1. Selim Suner MD, MS, FACEP Director of Disaster Medicine Professor of Emergency Medicine, Surgery and Engineering Brown University Eric Noji MD MPH: Cutler Lecture

2. Disaster Rate

3. Urban dwellers: 1920: 100 million 1980: 1 billion 2004: 2 billion 2004: 20 cities with >10 million people Sources: CDC & EK Noji, The Public Health Consequences of Disaster Factors Effecting Disaster Impact

4. THE FEDERAL RESPONSEPLAN RESPONSEPLAN Disaster Occurs Local First Responders Local First Responders County Executive County Executive Alert Requests Aid From Governor FEMA Regional Director FEMA Regional Director Informs FEMA Director FEMA Director Advises President Contacts DeclaresDisaster Declares Disaster Requests Assistance Emergency Response Team Emergency Response Team Emergency Support Functions (ESFs) Emergency Support Functions (ESFs) Provides Federal Coordinating Officer Federal Coordinating Officer State Coordinating Officer State Coordinating Officer Appoints Sets Up Joins Field Operations Disaster Field Office Federal Response Plan Activation

5. Coordination of all assets in a disaster may be like herding cats

6. 12 1 2 3 4 6 7 9 GSA FEMA ARC FEMA USDA & FS DOD DOT DOE NCS USDA EPA Urban Search and Rescue Hazardous Materials Food Energy Transportation Communications Public Works Firefighting Information & Planning Mass Care Resource Support Support Agencies USDAAID DOJARC DVAEPA DODFEMA DOTGSA DOENCS USPS 8 DHHS Health & Medical Services 8 ESF ESF Lead Agencies

7. DHHS Agencies, US PHS CCRF FEMA Response Branch National Disaster Medical System (NDMS) Other Federal Agencies Military Resources Coordination of Federal Response

8. History

11. Disaster Medical Assistance Teams (DMATs) Nationwide network of disaster medical response teams affiliated with NDMS Medical care to disaster- impacted communities –External medical disaster assistance –Capable of processing 200-250 patients/24 hrs

12. DMAT Roles Triage Medical care Casualty clearing Patient staging Patient reception Standby operations

13. Types of DMAT Medical Care Supplement staff in local facilities Primary care Inpatient care in free-standing field hospitals Public health care