National Disaster Medical System

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Robert F. Knouss, MDa This discussion focuses on the functions of the Office of Emergency Prepared ness (OEP) within the Department of Health and Human Services (DHHS), particularly as they relate to responses to any release of a weapon of mass destruction (WMD). It is important to be aware that an infrastructure is avail able to address consequences that will be created for the health care delivery system. Our office, OEP, is responsible for responses to a variety of disasters that could overwhelm local and state health systems with casualties. Examples in clude natural disasters, transportation disasters, technological disasters, and disasters that may be caused by the use of WMDs by terrorists. A fact that may be surprising to you is that our office, under agreement with the National Transpor tation Safety Board, also provides the teams for victim identification when we have transportation disasters such as commercial airline crashes. In addition, the OEP provides health care teams in response to a terrorist attack, which could overwhelm local health care systems. We may be called on to respond to techno logical disasters, if they would cause significant shortfalls in health care capacity. The Federal Response Plan has made the federal response to disasters very understandable. Essentially, it states that during any presidentially declared disaster in the United States, 12 essential functions might have to be performed to be able to have an effective response in support of state and local govern ments, ranging from mass care to transportation, urban search and rescue, environmental health services, and health and medical services. The health and medical services function is called Emergency Support Func tion #8 (ESF-8), for which DHHS has the lead but is supported by 12 other departments. These departments work with us in providing resources to assist in meeting the challenges that would be faced by our health care system in the event of a significant disaster creating mass casualties. ESF-8 provides four principal types of services: preventive health services, environmental health services, medical services, and mental health services. Two of these services are resource intense: medical services, which might have to be provided to mass casualty victims, and mental health services. These two potentially resource intense responses are largely accommodated through the National Disaster Medical System (NDMS), which has been in existence for more than 15 years.