Introduction:
Following the events of 11 September 2001 and highlighting others lifted the state of our national vulnerability as problems in the response to Hurricane Katrina in 2004 revealed that the federal government has concentrated enormous resources framework in the development of a national response The introduction of national targets to prepare and implement a National Incident Management System. Yet amid all these changes and improvements to the nationDisaster Medical System is like a ping pong ball from the Department of Health and Human Services (HHS), has been thrown by FEMA, and then subject to the Department of Homeland Security when FEMA was merged into the new organization, and threw it into the Department of Health and Human Services, such as January 1, 2007. During this time, continue to assert publicly released documents, the NDMS has the ability to respond to national disasters. This article is in the eyeResponding to the fundamentals of the NDMS, the present state, and their ability to respond to the scenario developed by the California Earthquake FEMA, in cooperation with the U.S. state of California in 1980.
Earthquake & Tsunami In Japan
Skiing:
After touring the destruction by the eruption of Mt. St. Helens in Washington state in May 1980, President Carter's concerned about the impact of a catastrophic earthquake in California, and the state of readiness to deal with the effects of such an event. He directed theNational Security Council to examine the preparedness of the nation in such an event should be. Determined that FEMA (Federal Emergency Management Agency, 1980) "The nation is largely unprepared for the catastrophic earthquake (with a probability of more than 50 percent), which is expected in California over the next three decades." Victims of this type of event projects ranged from 3.023 million deaths and between twelve and 91Thousand requiring hospitalization (based on census data 1980). The areas were the location of the epicenter and the time of day, is hit in the incident. The California Office of Statewide Health Planning and Development (OSHPD) recently found that nearly half of all hospital areas that meet current codes and retrofits must be a deadline of 2013 state seismic safety in buildings is that are considered vulnerable to collapse during an earthquake (CaliforniaHealth Care Foundation, 2007). Current planning scenario FEMA estimates that about two-thirds of hospital beds in Los Angeles, are orange, Riverside and San Bernardino County nonfunctional (Science Daily, 2008). Based on this estimate, a population of about 10 million of service, and that the United States currently has 3.6 hospital beds per 1000 inhabitants (NationMaster, nd), with a loss of about 24,000 patient beds that are occupied for mostor patients with acute and chronic, and the infrastructure to support them. These structures would be simultaneously a wave of new patients because of quake damage from the event live sustainably. Even assuming the use of only 60% (low for the industry), and moves about 14,400 patients would need help of inter-facility transfer or evacuation outside the affected region, regardless of the sacrifices that have been generated by thoseEvent.
In 1981, President Ronald Reagan's Council of the mobilization of a national system of emergency medical response (Kramer & Bahm, 1992) to develop. The Board consisted of representatives from the Federal Emergency Management Agency (FEMA), the Department of Defense (DOD), the Veterans Administration and the Public Health Service of the Department of Health and Human Services. This board has developed the National Disaster Medical System (NDMS), which was foundedby presidential directive in 1983. Originally developed as a partnership for the scenario of a large number of military personnel back, who were swept up in a conflict overseas with a continental U.S. (CONUS) military health system to respond violated, the NDMS has never been activated original mission for this meeting (Franco, E., French horn, Inglesby, and O'Toole, 2007).
