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How Will Military/Civilian Coordination Work for Reception of Mass Casualties from Overseas?

Published online by Cambridge University Press:  28 June 2012

Colin Mackenzie ,
John Donohue ,
Philip Wasylina ,
Woodrow Cullum ,
Peter Hu  and
David M. Lam
Colin Mackenzie*
Affiliation:
National Study Center for Trauma and Emergency Medical Systems; Professor, Department of Anesthesiology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
John Donohue
Affiliation:
Director Emergency Operations Program and Regional Programs, Maryland USA; Institute for Emergency Medical Services Systems, Baltimore, Maryland, USA
Philip Wasylina
Affiliation:
Walter Reed Army Medical Center, National Disaster Medical System, Federal Communication Center Area Coordinator, Federal Emergency Management Agency Region III, Bethesda, Maryland, USA
Woodrow Cullum
Affiliation:
Fire Chief, Baltimore-Washington Fire and Rescue Department, Baltimore, Maryland, USA
Peter Hu
Affiliation:
Assistant Professor, Department of Anesthesiology and Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland, USA
David M. Lam
Affiliation:
US Army, Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland, and National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, Maryland, USA
*
110 South Paca Street, 4th Floor, Room 4-S-132, Baltimore, Maryland 21201, USA, E-mail: [email protected]
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Abstract

Introduction:

In Maryland, there have been no military/civilian training exercises of the Medical Mutual Aid Agreement for >20 years. The aims of this paper are to describe the National Disaster Medical System (NDMS), to coordinate military and civilian medical mutual aid in response to arrival of overseas mass casualties, and to evaluate the mass-casualty reception and bed “urge” capacity of Maryland NDMS Hospitals.

Methods:

Three tabletop exercises and a functional exercise were performed using a simulated, overseas, military mass-casualty event. The first tabletop exercise was with military and civilian NMDS partners.The second tested the revised NDMS activation plan. The third exercised the Authorities of State Emergency Medical System and Walter Reed Army Medical Center Directors of Emergency Medicine over Maryland NDMS hospitals, and their Medical Mutual Aid Agreement.The functional exercise used Homeland Security Exercise Evaluation Program tools to evaluate reception, triage, staging, and transportation of 160 notional patients (including 20 live, moulaged “patients”) and one canine.

Results:

The first tabletop exercise identified deficiencies in operational protocols for military/civilian mass-casualty reception, triage, treatment, and problems with sharing a Unified Command. The second found improvements in the revised NDMS activation plan.The third informed expectations for NDMS hospitals. In the functional exercise, all notional patients were received, triaged, dispatched, and accounted in military and five civilian hospitals within two hours. The canine revealed deficiencies in companion/military animal reception, holding, treatment, and evacuation. Three working groups were suggested: (1) to ensure 100% compliance with triage tags, patient accountability, and return of equipment used in mass casualty events and exercises; (2) to investigate making information tech-nology and imaging networks available for Emergency Operation Centers and Incident Command; and (3) to establish NDMS training, education, and evaluation to further integrate and support civil-military operations.

Conclusions:

The exercises facilitated military/state inter-agency coopera-tion, resulting in revisions to the Maryland Emergency Operations Plan across all key state emergency response agencies. The recommendations from these exercises likely apply to the vast majority of NDMS activities in the US.

Keywords

airport receptionairport triagecommunicationsexercise evaluationfunctional exercisehomeland securityincident command systemmass casualtymilitary/civilian exercisenational disaster medical systemreception of mass casualtiestabletop exercisesvideo communications
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 5 , October 2009 , pp. 380 - 388
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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