Disaster Medical Assistance Team
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A Disaster Medical Assistance Team (DMAT) is a group of professional and para-professional medical personnel organized to provide rapid-response medical care or casualty decontamination during a terrorist attack, natural disaster, or other incident in the United States. DMATs are part of the National Disaster Medical System and operate under the Department of Health and Human Services (DHHS).
DMATs, since their origin have all been organized under the National Disaster Medical System (NDMS). NDMS as a branch was originally under the U.S. Public Health Service (USPHS) within The Department of Health and Human Services(DHHS). In 2003, as a direct result of the September 11 attacks in 2001 the newly formed Department of Homeland Security (DHS), requested, and was granted convening authority over NDMS which was then placed under the direction of the Federal Emergency Management Agency (FEMA). After Hurricane Katrina, amidst allegations of mismanagement (etc.), NDMS was removed from FEMA and sent back to DHHS, as legislated by an Act of Congress entitled. "the Pandemic and All Hazards Preparedness Act (PAHPA)", (Public Law 109-417), effective January 1, 2007 which positioned NDMS, organizationally, within ASPR’s Office of Preparedness and Emergency Operations (OPEO), where it is now an asset of the Office of the Assistant Secretary for Preparedness and Response (formerly the Office of Public Health Emergency Preparedness), and receives its annual budget from The Office of Preparedness and Emergency Operations (OPEO), which is also under the ASPR. The OPEO is responsible for developing operational plans, analytical products, and training exercises to ensure the preparedness of the Office, the Department, the Federal Government and the public to respond to domestic and international public health and medical threats and emergencies. OPEO is also responsible for ensuring that ASPR has the systems, logistical support, and procedures necessary to coordinate the Department’s operational response to acts of terrorism and other public health and medical threats and emergencies. OPEO maintains a regional planning and response coordination capability, and has operational responsibility for HHS functions related to the National Disaster Medical Systems (NDMS). OPEO acts as the primary operational liaison to emergency response entities within HHS (e.g., the U.S. Food and Drug Administration, HRSA, SAMHSA, Centers for Disease Control and Prevention), within the interagency community (e.g., HDS, United States Department of Veterans Affairs, United States Department of Defense), and the public. ).
The National Disaster Medical System (NDMS) is a Federally coordinated system that augments the Nation's emergency medical response capability. It was created by executive order by the President of the United States in 1984. The overall purpose of the NDMS is to establish a single integrated National medical response capability for assisting State and local authorities in dealing with the medical and health effects of major peacetime disasters and providing support to the military and Veterans Health Administration medical systems in caring for casualties evacuated back to the U.S. from overseas armed conflicts.
NDMS is a Federally coordinated system that is a private/public partnership between the Federal Emergency Management Agency (FEMA), Veterans Administration (VA), Department of Defense (DOD), US Public Health Service (PHS), DMAT members, and civilian hospitals throughout the United States.
DMATs formerly were primarily a local asset to their home region and were integrated into the Emergency Response Plan of that area. However, after an Act of Congress in 2003, when DMAT members were given the job protection of USERRA, DMAT members became federal intermittent employees and are considered by the federal government to be employees and not volunteers. They respond as needed to provide first aid, casualty clearing (triage and medical stabilization), emergent surgical stabilization, medical staging, transportation from disaster areas by military or civilian aeromedical transport, and definitive medical care in hospital facilities that have dedicated beds for the NDMS when needed.
There are 80 NDMS Teams of which 55 are DMATs spread out across the country and are formed by local groups of health care providers and support personnel. Under the National Response Framework (NRF, DMATs are defined according to their level of capability and experience. Once a level of training and proficiency has been shown, the higher level of priority is given to the team. In addition to medical DMATs, there are other response teams that specialize in specific types of medical emergencies such as hazardous material handling and decontamination and LRATs, which are primarily Logistics response teams to support any of the response teams under the NDMS umbrella. Such other types of teams are the DMORTs (Disaster Mortuary Operations Response Teams, NVRTs (National Veterinary Medical Response Teams), IMSuRTs (International Medical/Surgical Response Teams), and the IRCTs (Incident Response Coordination Teams).
A DMAT deploys to disaster sites with the assurance by OPEO that supplies and equipment will arrive at or before the teams arrive at a disaster site, so that they can be self-sufficient for 72 hours while providing medical care at a fixed or temporary medical care site. Responsibilities may include triaging patients, providing high-quality medical care in adverse and austere environments, and preparing patients for evacuation. Other situations may involve providing primary medical care or augmenting overloaded local health care facilities and staffs. DMATs have been used to implement mass inoculations and other immediate needs to large populations. Under rare circumstances, disaster victims may be evacuated to a different locale to receive medical care. DMATs may be activated to support patient reception and distribution of patients to hospitals.
Team composition and equipment
DMATs are composed of physicians, nurse practitioners, physician assistants, nurses, pharmacists and pharmacy technicians, respiratory therapists, paramedics, Emergency Medical Technicians, and a variety of other health and logistical personnel. DMATs typically have 120-150 members, from which the Team Leader chooses up to 50 members to deploy on missions requiring a full team. Smaller strike teams or other modular units can also be activated and deployed when less than full-scale deployments are needed. DMAT members are termed "intermittent" federal employees and once activated by federal order, their status changes to that of an active federal employee and follow the GS pay scale. Federally activated DMAT members are protected from tort liability while in operation and are also protected by the provisions of the Uniformed Services Employment and Reemployment Rights Act (USERRA) which affords the same protections extended to National Guard and Active Duty Military when they deploy in that their full-time jobs are not placed in jeopardy.
DMATs formerly traveled equipped with medical equipment and supplies, large tents, generators, and other support equipment (cache) necessary to establish a Base of Operations, designed to be self-sufficient for up to 72 hours, in a disaster area and treat up to 250 patients per day. However, during the period 2009-2011, ASPR changed the operational tactics and has removed team caches to a small number of federal warehouses, to save money, and thus teams no longer have the opportunity to practice and train with their own caches as was done previously. The capability is similar to an urgent care-level health care facility. In 2005, FEMA increased the response capabilities of DMATs by issuing trucks to teams that have obtained a certain standard of training and capabilities, but these, too, have been reclaimed by ASPR and are only available doing actual deployments, to deliver the caches from the federal warehouses.
DMATs have been called to respond to a variety incidents, many of which garnered significant media attention. Teams responded to the World Trade Center site in New York City and the Pentagon, following the 9/11 terrorist attacks. A critical element of the federal response to natural disasters including Hurricane Katrina, DMAT teams treated and helped evacuate patients in and around New Orleans, including at the Louisiana Superdome and Louis Armstrong New Orleans International Airport. Between January 17 and February 22, 2010, twelve DMATs participated in the international response to the 2010 Haiti Earthquake and cared for more than 31,300 patients, including 167 surgeries and the delivery of 45 infants. More recently, DMATs have aided in the response to Hurricane Sandy, which was particularly devastating to areas of New York and New Jersey.
- "National Disaster Medical System". Retrieved September 11, 2012.
- "HHS.gov". U.S. Department of Health & Human Services. Retrieved September 11, 2012.
- "USERRA". US Office of Special Counsel. Retrieved September 11, 2012.