Medical Surge Resources - NHRMC

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Medical Surge ResourcesMedical Surge Resources

A Manual of Disaster Medical ResourcesA Manual of Disaster Medical Resources

SMAT IISMAT II

Funded by Health Resources and Services Administration Funded by Health Resources and Services Administration Hospital Bioterrorism preparedness grant 2003Hospital Bioterrorism preparedness grant 2003--0303

This resource manual was created for training of State Medical Assistance Teams Type II (SMATII). The information enclosed is based upon existing knowledge of teams either operational or under development. Outlines and objectives are listed after the prologue for instructor reference and measurement. A pre test and post test a re also included for instructors and future students.

Bloom’s taxonomy has been utilized to enhance Adult Learning. The six areas within the cognitive domain will be included for the instructor after the objectives. Please be aware of these six levels of cognition to enhance efforts to share this information with potential team members.

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What is the plan?What is the plan?

To provide healthcare to North Carolinians To provide healthcare to North Carolinians across the state in times of disaster. across the state in times of disaster. Be they man made or natural.Be they man made or natural.

Hospitals play a major role in the healthcare delivery system. Disasters can impact the delivery of care in affected and unaffected areas by creating large gaps in normal methods of delivery.

North Carolina has been proactive in it’s pursuit of finding these gaps and bridging them with carefully planned resources. The five year strategic plan lists the State Medial Assistance Teams as vital to North Carolina’s ability to care for disaster victims from Murphy to Manteo. Providing care across the State follows the Surgeon General’s Healthy People 2010 goals to provide access to healthcare.

Ref: http://www.healthypeople.gov/

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History of Disaster Medical History of Disaster Medical Response in N.C.Response in N.C.

A Review of federal Bioterrorism Preparedness Programs from a Public Health Perspective. Subcommittee on Oversight and InvestigationsOctober 10, 200110:00 AM2322 Rayburn House Office Building

Dr. Lew Stringer North Carolina Division of Emergency Management

Mr. Chairman and Members of the Committee, thank you for inviting me here today to discuss the issue of Weapons of Mass Destruction Preparedness. I am Dr. Lew Stringer, Medical Director of the North Carolina Division of Emergency Management. I have a long history of emergency management experience that ranges from services as a local EMS Medical Director for 27 years, Director of the Special Operations Response Team a disaster organization in North Carolina and involvement with the National Disaster Medical System through the Office of Emergency Preparedness, USPHS since 1990.

Ref: http://energycommerce.house.gov/107/hearings/10102001Hearing390/Stringer625.htmef:

This congressional testimony of Dr. Lew Stringer post 9/11 was the first seed of the State Medical Response Plan. It is important to understand where the state has been to understand where we are going. The testimony touches on key issues and critical needs within the state of North Carolina as well as Nationally.

Allowing students and future SMAT members to read this testimony will enhance understanding and allow for a more in depth synthesis of the Medical Surge Resources we now have available. It is with great hope that these team members comprehend the impact of this team on disaster medical services in North Carolina and develop a great appreciation for being the first of their kind in the N.C.

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HistoryHistory

• In 1995, because of concerns regarding Weapons of Mass Destruction (WMD) in the US, I was one on sixteen people asked by the Office of Emergency Preparedness, USPHS, to advise and develop strategies to deal with the consequence management of a WMD event. PDD 39 and the Nunn-Lugar-Demenici initiative were enacted during this time.

• Our group concluded that from the consequence management side, a WMD event was primarily a local issue. Local agencies needed to be trained, organized in a uniform manner and equipped to deal with the initial response in order to save lives.

• Mutual aid agreements needed to be in place with surrounding communities and state agencies should be immediately involved. The state agencies should respond to assist the” locals” in dealing with this complex and unusual emergency event that would rapidly overwhelm most local communities.

• Our group concluded that law enforcement, fire, HAZMAT, EMS, hospitals, Public Health, and local emergency management had to be brought together to assess additional training, organizational and equipment needs. These agencies needed to develop a plan. And, they needed assistance from the federal government.

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Our committee named this new local entity the Metropolitan Medical Response Team , MMRT. In 1997, the first MMRT was formed in Washington, D.C. From that team concept, came the resource material to be used by OEP/USPHS for the other cities in the system.

120 of the largest cities in the US were selected to receive the Nunn-Lugar-Demenicitraining grants administer by DoD and then to receive the grants administered by the OEP/USPHS to organize and equip these MMST’s.

They are now known as Metropolitan Medical Response Systems, MMRS. It was our recommendation that several regional specialized medical respons e teams be formed and equipped by the National Disaster Medical System, OEP/USPHS to respond rapidly to assist communities affected by the WMD event.

These teams were founded as Nation Medical Response Team , NMRT/WMD. I developed the first SOP for the NMRT’s early in 1996. There are four teams. I am the commander of the NMRT/WMD East, in Winston-Salem, N. C.

HistoryHistory

The MMRS history can be found within the testimony. This will beimportant as it reflects the need for further regionalization. Thus, the SMAT II and III fill this gap in other areas not covered by teams that can decontaminate and treat patients.

