mortuary Teams (DMORTs). DMORTs are composed of private citizens, each with a particular field of expertise, who are activated in the event of a disaster. DMORT members are required to maintain appropriate certifications and licensure within their discipline. When members are activated, licensure and certification is recognized by all States, and the team members are compensated for their duty time by the Federal government as a temporary Federal employee. During an emergency response, DMORTs work under the guidance of local authorities by providing technical assistance and personnel to recover, identify, and process deceased victims. The DMORTs are directed by the National Disaster Medical System in conjunction with a Regional Coordinator in each of the ten Federal regions. Teams are composed of Funeral Directors, Medical Examiners, Coroners, Pathologists, Forensic Anthropologists, Medical Records Technicians and Transcribers, Finger Print Specialists, Forensic Odontologists, Dental Assistants, X-ray Technicians, Mental Health Specialists, Computer Professionals, Administrative support staff, and Security and Investigative personnel. The NFMC, in support of the NDMS DMORT program, maintains a Mobile Mortuary Container at Sky Harbor Airport, Phoenix, Arizona. The Mobile Mortuary Container is a depository of equipment and supplies for deployment to a disaster site. It contains a complete morgue with designated work stations for each processing element and prepackaged equipment and supplies. To join a DMORT or for more information, contact the Coordinator in your region. Regional Coordinators REGION I (ME, NH, VT, MA, CT, RI) REGION VI (NM, TX, OK, AR, LA) Paul Morrow 802-863-7320 Jack King 409-295-6363 REGION II (NY, NJ, PR, VI) REGION VII (NE, IA, KS, MO) John C. Oldfield 212-362-6160 Dean Snow 816-776-2255 REGION III (PA, MD, DC, DE, VA, WV) REGION VIII (MT, ND, SD, WY, UT, CO) Howard K. McComas 410-676-4600 Don Heer 970-842-2821

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities REGION IV (AL, KY, TN, NC, SC, GA, MS, FL) REGION IX (AZ, NV, CA, HI) Dale Downey 864-472-6836 Robert Hennis 602-464-8728 REGION V (MN, WI, IL, IN, MI, OH) REGION X (WA, AK, OR, ID) Jeff Hurd 309-289-4121 Charles Parks 503-397-1154 Revised: September 26, 1997

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Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents: Interim Report on Current Capabilities WHAT IS A VETERINARY MEDICAL ASSISTANCE TEAM (VMAT)? The Federal Response Plan tasks the National Disaster Medical System (NDMS) under Emergency Support Function #8 (ESF #8) to provide assistance in assessing the extent of disruption and need for veterinary services following major disasters or emergencies. These responsibilities include: assessment of clinical needs of animals animal care and handling animal sheltering and evacuation animal inspection and disease surveillance technical assistance hazard mitigation In order to accomplish this mission, NDMS entered into a Memorandum of Agreement with the American Veterinary Medical Association (AVMA), a nonprofit organization, to develop Veterinary Medical Assistance Teams (VMATs). VMATs are composed of private citizens who are activated in the event of a disaster. VMAT members are required to maintain appropriate certifications and licensure within their discipline. When members are activated, licensure and certification is recognized by all States and the team members are compensated for their duty time by the Federal government as temporary Federal employees. During an emergency response, VMATs work under the guidance of local authorities by providing technical assistance and veterinary services. The VMATs are directed by the National Disaster Medical System in conjunction with the Coordinator of Emergency Preparedness for the AVMA and Regional Veterinary Activities Commanders (ReVACS). Teams are composed of Clinical Veterinarians, Veterinary Pathologists, Animal Health Technicians (Veterinary Technicians), Microbiologist/Virologists, Epidemiologists, Toxicologists and various scientific and support personnel. To join a VMAT or for more information, contact the AVMA at 847-925-8070 extension 291. Revised: November 5, 1997

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