Dear (name of elected official): 

As a Disaster Medical Assistance Team Commander in the National Disaster Medical System / ASPR / HHS I have grave concerns regarding the health of the National Disaster Medical System (NDMS). It is my perception that there has been mismanagement, the misappropriation of funds, and other actions which has resulted in the degradation of the National Disaster Medical System and the ability of the teams to effectively respond to disasters. It is my feeling that these actions by the Department of Health and Human Services (HHS) are a threat to public health and safety and I request that immediate Congressional/Senatorial Hearings are called to investigate the decline of readiness of NDMS. 

HAMR Teams 

It is my belief that the Office of the Assistant Secretary for Preparedness and Response under the leadership of RADM W. Craig Vanderwagen, MD., USPHS has engaged in a systematic plan to deemphasize the National Disaster Medical System in favor of creating USPHS Commissioned Corps Health and Medical Response Teams (HAMR). It is my assessment as a seasoned disaster responder, that though I have many respected colleagues in the Commissioned Corps, the officers of the United States Public Health Service (USPHS) generally lack current clinical emergency medical/critical care patient care experience, sufficient experience in disaster response, and an appropriate number of officers to be successful in this mission. This plan is flawed and is a threat to public health and safety. 

Budget Skimming 

The Department of Health and Human Services has skimmed significant funding from the National Disaster Medical System to a point that even after an increase in funding from Congress this fiscal year the Disaster Medical Assistance Teams (DMAT) have smaller operational budgets than in previous years. Operational funding is even less than while recently under continuing resolution. It is widely acknowledged that teams have had too little funding to engage in team maintenance and development activities for many years. It is my assessment that teams are sliding to pre-Katrina readiness levels (or are there) which is a threat to public health and safety. It is unknown to teams where the NDMS budget monies went. It is widely suspected that HHS has utilized the money to build ASPR Logistics and to develop HAMR Teams. It is not my feeling that this was the intent of Congress as the Katrina Report supported the movement of NDMS to HHS from DHS “in whole”.  

Uncompensated Work 

DMAT personnel are classified as full time intermittent federal employees and are routinely and repeatedly required to perform work on behalf of the federal government without compensation. Some examples of this are:

  • HSPD-21 – to fulfill the requirements of this Presidential Directive DMAT/HHS employees have been required to without compensation, donate many hours of their time completing required paperwork, participating in online background checks, and traveling in some cases many hours to have photos taken and fingerprints electronically processed. Further these employees do not receive per diem or mileage reimbursement for travel. If they were to be involved in a traffic crash, because they are “on the payroll would be therefore ineligible for any benefits.
  • HSPD-5 – to fulfill the requirements of this Presidential Directive these DMAT/HHS employees are mandated to complete ICS/NIMS training yet there is no funding support this activity.
  • Immunizations – DMAT/HHS employees are required to maintain specific immunization schedules yet there is no funding to support these activities. Further if these personnel were to experience an adverse medical outcome associated with this medical procedure they would not be “on the payroll” and therefore ineligible for any benefits.
  • Medical Credentialing – DMAT/HHS employees with medical credentials are required to complete an online credentialing program. There is no budgetary support for this program.
  • Team Officers – insufficient budget monies are provided to team officers to manage, maintain, and develop the teams. Team officers are HHS employees and are required to either not perform essential duties or volunteer their time to the federal government in order to assure team readiness.

There are other examples of the same, but these are examples which are common to all NDMS intermittent employees. It is my feeling that these are unfair labor practice violations and HHS has demonstrated mismanagement by engaging in this activity. These unfunded requirements have also caused mistrust of HHS by many DMAT personnel and many have resigned or have refused to participate in these programs. The loss of these personnel has a negative impact on team readiness and has the potential to be a threat to public health and safety. It should be noted that all other HHS employees perform the above noted activities while on duty and are compensated during those hours.  

