This Is What It’s Like To Be On Call For Disaster



disasterweek

When catastrophe strikes, who you gonna call? Turns out, there
are teams of people across the country, ready and willing to
head straight into the arms of the next destructive event.

Posted on June 24, 2017, 16:15 GMT

He has no idea when his next work trip might be, but Danny
McPhaul’s suitcase is already packed. “I’ve got a ‘go’ bag.
It’s got my uniforms, MREs [ready-to-eat meals], lots of
clean socks and underwear,” he said. “Oh — an extension cord!
You always need an extension cord.”

Extension cords come in handy when setting up a field
hospital, which is a large part of McPhaul’s side gig, as
Deputy Commander of a Disaster Medical Assistance Team
(DMAT). In some cases, DMATs deploy to provide disaster
relief in the event that an incident occurs. A team will
travel to D.C. for the State of the Union, or to whichever
city is hosting the Super Bowl.

But DMATs primarily assist state and local resources in
responding to events that lead to a medical surge. “If you
fill up a cooler of water, and put too much water in, it’ll
overflow — that’s kind of like a medical surge,” McPhaul told
BuzzFeed. “If a hospital typically sees 100 patients a day,
and all of a sudden they’re seeing 1,000, DMAT is used to
decompress that medical situation.”

Most people would find it unusual to sit around, waiting for
disaster. As a full-time firefighter, McPhaul is used to
waiting for the unthinkable. But he admits he finds himself
checking the weather report, and scanning headlines, more
than the average person.

“I’m a news junkie,” McPhaul said. “Especially this time of
year, especially living in Florida,” he added, in a nod to
hurricane season.

“You always need an extension cord.”

The word “disaster” encompasses a whole number of events:
hurricanes, tornados, chemical spills, terrorist attacks.
Each one is unique in terms of the number of injured,
mortally wounded, and displaced, but they do share at least
one commonality: Because they happen suddenly (and often with
no warning) disasters are difficult to plan for. So when
catastrophe strikes, who you gonna call? Turns out, there are
teams of people across the country, ready and willing to head
straight into the arms of the next destructive event.

There are a lot of acronyms involved with disaster assistance
in the U.S. Let’s start with the NDMS, or National Disaster
Medical System, a federally coordinated healthcare system and
partnership of the Departments of Health and Human Services,
Homeland Security, Defense, and Veterans Affairs. The NDMS
works to support state and local authorities following
emergencies, by supplementing health and medical systems as
needed. They do so through the deployment of disaster
assistance teams, of which there are several types: Disaster
Medical Assistance Teams (DMATs) provide moderate medical
care; the Surgical Response Teams provide surgical and
critical care support; the National Veterinary Response Team
supplies veterinary care; and Disaster Mortuary Operational
Response teams provide victim identification and mortuary
services.

Courtesy Danny McPhaul

The DMAT’s Base of Operations during Superstorm Sandy.

“We have approximately 5,500 DMS federal intermittent
employees [i.e. not full-time federal employees, and only
available when the government requires them to be],” Ron
Miller, the Acting Director of NDMS, told BuzzFeed. “There
are 72 total teams: one for victim identification, one vet
team, three trauma teams, 10 mortuary teams, and 57 DMATs.”

The DMATs are “the workhorses of the disaster system in the
U.S.,” Dr. Selim Suner, the team leader for the Rhode Island
DMAT and an international expert in emergency preparedness
and disaster medicine, told BuzzFeed. “When deployed, they
travel with about 30 people and equipment and supplies. It’s
completely self-contained.”

If the team is traveling just a few hours away, they’ll
drive. Any farther, and they fly. “Typically, if we’re
traveling nearby, we’ll rent Tahoes or other SUVs and drive
in a convoy to the affected area,” said McPhaul. “If it’s
further, we’ll connect with the HR department in DC and
they’ll set us up with airline ticket.”

Once team members arrive at a destination, they’ll “stage”
(i.e. wait for the rest of the team to arrive) and then head
to wherever they need to go — for Superstorm Sandy, they took
a bus to an area in which they could set up a field hospital.

Though they pack their own personal belongings, larger pieces
of equipment (tents, medical appliances, etc.) typically
arrive separately.

