selim suner md, ms, facep director of disaster medicine professor of emergency medicine, surgery and...
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Selim Suner MD, MS, FACEPDirector of Disaster Medicine
Professor of Emergency Medicine, Surgery and EngineeringBrown University
Eric Noji MD MPH: Cutler Lecture
Disaster Rate
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
THE FEDERALRESPONSE
PLAN
DisasterOccurs
LocalFirst
Responders
CountyExecutiveAlert
RequestsAid From
GovernorFEMA
RegionalDirector
Informs
FEMADirector
Advises
President
Contacts
DeclaresDisaster
DeclaresDisaster
RequestsAssistance
EmergencyResponse
Team
EmergencySupport
Functions(ESFs)
Provides
FederalCoordinating
Officer
StateCoordinating
Officer
Appoints
Sets Up
Joins
FieldOperations
Disaster
Field Office
Federal Response Plan Activation
Coordination of all assets in a disaster may be like herding
cats
12 1
2
3
4
67
9
GSA
FEMA
ARCFEMA
USDA& FS
DOD
DOTDOE
NCS
USDA
EPA
Urban Search and Rescue
Hazardous
Materials
Food
Energy
Tran
spor
tatio
n
Communications
Public Works
Firefighting
Information
& Planning
MassCare
Res
ourc
eS
upp
ort
Support AgenciesUSDA AIDDOJ ARCDVA EPADOD FEMADOT GSADOE NCS
USPS
8
DHHSHealth & Medical
Services
8
ESF
ESF Lead Agencies
DHHS Agencies,US PHS CCRF
FEMAResponse Branch
National Disaster Medical System(NDMS)
Other Federal Agencies
Military Resources
Coordination of Federal Response
Year Event Description
1803 Portsmouth NH Fire1st Congressional Disaster Relief
1964 Great Alaska Earthquake 131 killed, 8.1 rs
1974 Disaster Relief Act Authorizes state governors to request federal assistance
1977Natural Earthquake Hazard Reduction Program
Funded research in earthquake prediction & mitigation
1979Federal Emergency Management Agency
Consolidates many agencies; emphasizes preparedness; mitigation and recovery
History
Year Event Description
1980Mt. St. Helen's volcanic eruption
58 killed
1984National Disaster Medical System
4 federal agencies led by PHS (DHHS); continues hospital bed contingency program, but also includes medical response
1985 DMATsMedical response limb of NDMS
History
Year Event Description
1989Hurricane Hugo (Caribbean, Eastern US)
51 killed, 25K homeless
1989Loma Prieta Earthquake (Bay Area CA)
62 killed, 2500 injured, 6K homeless
1990 Stafford Act
Authorizes President to direct federal agencies to provide emergency assistance to state/local jursidictions
1992 Federal Response Plan
Improves federal disaster response time; predeploys resources to predictable events and staging areas in disaster-prone communities
History
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
DMAT Roles
• Triage • Medical care• Casualty clearing• Patient staging • Patient reception • Standby
operations
Types of DMAT Medical Care
• Supplement staff in local facilities
• Primary care • Inpatient care in
free-standing field hospitals
• Public health care
Year Disaster Location1989 Hurricane Hugo East Coast1992 Hurricane Andrew Florida1992 Hurricane Iniki Kauai1993 Hurricane Emily East Coast1994 Northridge Earthquake Los Angeles 1995 Hurricane Marilyn USVI1996 Centennial Olympics Atlanta1997 North Dakota floods North Dakota1998 Ice storm New York1999 Kosavar refugees Ft. Dix, NJ1999 WTO riots Seattle2000 State of the Union Washington, DC
Year Disaster Location2001 WTC NYC2001 Anthrax NYC2005 Hurricanes Southern USA