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In 1999, OJP initiated a nationwide assessment of vulnerability, threat, risk, capabilities, and needs. Each state with their local jurisdictions was to complete this assessment and develop a long-range plan that was to include federal funding for the purchase of needed equipment. I have been told, that by September 2001, only four (4) states (give names) have turned in their completed assessment making them eligible for the 2000-2001 monies. Funding is not released until the completed assessment along with a three-year strategic plan is returned to OJP.

It has taken my state of North Carolina 1 ½ years to complete the assessment and the 3-year plan. I have found the assessment to be complex and difficult to complete. NC does not have the resources to collect the data in a timely fashion. Local jurisdictions needed help in amassing the information. There is much diversity within the state, large cities and small rural counties made completing complicated.

The plan for North Carolina includes:

Equipping our 6 regional HAZMAT response teams, our highway patrol, and our state disaster team.

Assisting financially our largest cities or highest risk cities (metropolitan area affecting 20 counties). Of our 100 counties, 80 counties will receive no financial assistance. Charlotte, NC, the second largest banking center in the US, will not receive funding through our plan, because they received separate financing from Congress.http://energycommerce.house.gov/107/hearings/10102001Hearing390/Stringer625.htm

HistoryHistory

Equipping our 6 regional HAZMAT response teams, our highway patrol, and our state disaster team.

This mission has been fulfilled with the Regional Response Teams. All teams are in place and trained. They are discussed in greater detail in this module.

Assisting financially our largest cities or highest risk cities (metropolitan area affecting 20 counties). Of our 100 counties, 80 counties will receive no financial assistance. Charlotte, NC, the second largest banking center in the US, will not receive funding through our plan, because they received separate financing from Congress.

This mission was to implement the MMRS teams which has been done as well. These teams are discussed in great detail in this module. The 80 counties which needed funding and also specialized training were the beginnings of the SMAT Type III units. They are now being simultaneously trained to meet medical decontamination needs on a local basis.

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In an explosive, chemical or nuclear event, victims are concentrated in that area. First responders will rescue, decontaminate, treat, and transport victims to health care facilities. With a biological event, victims will not likely be concentrated in any one area. Victims will receive most of their treatment at health care facilities. In this biological scenario, health care workers will be the first responders.

Until the horrendous events at the World Trade Center and the Pentagon and in the past history of disasters, victims have self-triaged to health care facilities bypassing the EMS system. In our present structure, ONLY law enforcement, fire, HAZMAT and EMS are considered First Responders by the federal government and eligible for funding in WMD Preparedness.

This shortfall was pointed out to Congress in the 2000 Gilmore Report. The Noble Training Center, OEP/USPHS at Fort McCullen in Alabama is the only federally funded WMD training support for health care workers that I know in existence today.

CDC has an excellent program, well received by the states, to assist states and local communities with a WMD event.

Ref: http://energycommerce.house.gov/107/hearings/10102001Hearing390/ Stringer625.htm

HistoryHistory

Reference to the biological attacks became evident after this testimony when only seven short days later a letter containing Anthrax spores was sent to the Hart Senate Office to Senator Daschle. The incident led to an outbreak of panic in Washington, D.C. Hospitals were crowded with the worried well and daily operations were impossible because of the surge of patients.

It has been found in numerous incidents people bypass EMS and show up at the hospitals ED contaminated and contagious. The systems put in place in the state are focused at keeping the hospital area clean and functional. This mission will require equipment and pre hospital and hospital wide training.

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The health care community has been a difficult player to bring to the WMD planning table. Sadly, the health care systems operate in a “crisis mode” of staffing and financial problems on a daily basis. Several health care facility managers in my state of North Carolina have told me, “I have no time or finances for a hope not activity”. This attitude must change. (We) in emergency management must help the health care system with planning, training and equipment to enable these dedicated individuals, be prepared to safely receive and effectively treat WMD victims.

I look at the support provided by the OEP’s National Disaster Medical System for the four National Medical Response Teams for WMD. The 4 teams, staffed by volunteers who have to train without pay, receive limited funds for additional equip purchases and maintenance. This funding is not enough to maintain the NMRT’sproper readiness state to respond to assist state or local communities. It would be proper, in my opinion, to increase the funding for the NMRT program.

I believe that the health care system must be funded and supported to become an active player in order to resolve the consequences of a WMD event. I am concerned that many cities will not be able to effectively manage the consequences of a WMD event for the next 4-5 years. I have pointed out to you that in my state of North Carolina, like many other states, little or no training or equipment is in place to respond to a WMD event if it occurred today. Ref:http://energycommerce.house.gov/107/hearings/10102001Hearing390/Stringer625.htm

HistoryHistory

The Health Resources and Services Administration (HRSA) is a sister agency to National Institute of Health, Indian Health Services, and the before the conversion to the answering to the Department of Homeland Security, Center for Disease Control. All fall under the U.S. Department of Health and Human Services.