The mission of NDMS developed a system whereby civilian hospital beds, not in the affected areas could createin the event of a disaster in the United States Medical Disaster Assistance Team (DMAT), which correspond to the areas affected by a disaster (National Association of DMAT, nd), may be used. Before the NDMS, the assets available to satisfy this type of mission hospitals 1000-930 Civil Defence emergency, have been pre-positioned throughout the country until 1964. The hospital emergency civil defense, later renamed the packaged disaster hospitals, 200 bedsmobile hospitals for mobile hospitals used the same Federal procuring military equipment. These hospitals were equipped with supplies for 30 days of operations. After the Office of Civil Defense DOD 1964 Annual Statistical Report, "Hospital Civil Defence emergency (CDEH) is an austere but fully functional Hospital 200 beds developed general, set to be within an existing structure as a school, church or community center. They needed 15,000 squareSurface, which allows the separation of the stations, operating rooms and other functional areas. The staff needs was for 316 people, including 10 doctors, four administrators and staff, 34 nurses, 18 nurses, six anesthesiologists, 2 pharmacists, 128 nurses and 124 other staff, including dentists, dental technicians, X-ray technicians, maintenance technicians, managers, volunteers, messengers and leaders are drawn from local resources "(Civil Defense Museum, nd). I am a little 'more than half (25%) of the Civil Hospital Emergency Defense in 1964 has made it possible to pre-positioned a total of 100,000 beds available, with a workforce of about 150,000 people. This number of beds in the worst case scenario developed by FEMA in 1980.
The NDMS system:
Currently, the National Disaster Medical System Disaster Medical Assistance Team has 55. A type I DMAT team is able to afford 35Roster person in 4 hours with 105 or more operating staff, including 12 doctors, has a full cache of equipment and accessories Federal DMAT, and is able to triage and treat 250 patients a day mixed classification for three days. The DMAT is not and ordered a field hospital, but with the increase in domestic food storage, and additional staff recruited strategic (local survivors with the necessary skills), can triage and first aidThe functions of a type of field hospital with the patient's ability to co-found a Federal Medical Station. The Federal Medical Station requires a team of 100 people and 250 patients with stable primary care beds Services (U.S. Department of Health and Human Services, nd) the need to maintain. Therefore, all the maximum number of hospital beds, which can generate NDMS system, provided there was at least a Federal Medical Station (FMS) for DMAT team, and thatDMAT teams were type I would be willing patent 13 750 beds, with a staff of 11 275 employees. This number of beds does not even address the 14 400 patients would be moved and in need of help, including plant transfer or evacuation outside the affected region, regardless of the sacrifices that have been generated by the event.
The logic behind the apparent lack of concern for another, plus 90,000 hospital beds for the worst-case scenario presented is requestedthe bedside more than 110,000 pre-committed patients' 1,800 participants of the national disaster medical system hospitals fixed structure. Community hospitals, teaching and trauma across the country with the National Disaster Medical System have teamed up to provide through a Memorandum of Understanding, its empty hospital beds available in times of disasters. As the military struggle, the media delivery system, patients are evacuated from the affected (combat) area to a safe area andInterior (ZI).
Challenges:
The challenge for this scenario is that the aero-medical evacuation and the activities of land is needed just to carry out a mission of this magnitude. Planning factors for aero-medical evacuation of more than 6,000 patients a day in Iraq during Operation Only 97% of the aero-medical evacuation assets, the U.S. military because they represented. In addition, the effective yield of 12 632 patents on a mission evacuated671 aero-medial flights on average less than 20 patents per cell (Green, nd). So, in this density, even to evacuate 50,000 people would need 2500 cells. Even when 250 flights a day, would need 10 days to evacuate about 50,000 patients. Other forms of transport can also be used as trains and buses, but these activities are not pre-configured, and the patient would need beds, this coordination has been completed. It is expected that asignificant number of patients are not able to at least 10 days after the accident, disaster, and therefore the level of patient care beds, there is need to keep patients until the evacuation activities were available to be programmed to be evacuated .
In order to further evacuate the premise of the majority of patients required hospitalization confusing area of the Interior is the harsh reality that the patient must be stabilized first, before they can be evacuated safely.Using techniques such as delayed closure, external fixator and the like, the definitive treatment of various orthopedic surgical patients may be delayed, without a significant increase in morbidity and cost savings associated logistics of providing the supplies necessary for these procedures in carrying out the expected ' environment close medical supervision in the area. However, the stabilization of internal injuries (crush) and other medical conditions, be reached before aAeromedical staging facility evacuation or other services to manage the site is clearly a patient for further evacuation. The general rule for the military medical evacuation to the zone of the interior was that the patient should remain stable, with on-board care products for at least 24 hours. In the case of a medical system overwhelmed in the affected region, the policy of evacuation, a short distance further stabilization for evacuation to the nearest medical facilities outside the facilitatedImpact area could be provided, but these institutions would also need to be transferred and to evacuate their patients through the area of the interior. To avoid additional calls on themselves and lose their ability to attract new patients from the affected area to obtain due to lack of hospital beds would also need to be expanded system with funds from the National Medical Disaster.