“NDMS has caches of equipment at hospitals all around the
country,” McPhaul said, “but, if it’s not enough for the
amount of time we’ll be somewhere, an NDMS employee will fly
up as needed to deliver more equipment. Our base of
operations is self-sufficient up to 72 hours before we need
new equipment brought to us.”

Courtesy Danny McPhaul

McPhaul checks in during Superstorm Sandy.

At any given time, there are at least 15 DMAT teams on call
throughout the U.S. “So that means if something happens, a
team would be called and respond within 24 hours,” Suner
said. In some cases, teams get advance notice that they’ll be
deploying. Before Hurricane Katrina made landfall, for
instance, teams were deployed to the area, to ensure quick
response times.

“Our first ever deployment was in 1989, during Hurricane
Andrew,” Miller said. In the years since, they’ve responded
to a whole host of disasters. Suner himself has led a team of
disaster specialists to provide support in the wake of the
September 11th terrorist attacks, Hurricane Katrina in New
Orleans and Mississippi, and the anthrax attacks in New York
City.

Each case is different. The anthrax response, for instance,
was primarily focused on providing education and antibiotics
to postal workers who may have been affected. “We set up a
system where all the postal workers would come into a room,
we would medically screen them, give them prophylactic
antibiotics and educate them,” Suner said. “There were a
couple of patients we did send to the hospital, out of an
abundance of caution.”

Many members of the team (all of whom have to apply for the
job through the federal government) have medical backgrounds
as doctors, nurses, or EMTs. But those medical professionals
are supported by a cadre of decidedly civilian administrative
staff. “We have information technology, communications,
safety, and security professionals on all the teams as well,”
Miller said. “Employees on NDMS range from a race car driver
to a greeter at Walmart to doctors who own private
practices.”

Wilfredo Lee / AP

Nurse Ann Hetrick prepares a cot in a Disaster Medical
Assistance Team (DMAT) tent in Florida after Hurricane
Wilma in 2005.

McPhaul joined DMAT around 2002, after seeing a news segment
about a team in South Florida. As a member of a DMAT, his
employment falls under the Uniformed Services Employment and
Reemployment Rights Act of 1994, a Federal law that
establishes rights and responsibilities for uniformed Service
members and their civilian employers. So, when disaster
strikes, he’s free to pack up and leave his day-to-day
duties. “We all have ‘real’ jobs outside of the DMAT, so this
is something we do part-time — when something happens and
it’s our team’s time to go, we deploy,” he said.

Because so many different types of emergencies can occur
during a disaster, those responding need to be ready for
anything. “We have multiple avenues of training,” Miller
said. “We provide training in Anderson, Alabama through a
partnership with FEMA. We go over the fundamentals — getting
everyone refreshed on the equipment and our systems — and
also provide scenarios.” Those scenarios involve actors and
health mannequins with specific conditions which can be
treated and injected as if they were real-life patients.

Though there are teams in various regions throughout the
U.S., they don’t respond to disasters based on location.
“Florida, for instance, has a couple of teams,” Miller said.
“But if something bad happened in Florida, we wouldn’t use
those teams, because we’d be pulling capabilities and
resources from the state.” When Hurricane Matthew hit the
Sunshine State, a team based in Pennsylvania responded.

Employees on NDMS range from a race car driver to a greeter
at Walmart to doctors who own private practices.

Deploying every type of team at once is extremely rare — in
fact, Miller can’t name a single instance in which teams from
every division (DMAT, Veterinary, Trauma, mortuary, and
victim identification) deployed for one disaster. “During
Hurricane Sandy, all teams were activated [i.e. placed on
orders to deploy] but the trauma team did not deploy,” he
said.

There have been instances, however, in which personnel from
nearly every type of team deployed to a disaster zone. In the
wake of the January 2010 earthquake in Haiti, for instance,
personnel from four out of five teams deployed (the
veterinary team did not).

The veterinary team travels most infrequently, generally only
deploying to help support federal animals (police K-9s,
Capitol Police horses, and the like). They did respond,
however, in the wake of Superstorm Sandy, said Miller. “The
vet team doesn’t typically support pets but, because people
left in such a hurry without taking their pets, the state
asked for an exception. The team went to help shelter
organizations, which were overwhelmed.”