The HRSA Hospital Bioterrorism Preparedness Grant came to fruition for North Carolina in March of 2001. The 01/02 grant money was given to Public Health for Hospital and Pre Hospital preparedness. The management of this funding was given to the North Carolina Office of Emergency Services (NCOEMS).

NCOEMS is the state agency in charge of Emergency Service Function (ESF) #8, which will be discussed in this module. In the past and present NCOEMS has been the coordinating agency for Health and Medical acting as a critical tool in the Emergency Management disaster tool box.

Disasters are not new in North Carolina. Hurricanes have long since been a causative factor for disaster preparedness. Many real life disasters have increased awareness of the need for preparation and heave further strengthened the system. Bringing healthcare into the preparedness mode.

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Manual ObjectivesManual Objectives•• List two local resources List two local resources

allocated for medical allocated for medical response.response.

•• Identify deployment times Identify deployment times and methods of local and methods of local medical response teams.medical response teams.

•• List three State and regional List three State and regional medical response medical response resources.resources.

•• Identify deployment Identify deployment methods for State and methods for State and Regional teams.Regional teams.

•• Compare and contrast the Compare and contrast the functions of State and functions of State and Regional teamsRegional teams

•• List the four Federal response List the four Federal response resources.resources.

•• Identify deployment methods Identify deployment methods and time frames.and time frames.

•• Describe the team composition Describe the team composition of one local, State, and Federal of one local, State, and Federal response team.response team.

•• Describe the Strategic National Describe the Strategic National Stockpiles’ purpose and Stockpiles’ purpose and deployment.deployment.

•• Identify one delivery method of Identify one delivery method of Medical Surge Resources Medical Surge Resources based on the six Bloom’s based on the six Bloom’s TaxonomyTaxonomy. .

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Bloom’s TaxonomyBloom’s Taxonomy

EvaluationEvaluationSynthesisSynthesisAnalysisAnalysis

ApplicationApplicationUnderstandingUnderstanding

KnowledgeKnowledge

6 levels of the Cognitive Domain6 levels of the Cognitive Domain

Evaluation: appraise, argue, assess, attach, choose compare, defend estimate, judge, predict, rate, core, select, support, value, evaluate.

Synthesis: arrange, assemble, collect, compose, construct, create, design, develop, formulate, manage, organize, plan, prepare, propose, set up, write.

Analysis: analyze, appraise, calculate, categorize, compare, contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, question, test.

Application: apply, choose, demonstrate, dramatize, employ, illustrate, interpret, operate, practice, schedule, sketch, solve, use, write.

Understanding: classify, describe, discuss, explain, express, identify, indicate, locate, recognize, report, restate, review, select, translate

Knowledge: arrange, define, duplicate, label, list, memorize, name, order, recognize, relate, recall, repeat, reproduce state.

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Local Local ResourcesResources

MMRS MMRS CARTCART

SMAT IIISMAT III

•Local Resources are defined by the geographic and deployment times.

•Local teams are often county or municipality driven.

•Deployment times for local teams should be 1 hour or less.

•These resources are usually comprised of local professionals.

•The resources can still be funded by the State or Federal Government based upon the source of the request and the declaration involved.

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Metropolitan Medical Metropolitan Medical Response SystemResponse System

§ Public information§ Coordination protocols§ Customized pharmaceuticals§ Plans for the prophylaxis of

an affected population:- 1,000 chemical victimsup to one hundred

biological victimsbetween 100 and 10,000

biological victimsmore than 10,000 biological

victims

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The Metropolitan Medical Response System The Metropolitan Medical Response System (MMRS) Program began in 1996 and currently (MMRS) Program began in 1996 and currently is funded by the United States Department of is funded by the United States Department of Homeland Security (DHSHomeland Security (DHS).).

Team MissionTeam Mission

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OriginalOriginalAnchorage, Baltimore, Boston, Chicago, Columbus, Dallas, Denver, Detroit, Honolulu, Houston, Indianapolis, Jacksonville, Kansas City, Los Angeles, Memphis, Miami, Milwaukee, New York, Philadelphia, Phoenix, San Antonio, San Diego, San Francisco, San Jose, Seattle, Washington DC (MMST) [Note: Atlanta was also a MMST]

Metropolitan Medical Response SystemsMetropolitan Medical Response Systems

19991999Albuquerque, Austin, Charlotte, Cleveland, El Paso, Fort Worth, Hampton Roads (Virginia Beach) Area, Long Beach, Nashville, New Orleans, Oakland, Oklahoma City, Pittsburgh, Portland (OR), Sacramento, Salt Lake City, St. Louis, Tucson, Tulsa, Twin Cities (Minneapolis)

2000 2000 Akron, Anaheim, Arlington, Aurora, Birmingham, Buffalo, Cincinnati, Corpus Christi, Fresno, Hampton Roads (Norfolk) Area, Jersey City, Las Vegas, Lexington-Fayette, Louisville, Mesa, Newark, Omaha, Riverside, Rochester, Santa Ana, St. Petersburg, Tampa, Toledo, Twin Cities (St. Paul), Wichita