The reality:
This discussion is about the presence of DMAT teams in theNational Medical Disaster System. Unfortunately, not all DMAT teams are in the Type I level of preparation. In fact, according to David GC McCann, MD Former Chief Medical Officer of FL-1 DMAT in 2003, a Senior Policy Fellow in the 2008 Homeland Security at George Washington University Homeland Security Policy Institute and current President of the Board of Disaster Medicine (ABODM), the "NDMS is like DHHS (Department of Health and Personnel Office) is preparing to update marginalizedCorps commissioned the USPHS (United States Public Health of the Service) as a "first line" used in the event of a disaster "(McCann, 2008). In support of this assertion, Dr. McCann, which reflects the number of volunteer members of the teams DMAT has declined from about 7000 to about 5000, that the contract that training for members of DMAT, which was necessary for teams to run as a type I 31 October 2005 and has not been renewed or replaced (University of Maryland, Baltimore, Maryland to be certified, ifCounty, 2005), which, despite a budget increase of 6.3% for FY08 over FY07 teams have significantly reduced funds and their manager is forced to keep the management team's credentials and documents in just over 20 % of the budget he had last year. He also said that there was a complete block to recruit NDMS supported over 2 years, like this: "Perhaps 10% of the 55 teams are Type 1". According to the RI-1 DMAT Team Deputy Commander, Tom Lawrence,his team is one of the 31% of all goods NDMS team, type I got ready, and which are "very soon nurses" (Rhode Hospital Iceland, 2008).
Bill Hall, spokesman for the Department of Health and Human Services, Dr. McCann claims disputes, said the department remains "fully committed" to NDMS. "We are not closing or team available. In fact, for fiscal year 2009, HHS is proposing an increase of 7,000 thousand dollars for NDMS." The commanders of six Florida-based DMATpublished online your letter at the site of the National Association of DMAT (Kruschke, et al., 2008), had "confirmed by multiple independent sources" within the department, the NDMS and HHS officials to replace "a systematic plan for deemphasize committed "with the PHS DMAT commissioned a new body of public health response (HAMR) teams, but Hall insisted that the teams HAMR play a" complementary role "to DMAT. "No one will be" replaced. (Garza, 2008)
Regardless of theHe validity of the claims or the commander of DMAT Florida or the spokesman of the Department of Health and Human Services, is easy to see that the current state of DEMAT teams in the National System of Disaster Medical is suboptimal. In a presentation on its website targeted elected officials, the press, the National Association of their concern for the DMAT teams HAMR, budgetary issues, the loss of storage space, the inability of the team are using devicesTraining, and delays in processing application. They conclude their remarks with the statement "NDMS team members feel less prepared now for a disaster to respond before Hurricane Katrina. This is a direct reaction to the actions to be taken to dismantle ASPR NDMS. The primary agency interventions medical emergency, we feel we need our elected leadership problems in the NDMS and the citizens of the United States, the next potential victims of the disaster is natural or artificial-looking "(National Association of DMAT, nd).
In September 2008 the National Biodefense Science Board (NBSB) feedback to the U.S. Department of Health and Human Services on the review of the National Disaster Medical System (NDMS) and national capacity for medical intervention such as the pandemic and the risk of all necessary legal preparations (PAHPA ) and as in § 28 of the Homeland Security Presidential Directive (HSPD) -21 indicated. (National Biodefense Science Board, 2008). The report highlightedconfidentiality was available on the open Internet. He made thirteen recommendations, which were summarized and listed below:
1 Strategic Vision: NDMS ... should not be a complete system for the medical needs of patients at a time of national.
2 DEVELOPMENT OF A NDMS / ESF-8 ADVISORY GROUP: The foundation of the group of civilians in the process of consulting for the National Medical Disaster System.