The mortuary affairs team is deployed only in cases in which
there have been multiple fatalities. “After [the 2011 tornado
in] Joplin, we sent our mortuary affairs team to support the
city with victim identification,” Miller said. “They work
on-site with families to gather information and turn that
information over to local or state coroners who will then
make identifications.”

The DMATs, which provide care for those suffering from non
life-threatening injuries, travel most frequently, deploying
to augment hospitals or healthcare facilities that are
inundated with patients. “During Hurricane Matthew last year,
a hospital in Florida lost power and wasn’t able to fully
treat patients,” said Miller, “so we sent in the augmentation
of a DMAT and they set up outside the hospital.”

Paul Moseley / MCT

Members of TX-4 DMAT after Hurricane Gustav in 2008.

McPhaul has responded to a number of disasters, though his
most notable was the 2010 deployment to Haiti. “The
earthquake hit sometime in the afternoon, while I was working
a woods fire,” he recounted. “I got back to the station and
my wife had called me, saying there was an earthquake in
Haiti. I immediately turned on CNN and saw what was
happening.”

Later that same night, he got a call from his DMAT commander,
asking him if he had a passport. “The team that was up for
call [deployment] that month was based in New Jersey, but its
commander didn’t have a passport,” he said. “So I was asked
to serve as deputy commander. I had just worked a 24 hour
shift at the fire station when I got the call.”

Less than 48 hours later, he was on a plane to Atlanta to
meet up with the New Jersey DMAT team. One by one, the
members of the team met at a hotel near the
Hartsfield-Jackson airport and, the next morning, headed to
Haiti on a government-chartered flight.

During large-scale events (States of the Union, Super Bowls),
DMATs will typically stay in hotels, but disaster-ravaged
areas are entirely different. “I was in Haiti for a month,”
McPhaul said, “sleeping on a tennis court under mosquito
netting. Sometimes we stay in austere conditions, eating
MREs, stuff like that. We have tents set up for sleeping
areas in some cases. We can live in the tents. Now, if
there’s a special event like the Super Bowl or State of the
Union, that’s when we stay in hotels.”

Courtesy Danny McPhaul

A DMAT field hospital in Haiti following the 2010
earthquake.

Typically, NDMS teams are deployed at the request of a state,
but there are exceptions. “During catastrophic events, the
president has the authority to deploy us without the states’
request,” Miller said.

McPhaul has deployed in some cases where there hasn’t been a
disaster at all, but there’s the potential for one. “I
deployed to the G-8 summit when it was up in Sea Island; they
send teams to D.C. for Fourth of July, for the State of the
Union, for Police Memorial Weekend,” he said. “Any kind of
national security event, teams will go as a precaution.”

One such event includes the potential rupture of the Cascadia fault which,
stretching from Northern Vancouver Island to Northern
California, is capable of producing what could be the worst
earthquake in history. It’s impossible to know what the
result of a rupture would be, but the disaster teams do have
a response plan in place — despite the fact that they
wouldn’t be allowed to travel to the area, due to potential
aftershocks. “Instead, patients would be evacuated to us,”
Miller said. “We’re ready if that happens.”

Another potential disaster lies on the New Madrid Fault Line,
a seismic zone in the southern and midwestern United States.
And then there are hurricanes, an all-too-regular occurrence
in McPhaul’s home state. “If New Madrid happens, that’s going
to be a bad day for the whole country. And Category 5
hurricanes are getting stronger and stronger,” he said.
“There are just so many things that happen that you wouldn’t
expect — look at Pulse Nightclub.”

And despite the fact that he and his colleagues undergo
rigorous, periodic training, he admits no one can be prepared
for every horrible situation. “We aren’t trained for
everything, but we are problem-solvers,” he laughed. “Pretty
much everybody on the team is a Type A personality. We try to
determine the best way to remedy the situation, whatever it
may be.”

This week, we’re talking
about preparing for and surviving the worst things
imaginable. See more Disaster Week content here.

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