Responding to Disasters Far and Wide

David J. Holcombe, M.D., M.S.A., Regional Medical Director, Region 6 (Alexandria Region)

The Louisiana Department of Health’s communications team talked to Dr. David Holcombe about his recent deployment to Washington, DC as a member of a federal disaster medical assistance team, or DMAT. Holcombe is the regional medical director for LDH’s Office of Public Health in the Alexandria region. During his deployment, he served as the Chief Medical Officer in the Federal Medical Station that is housed in the Hubert H. Humphrey Building, headquarters for the Department of Health and Human Services.
 
What is a Disaster Medical Assistance Team?
A DMAT is a group of individuals that form a unit that can be mobilized to administer medical care in and following a disaster. Members must be hired as any federal employee, but only work when they are mobilized in a disaster.

What does a DMAT team do?
DMATs usually provide acute medical care, often to assist hospitals because of damaged infrastructure or overwhelming need.  They can also be co-located with a FMS (Federal Medical Station comprised of U.S. Public Health Service employees) to assist in the practical care delivery.

What circumstances trigger a DMAT being activated?
DMAT teams are on call for specific months, but in large scale disasters, individual members can back-fill missing personnel in another team.

The Secretary of the Department of Health and Hospitals can request the Assistant Secretary of Preparedness Response (ASPR) to call up the teams.  Members are not mandated to go, but once they agree and orders are issued, they are considered part-time federal employees under federal employment.

What are the different roles of the members of a DMAT team?
Each DMAT team has a commander, an administrative officer, a logistics person, two or more doctors, two or more mid-level providers, several nurses, a pharmacist, a chaplain, various emergency medical technicians and other personnel.  Teams can be as small as 24 people and as large as 50. In the future, the federal government plans to standardize the size of each team to 35 members.

How is someone selected to be a DMAT member?
Members in a DMAT apply to the team and are chosen for their qualifications. Hiring varies from year to year and requires going through the regular (and fastidious) federal job application.

How were you selected?
Almost seven years ago, I was approached by the interim commander for LA-1 DMAT because they needed physicians, especially ones with disaster preparedness knowledge. They actually prefer ER doctors, orthopedists, trauma specialists and other practicing physicians, but they can and will use internists and family practice if they will provide consistent support.

Where are you deployed now? For how long?
My current deployment is with at the Secretary's Operation Center, much like our state-level emergency operations center, or EOC.  Deployments are two weeks, but may be shorter if the event is not prolonged or they may be longer if the need arises and the personnel is amenable for extension.

Given the huge problems in Puerto Rico and the back-to-back storms of Irma and Maria, this mission usually requires a 30-day commitment (although my orders are only for two weeks).

What is the responsibility or mission of your DMAT team?
Since our team, Delta-1 (a combination of the former Louisiana and Mississippi teams) was not on call until October and the need was so great, many members of our team (including myself) were called to fill specific positions in various teams and locations. 

What are your responsibilities?
My current position is to be the night Emergency Management Group Chief Medical Officer.  The CMO works with physicians in the field, notably the CMOs of the IRCTs (Incident Response Command Teams).  These physicians oversee the teams in the field and coordinate logistic requests, safety issues and other operational aspects. 

Describe your typical shift.
My shift starts at 7 p.m. and goes until 7 a.m.  I answer any calls that come in from the field (which is rare).  The CMO also tracks the patient volumes through the Health Information Registry, which also provided specific information about providers.

Providers such as myself s must be capable of deployment and, as such, must have completed a Responder Health Survey. They may be classified as non-deployable if there are significant health issues. 

Each shift must prepare an activity log which goes into a larger document for the Assistant Secretaries review.  The CMO works with those preparing other reports, including the public information officer and Fusion team.  The Fusion team compiles sophisticated maps of recourses including the deployment of teams and the status of available local health resources.

Do you come in contact with people who are served by the DMAT team?
Those in the SOC (Secretary's Operation Center) are not in direct contact with those who are being served. It is more like a command center where multiple groups work to oversee operations.  The more teams deployed, the greater the complexity of the operation.

Although we may incidentally receive individual requests for services, those are generally referred back to those in the field. 

What has been the most memorable thing to have happened during this deployment?
Perhaps the most memorable thing has been the extent of the resources (human and material) the National Disaster Management System oversees. These are extensive and expensive operations, but do provide much needed medical care in areas where it is unavailable. The number of moving parts is extraordinary, not unlike any state emergency operation. Yet somehow, it all comes together.

The other memorable aspect is the competence of the individuals involved. Most of the SOC participants are long-standing HHS employees in one capacity or another.  Like most workplace environments, many people are used to working together in many events and have an enormous advantage over those from the outside.


That being said, when events are very long, very complicated and very intense, even their personnel cannot sustain 12 hours shifts indefinitely. Allowing my colleagues to go home and rest, and even have a day off, allows them to work at their full potential. The breadth and depth of the operation is impressive, but, much like Louisiana, it is not inexhaustible.  

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