2.1. Personnel and Material Assistance
As the previous sections detail, SLTT entities may lack the capability to immediately provide sufficient care, MCMs, and/or PPE in the aftermath of a chemical incident. Availability, overwhelming public demand, and requests beyond impacted areas may make MCM and/or PPE distribution challenging; available MCMs and/or PPE may fall short of demand due to factors such as the geographical extent of contamination, logistical issues, or disruptions to production. In such cases, the federal government will assist SLTT entities with MCM/PPE distribution. HHS coordinates the federal emergency public health and medical response via ESF #8 – Public Health and Medical Services, which supports medical response assistance, including behavioral needs consisting of both mental health and substance abuse considerations for survivors and response workers, and veterinary and/or animal health issues.
Support from federal, state, NGO, and volunteer labor forces may be required to assist overwhelmed healthcare staff.
If staffing needs surpass those addressable by surge support from nearby jurisdictions, federal assistance for overwhelmed healthcare staff may be requested, although federal team deployment can take 12-48 hours. The National Disaster Medical System (NDMS) is a federally coordinated health care system and partnership of the Departments of Health and Human Services, Homeland Security, Defense, and Veterans Affairs that is designed to support SLTT authorities following disasters and emergencies by supplementing health and medical systems and response capabilities. Specifically, the NDMS provides patient care and movement, veterinary services, and fatality management support to requesting SLTT authorities or other federal departments via specialized teams (see following box for more information):83,84
- Disaster Medical Assistance Teams (DMATs)
- Trauma and Critical Care Teams (TCCTs)
- Disaster Mortuary Operational Response Teams (DMORTs)
- Victim Information Center Teams (VICs)
- National Veterinary Response Teams (NVRTs)
- National Medical Response Teams (NMRTs)
Additional health and medical assistance may come from within and from outside the federal government. Both skilled and non-skilled labor forces may be called upon to provide service in accordance with their capabilities. Assistance may come from agencies supporting ESF #6 (Mass Care, Emergency Assistance, Housing, and Human Services), ESF #8 (Public Health and Medical Services), and others, such as:
- HHS Commissioned Corps of the U.S. Public Health Service (USPHS) Readiness and Deployment Operations Group (RedDOG) available within 36 hours84
- Rapid Deployment Force – for mass care at shelters (including FMSs, see Section 2.2) and staffing at MCM/PPE distribution and casualty collection points (available within 12 hours)
- Applied Public Health Team – for assistance in public health assessments, environmental health, infrastructure integrity, food safety, vector control, epidemiology, and surveillance
- Mental Health Team – for assessing stress within the affected population and responders, and providing therapy and counseling
- CDC Epi-Aid teams, which provide epidemiologic assistance to SLTT public health investigations, including those of illnesses and injuries resulting from natural or manmade disasters such as chemical spills or pipeline explosions, and abnormal signs and symptoms following food ingestion or pharmaceutical use
- Medical Reserve Corps (MRC), a national network of medical and public health professionals who are coordinated at the local level to serve as volunteers in natural disasters and emergencies
- Non-governmental organizations (NGOs)/Volunteer Organizations Active in Disasters (VOADs) and nonclinical volunteers
- Emergency Management Assistance Compact (EMAC), a compact for state-to-state personnel, equipment, supply, and other assistance
National Disaster Medical System (NDMS)
Disaster Medical Assistance Teams
Disaster Medical Assistance Teams (DMATs) provide medical care during public health emergencies or National Security Special Events (NSSEs), such as:
- Triage, primary, acute, and stabilizing emergency care
- Emergency department decompression
- Inpatient care augmentation
- Supporting patient movement/transfer, including ill/injured and nursing home patients
- Staffing casualty/patient collection points
- Mass prophylaxis
- Medical site/shelter operations
DMAT teams include advanced clinicians (nurse practitioners/physician assistants), medical officers, registered nurses, respiratory therapists, paramedics, pharmacists, safety specialists, logistical specialists, information technologists, and communication and administrative specialists. DMATs of 35 personnel deploy to disaster sites within 48 hours with supplies and equipment for a period of 72 hours; the personnel are typically activated for a period of two weeks.
Trauma and Critical Care Teams
Trauma and Critical Care Teams (TCCT) provide trauma and critical care support during public health emergencies and special events including NSSEs. TCCTs can provide a deployable advance unit, augment existing medical facilities, or establish a stand-alone field hospital. The capabilities of the TCCT include:
- Critical care and advanced trauma life support
- Emergency care
- Operative care
TCCT personnel are deployed for fourteen days or until local medical resources are sufficiently recovered or have been supplemented by other organizations.
Disaster Mortuary Operational Response Teams
Disaster Mortuary Operational Response Teams (DMORTs) provide victim identification, mortuary services, and technical assistance and consultation on fatality management and mortuary affairs, including:
- Tracking and documenting human remains and personal effects
- Documenting field retrieval and morgue operations
- Establishing temporary morgue facilities
- Assisting in the determination of cause and manner of death
- Collecting ante-mortem and post-mortem data
- Collecting medical/dental records or DNA of victims from next of kin to assist in the forensic identification of the victims
- Performing forensic dental pathology and forensic anthropology methods
- Processing and re-interment of disinterred remains preparation
Teams are composed of funeral directors, medical examiners, pathologists, forensic anthropologists, fingerprint specialists, forensic odonatologists, dental assistants, and administrative and security specialists. DMORTs may deploy with a Disaster Portable Morgue Unit (DPMU), which contains a complete morgue and prepackaged equipment and supplies.
Victim Information Center Teams
A Victim Information Center (VIC) Team provides support to local authorities after a mass fatality or mass casualty incident by collecting ante-mortem data and serving as liaison to the victims’ families or other responsible parties in support of another NDMS team. The VIC Team provides support by:
- Providing subject matter expertise in mass fatality management and victim information procurement
- Training partners to appropriately gather the information required for victim identification from the family interview process
- Collecting dental records, medical records, DNA, and other ante-mortem data
- Explaining the HIPAA Privacy Rule Exemption for Medical Examiners and Coroners at 45 CFR 164.512(g)(1) to medical and dental providers to facilitate obtaining records
- Coordinating and sharing data with morgue and forensic staff for potential identification
- Coordinating with FSLTT law enforcement to facilitate victim identification and manage the missing persons list
- Maintaining the Victim Identification Program (VIP) database
- Coordinating the release of remains
National Veterinary Response Teams
A National Veterinary Response Team (NVRT) is the primary federal resource for the treatment of injured or ill animals affected by disasters. The NVRT is composed of veterinarians, animal health technicians, epidemiologists, safety specialists, logisticians, communications specialists, and other support personnel. A NVRT is supported by a cache of equipment, supplies, and pharmaceuticals, and provides assessments, technical assistance, and public health and veterinary services, such as:
- Assessments of the veterinary medical needs of animals and communities
- Veterinary medical support to working animals which might include search and rescue dogs, horses, and animals used for law enforcement
- Veterinary public health support including environmental and zoonotic disease assessment
National Medical Response Teams
National Medical Response Teams (NMRTs) provide medical care following a nuclear, biological, and/or chemical incident. Each team of 50 personnel is capable of providing mass casualty decontamination, medical triage, and primary and secondary medical care to stabilize victims for transportation to tertiary care facilities in a hazardous environment.