Selim Suner MD, MS, FACEPDirector of Disaster Medicine

Professor of Emergency Medicine, Surgery and EngineeringBrown University

Eric Noji MD MPH: Cutler Lecture

Disaster Rate

Urban dwellers:

1920: 100 million

1980: 1 billion

2004: 2 billion

2004: 20 cities with >10 million people

Sources: CDC & EK Noji, The Public Health Consequences of Disaster

Factors Effecting Disaster Impact

THE FEDERALRESPONSE

PLAN

DisasterOccurs

LocalFirst

Responders

CountyExecutiveAlert

RequestsAid From

GovernorFEMA

RegionalDirector

Informs

FEMADirector

Advises

President

Contacts

DeclaresDisaster

DeclaresDisaster

RequestsAssistance

EmergencyResponse

Team

EmergencySupport

Functions(ESFs)

Provides

FederalCoordinating

Officer

StateCoordinating

Officer

Appoints

Sets Up

Joins

FieldOperations

Disaster

Field Office

Federal Response Plan Activation

Coordination of all assets in a disaster may be like herding

cats

12 1

2

3

4

67

9

GSA

FEMA

ARCFEMA

USDA& FS

DOD

DOTDOE

NCS

USDA

EPA

Urban Search and Rescue

Hazardous

Materials

Food

Energy

Tran

spor

tatio

n

Communications

Public Works

Firefighting

Information

& Planning

MassCare

Res

ourc

eS

upp

ort

Support AgenciesUSDA AIDDOJ ARCDVA EPADOD FEMADOT GSADOE NCS

USPS

8

DHHSHealth & Medical

Services

8

ESF

ESF Lead Agencies

DHHS Agencies,US PHS CCRF

FEMAResponse Branch

National Disaster Medical System(NDMS)

Other Federal Agencies

Military Resources

Coordination of Federal Response

Year Event Description

1803 Portsmouth NH Fire1st Congressional Disaster Relief

1964 Great Alaska Earthquake 131 killed, 8.1 rs

1974 Disaster Relief Act Authorizes state governors to request federal assistance

1977Natural Earthquake Hazard Reduction Program

Funded research in earthquake prediction & mitigation

1979Federal Emergency Management Agency

Consolidates many agencies; emphasizes preparedness; mitigation and recovery

History

Year Event Description

1980Mt. St. Helen's volcanic eruption

58 killed

1984National Disaster Medical System

4 federal agencies led by PHS (DHHS); continues hospital bed contingency program, but also includes medical response

1985 DMATsMedical response limb of NDMS

History

Year Event Description

1989Hurricane Hugo (Caribbean, Eastern US)

51 killed, 25K homeless

1989Loma Prieta Earthquake (Bay Area CA)

62 killed, 2500 injured, 6K homeless

1990 Stafford Act

Authorizes President to direct federal agencies to provide emergency assistance to state/local jursidictions

1992 Federal Response Plan

Improves federal disaster response time; predeploys resources to predictable events and staging areas in disaster-prone communities

History

Disaster Medical Assistance Teams (DMATs)

• Nationwide network of disaster medical response teams affiliated with NDMS

• Medical care to disaster-impacted communities– External medical disaster

assistance– Capable of processing

200-250 patients/24 hrs

DMAT Roles

• Triage • Medical care• Casualty clearing• Patient staging • Patient reception • Standby

operations

Types of DMAT Medical Care

• Supplement staff in local facilities

• Primary care • Inpatient care in

free-standing field hospitals

• Public health care

Year Disaster Location1989 Hurricane Hugo East Coast1992 Hurricane Andrew Florida1992 Hurricane Iniki Kauai1993 Hurricane Emily East Coast1994 Northridge Earthquake Los Angeles 1995 Hurricane Marilyn USVI1996 Centennial Olympics Atlanta1997 North Dakota floods North Dakota1998 Ice storm New York1999 Kosavar refugees Ft. Dix, NJ1999 WTO riots Seattle2000 State of the Union Washington, DC

Year Disaster Location2001 WTC NYC2001 Anthrax NYC2005 Hurricanes Southern USA