Disaster Medicine in New York: Are You Prepared?

Melissa M. Fiorini, MD FACEP, Attending Emergency Physician, St. Luke’s-Roosevelt Hospital Center

“I had my bags packed, plane ticket in hand, invited by the state of Louisiana to come to Baton Rouge. The day before I was leaving, they told me the feds had told them there are too many docs, and to cancel all trips. I canceled. About an hour later, the federal credentials group called me and told me they had 1000 doctors), and needed 70000, and to call a number right away to let them know I could come. I called. Then they told me I couldn’t go until they completed the paper work.”

We have all heard stories of frustration in the aftermath of Hurricane Katrina. So many health care providers were willing to offer their time, expertise and their bedside manner, but were unable to due to what seemed like a lack of a coordinated and timely response. What was the right thing to do? Was it right to go down to the Gulf and jump right in? Or do health care providers who enter into disaster zones on their own (“self-deploy”), cause more chaos?

Emergency management experts agree that it is critical that providers not self-deploy to disaster areas, but rather align themselves with organized efforts being undertaken by the authorities and relief agencies in the affected areas.

“It is important for people to realize that rushing to a disaster when it occurs is not the ideal scenario,” states Dr. Phillip Hew, Medical Director of Emergency Medical Services, St. Luke’s/Roosevelt Hospital and former NYC Urban Search and Rescue Team Member. “The key is to be prepared by having the necessary knowledge base and training in disaster health care. Being prepared and knowledgeable decreases the frustration level of everyone involved.”

This applies not only to dealing with the devastating effects of natural disasters, as we have seen with the recent hurricanes, but also in dealing with the aftermath of a terrorist attack, something many New Yorkers may be more focused on. Therefore, we would like to provide you with information about how you can get involved in disaster response programs on a city, state and national level, before the next disaster occurs.

There are several organized groups, which New York health care providers may join to become better prepared:
1.) The New York State Volunteer Program: The New York State Department of Health (NYSDOH) through a partnership with the New York State Nurses Association (NYSNA) and the Medical Society of the State of New York (MSSNY) has instituted a New York State Volunteer Program for physicians and nurses. Health care providers who join this program may be activated for various types of emergencies, and may be asked to travel to other counties in New York State during an emergency. If activated by the State, you would be considered an employee of the state and will be provided defense and indemnification under the Public Officers Law Section 17. The program is being expanded this year to include nurse practitioners, physician assistants, dentists, and pharmacists. Interested providers should log on to the New York State Health Information Network (HIN) at https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/mpvols/VolunteerHome.

2.) The Medical Reserve Corps/New York City: The New York City Department of Health and Mental Hygiene (NYCDOHMH) has developed a Medical Reserve Corps to organize a multidisciplinary group of health professionals who would be available to assist New York City during a large-scale local health emergency. Volunteers in the MRC/New York City will be asked to serve in one of the five boroughs where they live and/or work during a public health emergency. If activated by the City, volunteers will be considered extensions of the City’s workforce and indemnified through the General Municipal Law Section 50-k.

There are currently 16 MRC units in New York State. Volunteers may register with both their local MRC unit, and the New York State Volunteer Program to ensure that they are trained in their local emergency protocols, but are also available to assist elsewhere in the state, if necessary. For more information on the MRC/New York City visit www.medicalreserve.org or call 311. For information on a MRC unit in your area, visit the national MRC website at www.medicalreservecorps.gov.

3.) Disaster Medical Assistance Teams/DMATs: (DMATs) are a group of professional and paraprofessional medical personnel designed to provide emergency medical care during a disaster or other event. DMATs are a community resource available to support local, regional, and state requirements. However, as a national resource they can be federalized to provide interstate aid.

DMATs deploy to disaster sites with teams that consist of thirty-five members, the composition of which depends on the type of disaster for which they are responding. They have sufficient supplies and equipment to sustain themselves for a period of 72 hours. In mass casualty incidents, their responsibilities include triaging patients, providing medical care, and preparing patients for evacuation. In other types of situations, DMATs may provide primary health care and/or may serve to augment overloaded local health care staffs. Under the rare circumstance that disaster victims are evacuated to a different locale, as we saw in Houston, DMATs may be activated to support patient reception and disposition of patients to hospitals. DMATs are designed to be a rapid-response element to supplement local medical care until other federal or contract resources can be mobilized, or the situation is resolved.

When members of DMATs are activated as Federal employees, licensure and certification is recognized by all states. They function under the National Disaster Medical System (NDMS) (in conjunction with FEMA), a federally coordinated system that augments the Nation’s emergency medical response capability. The overall purpose of 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 a disaster. DMAT members will then have the protection of the Federal Tort Claims Act in which the Federal Government becomes the defendant in the event of a malpractice claim.

There are two New York DMAT teams, DMATNY-2 and DMATNY-4 stationed in Westchester and Pamona, NY, respectively. There is also a New Jersey DMAT team as well, which may be closer to New York City. Health care providers who would like to join a DMAT may visit www.dmatny2.org or www.dmatny4.com for more information.

Most of us can identify with being emotionally charged and desirous of ways to get involved in the weeks and months immediately after 9/11 and, now, after the recent hurricanes. As Anne Rinchiuso, director of New York City’s Medical Reserve Corps explains, “Unfortunately, as time passes and we settle back into our daily routines, we tend to forget how greatly the assistance of health professionals may be needed during a disaster. That is why it is critical to become a member of an organized volunteer program and continue to hone your preparedness skills.”

New York ACEP would like to invite those of you who have stories to tell and who continue to be a part of disaster planning to submit information that we can publish to www.nyacep.org, so that we may keep our readers informed and aware of the ongoing task of disaster preparedness.