Cache Regionalization 

In a recent initiative to save money HHS has begun a program to regionalize DMAT caches. The plan is to move many DMAT caches of lifesaving medical equipment and supplies to regional warehouses managed by contracted HHS logisticians. As a DMAT commander I object to this concept. It is my opinion that DMAT caches are best managed at the team level. It is well known to DMAT personnel that caches received from federal logistics centers in Katrina were not maintained to the standard of team maintained caches. This is due to the fact that teams know that in the event of DMAT deployment that they will initially utilize their own cache. Those caches are as a result maintained to the highest standard. A recent specific example of poor cache maintenance by HHS can be documented as recently as the California Wildfires. DMAT pharmaceutical caches deployed to California were found to have 30% of their drugs expired. DMAT pharmacists spent days rehabilitating these caches that were “maintained” at an HHS warehouse. 

I am also concerned that DMATs will arrive on the sites of disasters prior to caches shipped from regional warehouses. A good example of the potential for this scenario is Hurricane Charlie. FL-5 DMAT (South Florida) was the first operational DMAT to arrive at ground-zero of heavily damaged Punta Gorda, FL. The rest of the teams were cutoff by the storm and even heavily impacted by the hurricane. Without their team maintained cache the FL-5 DMAT could not have been capable of initiating life-saving patient care. It should be noted that the FL-5 cache was the first to be relocated and is now located Orlando, FL. This DMAT was developed in South Florida in direct response to Hurricane Andrew. This now leaves one of the largest and most hurricane/terrorism vulnerable metro areas in the United States without DMAT cache. It is my feeling that cache regionalization is an ill conceived plan which fails to acknowledge operational realities and is both mismanagement and a threat to public health and safety. 

As a DMAT Commander I also have a litany of less high profile, but important concerns. Some of those are: 

  • Delays in applicant processing – some potential personnel have been waiting for 2 years to join DMATs. There is no in place mechanism to hire new personnel.
  • The ability for outside organizations to loan equipment to NDMS – DMAT caches have had no significant upgrade to medical equipment in many years and are mostly 1980’s technologies. Caches lack such important medical equipment as X-Ray, ultrasound, and sufficient lab resources. Such equipment is available to be loaned by outside organizations but is prohibited by HHS (permissible when with FEMA).
  • Team maintained pharmaceutical caches are needed – pharmaceutical caches are regionalized and teams need lifesaving drugs as soon as they arrive. Those caches also are in desperate need of update.
  • Live-patient training – DMATs traditionally have been permitted to provide stand-by coverage at community functions such as air shows. This gives team members the opportunity to work together under realistic circumstances in live-patent care events. This is important as personnel do not work together in daily work settings.
  • Team credit cards – under FEMA DMATs were issued team credit cards to facilitate purchases like blocks of hotel rooms and mass travel of teams. HHS prohibits this practice requiring DMAT personnel to travel as individuals. It is not efficient in disasters for 35-40 individuals in and out of hotels during responses.
  • DMAT Trucks – the trucks were poorly designed and require system wide maintenance to correct fleet wide problems. The DMAT organic transportation is unreliable.
  • Logistics – team commanders have no visibility of how teams will be supported in the field.
  • MOAs with other federal agencies to share employees – DMATs have personnel from the VA, CDC, and other agencies who are prohibited from team participation due to the lack of inter-agency Memorandums of Agreements.
 

It is my assessment that the Assistant Secretary for Preparedness and Response has taken actions with which have crippled the National Disaster Medical System and plans to replace it with inadequately prepared USPHS Commissioned Corps HAMR Teams.  

The National Disaster Medical System and the Disaster Medical Assistance Teams were highlighted by the Congressional Katrina report as one of the federal response successes to this catastrophic incident. This program remains under-funded and is being mismanaged by HHS. DMATs saved many lives and treated approximately 180,000 patients during the Hurricane Katrina response. Please help us SAVE the National Disaster Medical System and call for immediate Congressional/Senatorial Hearings. 
 

Sincerely, 
 
 
 

Team Commander