20012001Baton Rouge, Colorado Springs, Columbus (GA), Dayton, Des Moines, Garland, Glendale (CA), Grand Rapids, Greensboro, Hialeah, Huntington Beach, Jackson, Lincoln, Little Rock, Lubbock, Madison, Mobile, Montgomery, Raleigh, Richmond (VA), Shreveport, Spokane, Stockton, Tacoma, Yonkers

20022002Amarillo, Arlington, Bakersfield, Chattanooga, Columbia, Fremont, Ft. Lauderdale, Ft. Wayne, Glendale, Hampton Roads (Newport News, Chesapeake) Area, Hartford, Huntsville, Irving, Jefferson Parish, Kansas City, Knoxville, Modesto, Orlando, Providence, San Bernardino, Springfield, Syracuse, Warren, Worcester

20032003Atlanta Regional Coalition, Northern New England Region (New Hampshire, Maine, Vermont), Southern Rio Grande Region (TX), Southeast Alaska Region

As of October 2003

DHHS through its Office of Emergency Response (OER – formally OEP) started development of local Metropolitan Medical Response System (MMRS) in 1995. Contractual relationships were started between existing emergency response systems. Emergency Management, Medical and Mental Health providers, Public Health Departments, Law Enforcement, Fire Departments, EMS, and National Guard were all asked to come to the planning table and map out an emergency response plan for the large metro areas. The goal is to provide a unified response to mass casualty events.

As of September 30, 2001, 97 municipalities had been contracted to develop MMRS. During 2002 25 more cities were added with an additional $20 million dollars. This brought the total cities to 122 at the beginning of 2003.

Bartlett, John, Bioterrorism and Public Health: An Internet Resource Guide: First Edition, 2001.

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KEY PROGRAM COMPONENTSKEY PROGRAM COMPONENTS(cont.)(cont.)

§§ Public informationPublic information§§ Coordination protocolsCoordination protocols§§ Customized pharmaceuticalsCustomized pharmaceuticals§§ Plans for the prophylaxis of an affected Plans for the prophylaxis of an affected

populationpopulation-- 1,000 chemical victims1,000 chemical victims-- up to one hundred biological victimsup to one hundred biological victims-- between 100 and 10,000 biological victimsbetween 100 and 10,000 biological victims-- more than 10,000 biological victimsmore than 10,000 biological victims

The basic goals and deliverables of the MMRS projects are listedabove. Currently, Mecklenburg, Wake, and Guilford county all have MMRS. Stockpiles of medications have been obtained along with specialized training of these diverse teams.

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LINKING RESPONSE LINKING RESPONSE SYSTEMSSYSTEMS

Public HealthPublic Health

First First Responders Responders

Fire/EMSFire/EMS

Medical & Medical & Mental Health Mental Health

ServicesServices

LawLaw EnforcementEnforcement

EmergencyEmergency ManagementManagement

http://69.25.4.196/PublicDocs/9http://69.25.4.196/PublicDocs/9

Joined together for planning, training, and exercise. This leads to a unified response to an event man made or natural. If you do not know the players before and event you will not respond as a team during the event.

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• Deployed per SERT activation

• Can be State or locally deployed as a dual resource

Team ActivationTeam Activation

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Team CompositionTeam Composition

FireFireLaw EnforcementLaw Enforcement

EMSEMSPublic HealthPublic Health

Medical and Mental Health ProvidersMedical and Mental Health ProvidersOthersOthers

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State Animal Response State Animal Response TeamTeam

•Providing prevention, response and recovery for animal emergencies.

•The team’s mission is to develop and implement procedures and train participants to facilitate a safe, environmentally sound and efficient response to animal emergencies on the local, county, state and federal level.


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State Animal Response State Animal Response TeamTeam

The team is organized and operates under the auspices of the State Emergency Response Team (SERT) utilizing the principles of the Incident Command System.

The North Carolina State Animal Response Team is an interagency,coordinated effort dedicated to preparing, planning, responding and recovering during animal emergencies in North Carolina. The team’s mission is to develop and implement procedures and train participants to facilitate a safe, environmentally sound and efficient response to animal emergencies on the local, county, state and federal level. The team is organized and operates under the auspices of the State Emergency Response Team (SERT) utilizing the principles of the Incident Command System.

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State Animal Response TeamState Animal Response Team

The North Carolina State Animal Response Team is an interagency, coordinated effort dedicated to preparing, planning, responding and recovering during animal emergencies in North Carolina.

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•This map reflects the counties that currently have teams or are developing teams.

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County Animal Response TeamCounty Animal Response Team


County Animal Response County Animal Response Teams are intended for use by Teams are intended for use by local government to minimize local government to minimize animal suffering in the event animal suffering in the event of a large scale emergency. of a large scale emergency. This action will be aimed at all This action will be aimed at all animals that may need help, animals that may need help, whether such animals are whether such animals are owned, stray, domestic or owned, stray, domestic or wild. Under these wild. Under these circumstances, CART will circumstances, CART will provide immediate action to provide immediate action to provide care for animals provide care for animals affected. affected.