3 NDMS improve monitoring and documentation, previous studies haveidentify ways to improve the NDMS ... does not seem to try an organized method for tracking and monitoring, to address these identified problems.
4 PERSONAL medical response: In order to achieve full staffing and operational status for all NDMS Response Team ... An improved method and optimized for the DMAT membership is required. Develop a training program to be adopted and implemented.
5 NDMS field personnel and skills gap analysis:It should answer to improving the NDMS personnel, especially in relation to the responsibilities of volunteers and conflict of time, are given for different scenarios specified country.
6 DEFINITION OF NDMS Patient: The definition of what should be under a "NDMS patient" to be reviewed and extended for reimbursement.
7 Refinement of the concept of motion using the patient's ability to provide an effective and easy to implement the mass evacuation of patients fromtrapped field remains an unsolved problem.
8 NDMS Electronic Medical Record (EMR): Although the advantages of EMR are many ... Its use must not impair the efficiency of service providers in the field.
Better communication with 9 REPRESENTATIVE OF STATE / LOCAL: it should be seriously considered for the return of the DMAT program to its original intent of the first building and the capacity of local government, and then export of these resources by volunteering for the NDMSFederal support for other parts of the country affected by a disaster.
Development of improved NDMS 10 feet should seriously consider the creation of alliances between NDMS and improved public health sector / private to help field maintenance, patient transport and patient care to give definitive.
11 Federal Regulations: Criteria should be developed in advance to determine when federal regulations related to health (eg HIPAA) must be consideredtemporary suspension.
12 NDMS GENERAL FINANCING: It 'not clear that sufficient resources required for the NDMS to search the current state of the NDMS to support operations.
13 The Department of Health and Human Services is asked to respond to these recommendations in writing to its summer 2009 public meeting.
Conclusion: The materials presented here clearly show the national disaster medical system that is not prepared for an earthquake of great magnitude responseCalifornia. The NDMS system can now confidently as broken, and the challenge of the next government is to address these problems in time, be called before the system needs to meet the medical needs of our citizens during a major or catastrophic event.
Selected References:
California Health Care Foundation. (2007, January 18). To satisfy nearly half of California hospitals unprepared for the seismic safety deadlines. Accessed October 15, 2008, fromCalifornia Health Care Foundation Press: http://www.chcf.org/press/view.cfm?itemID=129513
Federal Emergency Management Agency. (1980, November). An evaluation of the consequences and the preparations for a catastrophic earthquake Californis: the results and actions taken. Accessed September 24, 2008, from Project Gutenberg: http://www.gutenberg.org/files/18527/18527-h/18527-h.htm
Garza, M. (2008, May). Special Report: DMAT at risk? Accessed October 15, 2008, from JEMS.Com:[Http: / / www.jems.com/news_and_articles/articles/jems/3305/dmats_in_danger.html]
Kruschke, G., Hendrickson, B., Wrona, N., Sloop, K., Caprio, J., Parker, L., et al. (2008, February 1). Letter from the Commander of Florida. Accessed 15 October 2008 the National Association of Disaster Medical Assistance Teams: [http://www.nadmat.org/File/FLCommadersLetter.pdf]
McCann, DG (2008, February 4). NDMS: Do Not Go Gentle into that good night. Accessed October 15, 2008, the NationalEmergency Management Summit, Agenda One Day, Monday Febriuary 4, 2008: http://www.emergencymanagementsummit.com/past2008/agenda/day1.html
National Association of DMAT. (Nd). Presentation to elected officials. Accessed 19 October 2008 by the National Association of DMAT: [http://www.nadmat.org/index.cfm/m/5/dn/Presentation] for elected representatives /
National Disaster Medical System, may react to a major earthquake in Southern California?
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