In 1983 the President of the United States declared, by executive order, the formation of the National Disaster Medical System (NDMS). NDMS was to have two functions:

  • Create a system whereby civilian hospital beds could be used in the event of a disaster within the U.S. and
  • create Disaster Medical Assistance Teams (DMATs) who could respond to those disasters

Today NDMS under HHS is the primary US response agency for disasters, natural and man-made. NDMS provides medical, veterinary, and mortuary services in the opening hours of a disaster. During Hurricane Katrina the NDMS teams cared for over 180,000 patients

Our concerns:

  • HAMR Teams - the Assistant Secretary of Preparedness and Response has engaged in a systematic plan to dismantle the DMATs in favor of Health and Medical Response (HAMR) Teams of the USPHS Commissioned Corps. Commissioned Corps clinicians lack insufficient numbers personnel with current emergency and critical care medical skills. END RESULT- the unnecessary loss of human lives in the next disaster.
  • Budget issues – teams and command staff do not have access to budgeted funds to manage the teams. We do not have sufficient hours to maintain our medical and logistical equipment. In the past teams would volunteer time to take care of these issues, but as we are federal employees, this is not allowed. END RESULT- team equipment is not in ready state to deploy for a disaster
  • Loss of warehouses and equipment – Each team was issued a cache of equipment to use for a disaster deployment. The team would keep the equipment in a ready state, and also would have the equipment to train regularly. DMAT’s had the capability of responding within 4 hours after a disaster. Under HHS our equipment is either being moved to locations far from our ability to maintain or train with (greater than 4 hours away), or planned to be centralized throughout the country. This may seem as prudent except for the track record of equipment shipped for previous disasters. A recent specific example of poor cache maintenance by HHS can be documented as recently as the California Wildfires. The only two DMAT pharmaceutical caches deployed to California were found to have many expired drugs and medical supplies. DMAT pharmacists spent three days rehabilitating these caches to put them in mission ready condition.  These caches came straight from an HHS warehouse and were supposed to be complete and in date. Also equipment is now not available to the local area the DMAT is based in (example no equipment in South Florida high risk for hurricanes).         END RESULT – Issued equipment will not be maintained to an acceptable level for field deployment. There will be delays in getting teams and equipment to a disaster area. Arriving teams will be in a disaster area and have to wait for equipment to treat patients
  • Inability to use team owned equipment – Due to the fact that federally issued caches are below the basic standard for delivering acute medical care after a disaster, DMAT teams have been resourceful and obtained necessary equipment with donations from sponsoring organizations. Under FEMA we legally were able to bring this extra equipment to enable us to provide state of the art medical care in disaster environments. Now under HHS we are forbidden to bring this life saving equipment with us. END RESULT- Lives that potentially could have been saved by newer and better equipment will be lost
  • Training – DMAT’s consist of medical professionals of a local community. Most often coming from many institutions. Team members do not routinely work together. In the past teams have held field exercises, often treating real patients at community functions (ex FL-5 DMAT was the primary medical agency on site for the Fort Lauderdale Air-Sea Show). This gave team members the opportunity to work with each other prior to being in a disaster situation. Under HHS we are no longer able to train in realistic medical scenarios. END RESULT- teams will not function cohesively as will be required during a disaster.
  • Delays in application processing – we have been unable to process new members for two years. The process by which the current team members have had to obtain federal approval and ID cards has been redundant, mismanaged and costly to the team member ( done on personal time without reimbursement, must travel by own means to location for fingerprinting). Medical credentialing and mandatory training (NIMS and ICS) must be done on own time. END RESULT- teams are losing expert disaster response health care practioners to government red tape, and are unable to replace them with new members

NDMS team members feel we are less prepared now to respond to a disaster than before Hurricane Katrina. This is a direct response to action taken by ASPR to dismantle NDMS. As the primary disaster medicine response agency we feel our elected leadership must look into the problems facing NDMS and the citizens of the United States who are the potential victims of the next disaster, natural or man-made