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County Animal Response County Animal Response TeamTeam

CARTs are under the jurisdiction of the county Emergency Management

Coordinator.

•The CARTS have been used in many natural disasters such as hurricanes in the East and mud slides in the West.

•In Isabel, teams were available to assist healthcare professionals who were on the job and could not get home to animals in flood areas.

•During Isabel pets were picked up from Emergency Departments andcared for. Many elderly will not leave without their pets and cannot be treated until their worries are decreased concerning their pets.

•The scope of the CART’s goes beyond household pets.

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County Animal Response County Animal Response TeamTeam

õAnimal Control OfficersõAnimal Industry LeadersõCooperative Extension

õForestry OfficersõVeterinarians

õSheriff’s PersonnelõConcerned Citizens


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State Medical Assistance State Medical Assistance Team Type IIITeam Type III

• Teams will provide a rapid victim decontamination and

mass casualty medical management service at the

local, regional, or state level.

• Teams can be deployed locally within 30 minutes, and

statewide within 2 hours of deployment request.

Team Activation Team Activation

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• Minimal 5 EMT, 1 EMT-I, and1 EMT-POR

6EMTs and 1 EMT-P

• May be other healthcare providers


The composition of the SMAT III units is developed under three assumptions:

1. The team will have a minimal of one Paramedic for intubations and specific medication delivery.

2. The team should be minimally staffed with 7, but three people should be trained for three shifts. Thus making the team three deep for each position. This totals the team to twenty-one people at a minimum. Teams can be comprised of healthcare providers from different counties functioning as one team

3. Other healthcare providers can be added to the team, but keep in mind the teams mission and operations.

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• Provide a first line of defense locally, assist at hospitals, or be deployed within region or state at the request of NC Division of Emergency Management (NCEM) through the statewide mutual aid agreement.

• Provide local decontamination/medical treatment teams (Type III) that could rapidly assist/start decontamination operations on victims from a chemical exposure or other potential incidents that require decontamination.


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State ResourcesState Resources

SORTSORTSMAT I, II, and IIISMAT I, II, and III

PHRSTPHRSTRRTRRT

SARTSART

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State Medical Assistance State Medical Assistance Team Type ITeam Type I

• Team can be deployed in 4 to 6 hours statewide.

• Mission length 7 days

• Self Sustained Team


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• Medical care in Disaster and Special Events

• Manage 150 bed Alternate Care Facilities

• Assist at the National Pharmaceutical Stockpile receiving site

• Establish the Drug Distribution and Mass Immunization site

• Establish Field Medical Stations 250 patients 24 hr operation self sustained

MissionMission

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• Teams 12-54 Members

• Physicians, Nurses, Nurse Practitioners, PA, Paramedics, Veterinarians, Firefighters, Law Enforcement

• Other Medical Specialist


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AlamanceAlexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

BuncombeBurke

Cabarrus

Caldwell

Camden

Carteret

Caswell

Catawba

Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Currituck

DareDavidson

Davie

Duplin

Durham

Edgecombe

Forsyth Franklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

McDowell

Macon

MadisonMartin

Mecklenburg

Mitchell

Montgomery

Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Vance

Warren

Washington

Wayne

Wilkes

Wilson

Yadkin

YanceyWake

Regional Advisory Committees (RACs)January 2002

Mountain Area Trauma RAC (Mission)

Metrolina Trauma Adv. Com. (Carolinas Med. Ctr.)

Triad RAC (WFU Baptist/Moses Cone)

Southeastern Trauma RAC (New Hanover)

Eastern RAC (Pitt)

Duke RAC (Duke)

MidCarolina Trauma RAC (UNC/WakeMed)

Administrative RAC’s

Indicates selection of a secondary RAC. The star color matches the RAC as noted in the legend above.Indicates a Level I or II Trauma Center

Watauga

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State Medical Assistance State Medical Assistance Team IITeam II

When activated by State Emergency Operation Center (EOC), the Type II Team should be deployable within 6 hours in region and state-wide within 12-24 hours

Team Activation Team Activation

SMAT II units can be activated by the State Emergency Response Team (SERT) as a state or regional asset. It can also be utilized within the region for smaller incidents or medical needs.

The SMAT II units are being integrated into the State Response Plan. Their role within the state and region are being defined even now. SMAT II units should be deployable within 6 hour to anywhere in their RAC region and statewide between 12-24 hours.

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•Physicians

•Nurses

•Paramedics

•Nurse Practitioners

•Pharmacists

•Physician Assistants


Hospitals >150 beds; minimum 1 MD, 2 RN’s, 1 Pharmacist

Hospitals <150 beds; minimum 1 RN

County health department; minimum 1 RN

County EMS; 1 Advance Life Support (ALS) ambulance and 2 Paramedics / EMT-Intermediates

County EMS/EM; 1-2 Type III teams (when indicated by mission) counties providing the Type III Teams will not be required to provide ALS unit.

