Region Prepares for Terrorism
By Jim Chandler
(Originally published in the Tidewater EMS Council's Response newsletter, January, 2003)
The Hampton Roads region is improving its medical response to terrorism by developing the Metropolitan Medical Response System (MMRS). This article outlines current MMRS news of interest to the EMS community.
To review, MMRS is the preparation for an enhanced regional response to terrorist attacks using weapons of mass destruction (WMD). The Hampton Roads Planning District Commission, on behalf of 16 cities and counties, entered into a contract with the US Public Health Service to plan for the MMRS. MMRS is not a standalone function. It is, rather, an augmentation of every responder in the medical system. Augmentation includes enhanced awareness, knowledge and preparation; enhanced equipment and protection; and enhanced planning and coordination at all levels. One specific MMRS asset, called the strike team, will be available to an incident commander as an expert resource in the management of WMD events.
Federal funding supported the MMRS planning process and purchase of large quantities of medications, personal protective equipment, communications equipment and other related supplies. $1.2 million has already been received for these purposes, and purchases are in progress. Another $800 thousand will be received within the year to supplement the first purchases, to add response capability, to assist hospitals and to test the system. In addition, the 16 Hampton Roads cities and counties are supporting the long term "sustainment" of MMRS by funding program management, plan implementation and replacement of expiring medications and supplies.
Over 1200 sets of personal protective equipment are being purchased by the MMRS. Each of the localities within the MMRS region has or will receive an allotment of respirators and protective gear for EMS and law enforcement. Public health, regional medical examiner, hospital and MMRS strike team personnel are also receiving allotments of personal protective equipment.
All civilian hospitals in the region are receiving portable decontamination shower systems. These systems, costing over $15,000 each, are designed for rapid setup by two or three people and can handle two decon lanes of ambulatory patients (male and female) and one lane for non-ambulatory patients.
MMRS purchased large supplies of antidotes for certain chemical attacks as well as antibiotics for use against biological attack. Some of these drugs are located in hospitals, but a large amount is being distributed into the field in MMRS drug kits. Some 100 kits are being disbursed throughout the Hampton Roads region, with at least two in each locality (more in the populous jurisdictions) and some with the hazardous materials teams. Several kits will be cached with MMRS strike team supplies with one set on the Southside and one on the Peninsula. These MMRS medications will help the region defend itself until arrival of the National Pharmaceutical Stockpile. Training kits are available from the EMS council.
Most of the MMRS plans account for the physical separation of the two areas, Southside and Peninsula. Duplicate equipment, supplies, medications and personnel are being established in case an attack blocks one or more of the bridges and tunnels or in case of multiple attacks.
An MMRS strike team will consist of nearly 50 on-duty individuals with advanced training and experience that, together with existing hazardous materials team response, provide a substantial asset for any incident commander. Before response of the entire strike team, an advance team of some 10 members is immediately deployed in a WMD incident as requested to assist incident command. The advance team will be dispatched by Norfolk Emergency Communications as primary and by York County Emergency Communications as backup. In order to guarantee advance team and strike team response and availability, each position is being filled three deep with duplication of advance team members on the Peninsula and Southside. With the depth required, the total strike team roster will total over 210 members.
Within the MMRS strike team is an EMS/Medical Operations group consisting of four units each with a leader and five specialists. This group will offer flexible EMS support for local personnel, field decontamination, mass treatment for exposure to various agents, mass casualty management, transportation or other functions as needed. This group presents an opportunity for nearly 80 EMS providers to become part of the MMRS strike team.
The next important step for the region's responders is increased training and exercises. While some training has already occurred in some localities, everyone will need to improve terrorism awareness and enhance specific knowledge related to the responder's role. Training on the use of any new personnel protective equipment and decontamination systems is essential. Every medical responder should complete a terrorism awareness course. Most medical responders should complete some level of an operations course. A few responders, mainly supervisory, and all strike team personnel, should complete advanced levels of training that includes terrorism management. An MMRS training committee is preparing recommendations for all who may serve as responders during a WMD attack. EMS agencies should also ensure that all personnel have completed mass casualty training. During the next several years, multijurisdictional drills will be scheduled to test our overall preparedness.
MMRS implementation continues in other areas as well. Mental health providers are refining their response to terrorist attacks. Public health is developing guidelines and integrating national recommendations for pre- and post-exposure vaccinations and treatments. Public health, local and state emergency management, pharmacists, hospitals, volunteers and many more are preparing to receive and distribute the National Pharmaceutical Stockpile. Establishing mass treatment centers, alternate care centers and infectious disease containment facilities involve massive planning and logistics. A volunteer committee is examining the many issues of cataloging and effectively using volunteers in a range of tasks. Regional MMRS committees are working in each of these areas.
For more information about the Hampton Roads MMRS and for WMD medical protocols, visit www.TidewaterEMS.org and select MMRS or protocols.