HEALTH
CARE
INTRODUCTION: Military medicine played a major role in the federal assistance effort. U.S. military medical personnel accepted this role as an implied task based upon President Bush's 27 August 1992 announcement of increased DOD assistance. The medical role included hands-on care of civilians and was reinforced by the Army Chief of Staff during his visit to Ft Bragg, N. C., in the initial phases of the deployment. Direct taskings from FEMA included requests for support to the Disaster Medical Assistance Teams (DMATs), medical logistical support for civilians, specialty support care for large and small animals, and water sampling for wells. All other care and assistance was provided within the framework of Health and Human Services as the lead agency for Emergency Support Function (ESF) No. 8 (Health and Medical) and with a Public Health Service (PHS) officer designated by the President as the director of the federal medical effort.
TOPIC: National Disaster Medical System (NDMS).
DISCUSSION: The NDMS was activated for Hurricane Andrew and two non-DOD DMATs deployed immediately. The DMATs were not equipped or supplied for sustained operations, but this problem was overcome by DOD resources. Fifteen DMATs were eventually deployed. The medical effort was managed within the following functional areas.
Command and Control: The military provided organizational support to the White House-designated PHS Officer, the defacto lead for ESF No. 8, by collocating the headquarters of the 44th Medical Brigade with the Management Support Unit (Forward) in the disaster area.
Treatment: Area medical coverage was provided by divisional medical assets and two area support medical companies from the Medical Brigade. Two medical companies from the Florida National Guard, working with the 44th Medical Brigade, provided support throughout the assistance effort. Support was drawn down as civilian sources of care were reestablished. Adequate civilian hospital beds were available in the greater Miami area throughout the effort even though a combat support hospital was available for augmentation if needed. Some military providers expressed concern that service regulations did not provide legal protection for them when caring for civilians who were not DOD beneficiaries. This was clarified by memorandum from the Office of the Army Surgeon General and applied to all military services.
Medical Logistics: Civilian agencies were unable to control and organize massive shipments of donated medical supplies. The 32d Medical Logistics Battalion assumed this mission and, working with the Florida Department of Health and Rehabilitative Services, supplied both civilian and military customers with the Class VIII required for humanitarian support. Geriatric and pediatric medications not on the military stockage lists became available to military providers through this mechanism.
Mental Health: State officials were supported by military consultants. Military mental health teams collected data in the disaster areas and assisted the state mental health teams in providing support to the local population.
Preventive Medicine: Military preventive medicine specialists arrived early and their efforts were coordinated through a Preventive Medicine task force. Initially, the Emergency Medical Task Force (EMTF) was headed by a PHS captain and ultimately chaired by an environmental science officer from Dade County. All services provided assets to this effort. The Air Force Reserve mosquito spray missions illustrated the importance of coordination. Public affairs, air space management, and environmental concerns all had to be addressed.
Veterinary: Organization of the state effort in care for both large and small animals injured or displaced by the hurricane was facilitated by the early arrival of Army veterinary specialists. They coordinated local, state, and national agencies in establishing immediate response programs and the return to more normal sources of veterinary care. Veterinary units deployed with missions for food inspection, animal medicine and area assessment (disease threats).
Dental: Limited military dental care for the civilian populace was required because public and private dental care was available.
All of the functional areas were integrated with appropriate members of the state health agencies. State officials were encouraged to take lead positions. The presence of a single senior DOD medical point of contact participating daily in a cooperative fashion with the PHS lead allowed the functional experts to guide the civilian relief and recovery efforts.
LESSON(S):
TOPIC: Medication Required to Support Disaster Assistance.
DISCUSSION: Army medical units arrived at the disaster site with a full complement of their basic load of standard medications. However, certain patients (pediatric and geriatrics) required medications that were not available in the unit's pharmacies. Until local servicing pharmaceutical and medical facilities became functional, some pediatric and geriatric patients went without needed medication.
LESSON(S): Medical units should be prepared to provide pediatric and geriatric support (i.e., medications) to support disaster assistance missions. DOD medical units responding to disaster assistance missions should establish a list of common pediatric and geriatric medication for use.
TOPIC: Treatment of Civilian Relief Workers.
DISCUSSION: Medical personnel were uncertain whether treatment could be provided to civilian relief workers. The JTF Staff Judge Advocate (SJA) staffed the issue with FEMA who indicated that 42 U.S.C. 5170(b) authorizes the provision of routine medical services to relief workers and disaster victims. The JTF SJA felt that military medical support should end when the civilian health care infrastructure is restored. The Public Health Service will normally determine when civilian systems have been reestablished.
LESSON(S): Medical personnel must understand who can be treated in military facilities during a disaster situation. The JTF SJA's interpretation of the legal position for providing medical support during declared disasters should be included in the medical annex of unit operation orders.
TOPIC: Requesting Military Veterinary Assistance.
DISCUSSION: Requests from private organizations and Florida state authorities were delayed unnecessarily by the lack of knowledge of the proper methods to make request for military veterinary help. The local and state civilian authorities needed military veterinary assistance on very short notice. The requesting offices were unaware that all requests had to be directed through FEMA and eventually to the Florida State officials and HQ FORSCOM. Final approval took from three to five days.
LESSON(S):
The
exact line of authority and the sequence of events for civilian organizations
to request military assistance must be clarified, defined and published.
Table
of Contents
Interoperability,
Part 2
Logistics
|
NEWSLETTER
|
| Join the GlobalSecurity.org mailing list |
|
|
|