State Office of Emergency Medical Services (OEMS) regional specialist-1

State EM regional coordinator -1

State regional Veterinarian -1

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State Medical Assistance Team IIState Medical Assistance Team IIAdditional Team MembersAdditional Team Members

•Pediatricians

•Obstetricians

•Psychologists

•Psychiatrists

•Geriatric Nurse Practitioners

•Hispanic Healthcare Professionals

•Filipino Healthcare Professionals

The multiple functions of the SMAT II units make the team composition needs more diverse in nature. Teams can and will vary from region to region. Units could even be staffed by Medical Social Workers, Housekeeping, Maintenance, Medical Records staff, Administration, Home Health Care Aides, Physical Therapists, Pharmacy Technicians, Supply Room Technicians, Respiratory Therapists, and Dieticians. The SMATunits can be any variation of these or even all of these.

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•Assist in hospitals

•Establish alternate care facility (40 beds)

• Establish mass immunization/drug distribution center

•Duration 3 days


SMAT II trailers will be titled to the lead RAC hospitals. These seven hospitals are Level I and II trauma centers across North Carolina. The location of each trailer will be decided upon by the RAC based on high risk areas and deployment needs. Trailers may not reside within the county of the lead RAC hospital. Example: UNC may place their trailer in Hoke County versus Orange County. The lead hospitals receiving trailers and developing teams are:•Mission Memorial St Josephs•Carolinas Medical Center•Wake Forest University Baptist Memorial Hospital•Duke University Medical Center•UNC Hospital •New Hanover Regional Medical Center•Pitt Memorial HospitalEach team will be comprised of healthcare professionals from within their prospective RAC area.

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Public Health Regional Public Health Regional Surveillance TeamSurveillance Team

The Public Health Regional Surveillance Teams (PHRST) are strategically located across North Carolina. The teams coincide with the Regional Response Teams (RRT) areas.

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Each team includes:

•An epidemiologist

•An industrial hygienist

•A nurse consultant

•An administrative specialist.


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•Surveillance

•Outbreak investigation

•Education and training

•Vulnerability Assessment

•Preparedness

•Response


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•Co-located in 7 host counties with 7 regional Haz-Mat Teams (RRT’s)

•Government Employees funded through State aid to local government.

•Serving 6 to 26 county regions through memoranda of agreement between counties

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Regional Response TeamRegional Response Team

To supplement the efforts of local government hazardous materials teams in incidents beyond the capabilities of the first responders.

Team Mission

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The NC Hazardous Materials Regional Response program is a system of seven teams strategically located in the state to provide hazardous materials response services to the citizens of North Carolina. The RRTs are available to respond whenever an incident exceeds local capabilities with technical support, manpower, specialized equipment and/or supplies.

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•Each team is composed of emergency response personnel certified according to State Division of Occupational Safety and Health standards.

•Team members are qualified to handle a wide range of hazardous materials incidents.

•At a minimum, each technician must have a Firefighter I certification, plus more than 200 hours of specialized hazardous materials training.

The six teams are strategically located across North Carolina, taking into consideration population centers and transportation corridors, among other things. Due to travel time and distances for a responding team, local emergency response agencies must be capable of "holding the situation" until the RRT arrives.

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Requests for a RRT emergency response may be initiated by the incident commander, local emergency management coordinator, or N.C. Emergency Management Division’s Area Coordinator. The requester must provide some basic information, such as:


1. Substance/chemical name (if known)

2. Incident location, size and severity

3. Is substance liquid, solid or gas

4. Danger present and area threatened

5. Fire, health, or explosion hazards

6. Evacuations in progress, or contemplated

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Federal ResourcesFederal ResourcesNational Disaster Medical System (NDMS)

• Disaster Medical Assistance Team (DMAT)• Disaster Mortuary Operation Response Team (DMORT) • Veterinary Medical Assistance Team (VMAT)• National Medical Response Team (NMRT)

Nuclear Emergency Support Team (NEST)

Domestic Emergency Support Team (DEST)

Strategic National Stockpile (SNS)

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The slide illustrates the incorporation of agencies and branches within the NDMS to provide unified response to natural or man made disasters. All stakeholders play a major role in the NDMS response plan. Large NDMS drills are held in North Carolina bi annually.

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Emergency Support Emergency Support Function #8Function #8

Emergency Support Function (ESF) #8

Health and Medical Services provides coordinated Federal assistance to supplement State and local resources in response to public health and medical care needs following a major disaster or emergency, or during a developing potential medical situation.

Assistance provided under ESF #8 is directed by the Department of Health and Human Services (HHS) through its executive agent, theAssistant Secretary for Emergency Preparedness. Resources will be furnished when State and local resources are overwhelmed and pub lic health and/or medical assistance is requested from the Federal Government.

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Emergency Support Emergency Support Function #8Function #8

ESF #8 involves supplemental assistance to State and local governments in identifying and meeting the health and medical needs of victims of a major disaster, emergency, or terrorist attack.

