DMAT Response to Hurricanes Charley and Katrina in Florida

Introduction to Disaster Medical Assistance Teams

Disaster Medical Assistance Teams (DMATs) are defined as "a group of professional and paraprofessional medical personnel designed to provide emergency medical care during a disaster or other event" (McEntire 156). They are utilized when a disaster or other event results in local medical professionals being overwhelmed by the situation. The system was established by the National Disaster Medical System (NDMS) in 1985 as a result of a meeting between local and state experts. There are currently 80 DMATs in the NDMS, with more than 7,000 medical and support personnel taking part.

DMAT teams carry their own supplies and are able to work for a prolonged period of time, even in challenging conditions. Any supplies are replenished by the NDMS so that the teams can remain operational throughout the disaster, for as long as required. DMAT teams are usually able to work entirely independently of local teams, and also supply their own housing and field hospitals. This is important because local resources are likely to be stretched already in the event of a disaster serious enough to warrant DMAT involvement. A DMAT comprises various medical professionals, all of whom must undertake and maintain appropriate training. DMAT team members are on standby 24 hours a day, and in the event of deployment they will be notified and attend the scene within 12 hours, although the urgency of most situations means that members typically attend immediately (McEntire).

Across the United States, DMATs have been deployed to a wide variety of natural and man-made disasters over the last two decades. These have included terrorist attacks such as 9/11, epidemics such as the anthrax attacks in the same year, wildfires, blizzards, plane crashes, and earthquakes. The two types of natural disaster in which DMATs have been most predominantly used are hurricanes and floods (Mace).

South Florida DMAT-5: Composition and Capabilities

South FL DMAT-5 is the South Florida Disaster Medical Assistance Team. Upon deployment, the team's responsibility is to provide medical care to the sick and injured. This may mean using local hospital facilities, or it may mean setting up their own field hospital or mobile units if no permanent medical facilities are available. The team may also be required to participate in patient care and transportation, moving disaster victims away from the site. This is usually only part of the DMAT's duties when victims are considered to be in immediate danger, as other agencies handle transportation in non-urgent situations.

The team is comprised predominantly of doctors, nurses, paramedics, and EMTs. However, a number of support staff — including pharmacists, communications personnel, and logistics personnel — are also essential to ensure the team's continued operation once deployed. Although the team is designed to provide medical assistance at the disaster site, support team members are equally vital to fulfilling its various roles. The team must bring all its own supplies, as there is no guarantee that resources will be available at the disaster site. This makes logistics members of the DMAT crucial. Communications staff are also critical, as standard methods of communication may not be available at a disaster site. At the scene of natural disasters it is very likely that telephone lines will be damaged, making both landline and mobile calls impossible. It is essential that the team be able to communicate with one another and with outside facilities to arrange the transfer of critically ill patients beyond the disaster zone.

South FL DMAT-5 also operates as one of three FEMA International Medical Surgical Response Teams — highly specialized DMATs capable of setting up and running their own freestanding hospital facilities (Young). This makes FL DMAT-5 particularly suited to responding to the hurricanes that frequently affect the region. Hurricanes often disable area hospitals through the damage they cause, which means DMATs are far more effective when they can operate completely independently of permanent medical facilities, as FL DMAT-5 is able to do.

The South Florida DMAT, like all DMATs, is available for deployment to a range of disasters. To date, however, it has been deployed to two events: Hurricane Charley, which struck Florida, and Hurricane Katrina in New Orleans. Despite having been deployed only twice, both were very large-scale incidents in which the DMAT's role proved indispensable. The team also maintains readiness through regular drills in the Florida Keys (South Florida DMAT FL 5). This ensures that the team's disaster management skills are always current so that they can manage disaster medical response efficiently — an important consideration, given that a large number of other medical and support staff would look to the team for direction during an actual disaster.

Hurricane Charley struck Punta Gorda, Florida, in August 2004, and was one of four hurricanes to hit Florida that year. It made landfall on August 13 and was rated Category 4 on the Saffir-Simpson scale, indicating significant potential for property damage and flooding. Due to the overwhelming demand for medical services, South Florida DMAT-5 was deployed in response. They were specifically dispatched to assist the victims in Charlotte County, where all four hospitals had been damaged by the hurricane and were struggling to cope with the enormous influx of patients.

Hurricane Charley: Deployment and Preparation

The disaster was further complicated by the higher-than-average proportion of elderly residents in the area. Overall, 45% of Charlotte County's population was aged 65 or over. This created an urgent need for prompt medical care, as the elderly were placed at substantially greater risk from disaster conditions than many other demographic groups.

When the hurricane hit, residents had only approximately three hours of warning, as early indicators suggested the storm would make landfall around 70 miles north of Port Charlotte and Punta Gorda. This left little time for adequate preparations. Overall, the hurricane caused $14 billion in property damage and resulted in 31 deaths across the state. It caused an immediate loss of electrical power upon making landfall, and disrupted running water and sewage systems — all of which severely impacted daily life for residents. These conditions also seriously hampered rescue efforts by limiting the resources needed to care for the injured and homeless. The loss of electricity caused particular problems: where generators would normally substitute for mains power, many gas stations had been severely damaged, and fuel pumps could not operate without an electricity supply. The hurricane also disrupted communications, as large numbers of telephone lines were brought down across the area. This made it difficult for residents to contact family to arrange alternative accommodation and for individuals to call for assistance.

The large proportion of elderly residents meant that these disruptions had especially serious consequences, as pre-existing health conditions make it difficult for the elderly to go without regular medical care — which was severely compromised by the storm. The absence of basic amenities placed the elderly at even greater risk.

The damage suffered by hospitals in the area created a clear need for DMAT involvement to provide immediate shelter, working emergency medical facilities, functioning pharmacies, and the ability to refill home oxygen tanks.

South FL DMAT-5 was placed on alert on August 11, meaning it had to be ready to deploy within two hours of being called. This prompted pre-loading of supplies for the mission and ensured that all personnel were packed and ready to depart at a moment's notice. The team was deployed to the disaster at 1:30 a.m. on August 14, 2004. Although South FL DMAT-5 had no prior practical deployment experience as a team at that stage, their training ensured they were well prepared. The availability of a DMAT in the region saved valuable time in mounting a response. Without it, local healthcare facilities would have had to organize their own response — contacting staff who may not have anticipated being called, potentially resulting in unavailability at short notice and a significant delay in providing support to healthcare professionals already at the disaster site.

The DMAT's initial duties were to assist the nursing team at Charlotte Regional Medical Centre, where most nurses had been on duty for approximately 40 hours. This was due to difficulties relief staff faced in reaching the facility, as well as the problems caused by power failures and structural damage at the hospital (Cohen and Mulvaney). This early assistance was invaluable: had the DMAT not been so well prepared and arrived so promptly, pressure on the hospital's existing staff would have been far greater, significantly reducing the quality of patient care.