FunctionFunction

This support is categorized in the following functional areas:

Assessment of health/medical needs

Health surveillance

Medical care personnel

Health/medical equipment and supplies

Patient evacuation

In-hospital care

Food/drug/medical device safety

Worker health/safety

Radiological/chemical/biological hazards consultation

Mental health care

Vector control

Potable water/wastewater and solid waste disposal

Victim identification/mortuary services

Veterinary service

Ref: http://www.au.af.mil/au/awc/awcgate/frp/frpesf8.htm

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Emergency Support Function Annexes to the Federal Response Plan, April 1999

ESF #1 — Transportation ESF #2 — Communications ESF #3 — Public Works and Engineering ESF #4 — Firefighting ESF #5 — Information and Planning ESF #6 — Mass Care ESF #7 — Resource Support ESF #8 — Health and Medical Services ESF #9 — Urban Search and Rescue ESF #10 — Hazardous Materials ESF #11 — Food ESF #12 — Energy

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National Disaster Medical System National Disaster Medical System (NDMS)(NDMS)

The National Disaster Medical System (NDMS) is a section within the U.S. Department of Homeland Security, Federal Emergency Management Agency, Response Division, Operations Branch, and has the responsibility for managing and coordinating the Federal medical response to major emergencies and Federally declared disasters.

•Some examples of deployment and activation are listed below.

•Natural Disasters

•Technological Disasters

•Major Transportation Accidents

•Acts of Terrorism including Weapons of Mass Destruction Events

There are three operational components of NDMS:

•1. Medical response to a disaster area in the form of teams, supplies, and equipment.

•2. Patient movement from a disaster site to unaffected areas of the nation.

•3. Definitive medical care at participating hospitals in unaffected areas.

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Disaster Medical Disaster Medical Assistance TeamAssistance Team

The Department of Homeland Security (DHS), through the National Disaster Medical System (NDMS) fosters the development of Disaster Medical Assistance Teams (DMATs). A DMAT is a group of professional and para-professional medical personnel (supported by a cadre of logistical and administrative staff) designed to provide medical care during a disaster or other event. Each team has a sponsoring organization, such as a major medical center, public health or safety agency, non-profit, public or private organization that signs a Memorandum of Agreement (MOA) with the DHS. The DMAT sponsor organizes the team and recruits members, arranges training, and coordinates the dispatch of the team.

Ref: http://oep-ndms.dhhs.gov/dmat.html

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Disaster Medical Assistance TeamDisaster Medical Assistance Team

A regional group of volunteer medical professionals and support personnel with the ability to quickly move into a disaster area and provide medical care. These units are under the auspices of the Department of Homeland Security/FEMA. They can rapidly deploy for any type of disaster that requires an immediate medical response

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Disaster Medical Assistance TeamDisaster Medical Assistance Team

Three primary responsibilities of this team include triage, staging, and extended medical care. DMAT has a minimum of 35 members, including at least 3 physicians, 5 nurses and 5 Paramedics, withthe remainder of the team made up of medical support personnel. There are also specialized DMATs located throughout the country. These DMATs can specialize in burn care, pediatrics, urban search and rescue, mortuary services, infectious disease outbreaks, and other problems.

DMATs deploy to disaster sites with sufficient supplies and equipmentto sustain themselves for a period of 72 hours while providing medical care at a fixed or temporary medical care site. In mass casualtyincidents, their responsibilities may include triaging patients, providing high-quality medical care despite the adverse and austere environmentoften found at a disaster site, and preparing patients for evacuation. In

other types of situations, DMATs may provide primary medical careand/or may serve to augment overloaded local health care staffs. Under the rare circumstance that disaster victims are evacuated to a different locale to receive definitive medical care, DMATs may be activated to support patient reception and disposition of patients to hospitals. DMATs are designed to be a rapid-response element to supplement local medical care until other Federal or contract resources can be mobilized, or the situation is resolved.

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Team Levels

• Level I = Fully Operational

• Level II = Operational

• Level III = Local / Augmentation

• Level IV = Developmental

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Level I = Fully Operational

• Have all of the required personnel in the prescribed positions and required numbers.

• Have required equipment and supplies to be self sufficient for 72 hours.

• Can deploy within 6 hours of notification.

• Have previous disaster deployment experience as a full team.

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Level II = Operational

• Have the minimum required personnel in the prescribed positions and required numbers.

• Have required equipment and supplies to be self sufficient for 72 hours.

• Can deploy within 12 hours of notification.

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Level III Local / Augmentation

• Have the required personnel in less than the prescribed positions and required numbers of personnel.

• Have some or all of the required equipment and supplies to be self sufficient for 72 hours.

• Can deploy within 24 hours of notification with additional personnel supplied from other NDMS teams.

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Disaster Mortuary Disaster Mortuary Operational Response Team Operational Response Team

To assist local authorities during a: Mass Fatality Incident

A Mass fatality incident can be defined as:

‘An incident where more deaths occur than can be handled by local resources’


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•Mobile Morgue Operations

•Forensic examination

•DNA Acquisition

•Remains identification

•Search and recovery

•Scene documentation

•Medical/psychology support

•Embalming/casketing

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•Family Assistance center

•Antemortem data collection

•Postmortem data collection

•Records data entry

•Database administration

•Personal effects processing

•Coordination of release of remains

•Provide a Liaison to USPHS

•Provide communications equipment

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Team Composition

-Medical Examiner/Coroners -Forensic Pathologists

- Forensic Anthropologists - Fingerprint Specialists

- Forensic Odontologists -Funeral Directors/Embalmers

-Dental Assistants -X-ray Technicians

-Photographic Specialists -Heavy Equipment Operators

-Mental Health Specialists -DNA Specialists

-Computer Specialists -Medical Records Technicians

-Transcriptionists -Administrative support staff

-Security personnel -Investigative personnel

-Evidence Specialists -Facility Maintenance Personnel

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Veterinarian Medical Response TeamVeterinarian Medical Response Team

The VMAT’s are highly trained teams composed of veterinarians, veterinary technicians, and support personnel. They provide nationwide coverage during times of disaster and can be deployed to any state or United States territory.

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Veterinarian Medical Assistance TeamVeterinarian Medical Assistance Team

VMAT team members triage and stabilize patients at a disaster site and provide austere veterinary medical care.

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Veterinarian Medical Assistance TeamVeterinarian Medical Assistance Team

These teams are mobile units that can deploy within 12-24 hours. The members carry a 3-day supply of food, water, personal living necessities, and medical supplies and equipment, if needed. Each team is capable of establishing a veterinary field hospital or traveling to individual veterinary hospitals to aid local veterinarians.

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Strategic National Stockpile Strategic National Stockpile (SNS)(SNS)

In 1999 Congress charged the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) with the establishment of the National Pharmaceutical Stockpile (NPS).

HistoryHistory

The mission was to provide a re-supply of large quantities of essential medical materiel to states and communities during an emergency within twelve hours of the federal decision to deploy.

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National Medical Response Team National Medical Response Team (NMRT)(NMRT)

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National Medical Response Teams

• 4 Federal Teams

– NMRT-East Winston-Salem, NC– NMRT-Central Denver, CO– NMRT-West Los Angles, CA– NMRT-DC Washington, DC

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NMRT Scope of NMRT Scope of ServicesServices

• Standard Responder Decon < 20 victims• Mass Decon >20 victims

– Ambulatory - 100-200 per hour– Non-Ambulatory - 32 per hour

• Medical Tx in Decon line - 32 per hour• Collect patient sampling for laboratory

analysis

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NMRT Scope of ServicesNMRT Scope of Services

• In Hot Zone:– Provide medical supervision if needed - 1

person– Assist with medical care, but would

decrease mass decon of non-ambulatory by 60%

– Limited field chemical monitoring and environmental sampling - 1 person

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• Pre-Hospital– Technical assistance to EMS – Triage and medical care of NBC event after

Decon

• Medical Facility– Technical Assistance at hospital– Decon at Hospital– Assist with definitive care in NBC event

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Provide medical services to responders during and after an event.

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Strategic National StockpileStrategic National Stockpile

The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items.

MissionMission

• The SNS is designed to supplement and re-supply state and local public health agencies in the event of a national emergency anywhere and at anytime within the U.S. or its territories.• The SNS is organized for flexible response. The first line of support lies within the immediate response 12-hour Push Packages. These are caches of pharmaceuticals, antidotes, and medical supplies designed to provide rapid delivery of a broad spectrum of assets for an ill defined threat in the early hours of an event. These Push Packages are positioned in strategically located, secure warehouses ready for immediate deployment to a designated site within 12 hours of the federal decision to deploy SNS assets. • If the incident requires additional pharmaceuticals and/or medical supplies, follow-on vendor managed inventory (VMI) supplies will be shipped to arrive within 24 to 36 hours. If theagent is well defined, VMI can be tailored to provide pharmaceuticals, supplies and/or products specific to the suspected or confirmed agent(s). In this case, the VMI could act as the first option for immediate response from the SNS.

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Strategic National Stockpile

• The SNS Program is committed to have 12-hour Push Packages delivered anywhere in the U.S. or its territories within 12 hours of a federal decision to deploy.

ActivationActivation

• The 12-hour Push Packages have been configured to be immediately loaded onto either trucks or commercial cargo aircraft for the most rapid transportation. Concurrent to SNS transport, the SNS Program will deploy its Technical Advisory Response Unit (TARU). The TARU staff will coordinate with state and local officials so that the SNS assets can be efficiently received and distributed upon arrival at the site.

•The decision to deploy SNS assets may be based on evidence showing the overt release of an agent that might adversely affect public health. It is more likely, however, that subtle indicators, such as unusual morbidity and/or mortality identified through the nation’s disease outbreak surveillance and epidemiology network, will alert health officials to the possibility (and confirmation) of a biological or chemical incident or a national emergency. To receive SNS assets, the affected state’s governor’s office will directly request the deployment of the SNS assets from CDC or DHS. DHS, HHS, CDC, and other federal officials will evaluate the situation and determine a prompt course of action

Documents

Medical Surge Resources - NHRMC