The National Disaster Medical System (NDMS) is a federally coordinated initiative designed to augment the emergency medical response capability of the United States in the event of a catastrophic disaster.69 This system is a cooperative program of four federal government agencies: the Department of Defense, the Department of Health and Human Services, FEMA, and the Department of Veterans Affairs. The NdMs provides an interstate medical mutual-aid system linking federal, state, and local agencies and private-sector institutions to address medical care needs in a catastrophic disaster. The program was designed to supplement the activities of state and local governments during a massive civil disaster and to supplement the military medical care system in the event of an overseas conventional conflict. The NDMS contains a medical response element to provide organized aid to a disaster-affected area, an evacuation system, and a network of precommitted hospital beds throughout the United States. Its medical response element includes dozens of volunteer civilian disaster medical assistance teams (DMATs), which (1) operate supplemental casualty clearing facilities for triage, stabilization, and holding care for disaster victims; and (2) operate evacuation facilities for patients in excess of local hospital capacity. DMATs have also been developed for specialized needs, such as quick response, preventive medicine, burn care, renal dialysis, mental health, intensive care, and mortuary services.
In a disaster, NDMS will be activated only when state resources have been overwhelmed and the governor has requested federal assistance. 70 The DMATs are designated by the Department of Health and Human Services and must meet specific NDMS standards. Although DMAT members are volunteers, they become temporary federal employees if they are activated and are paid a per diem rate.
Throughout the NDMS, emergency physicians play key roles in the definition of training standards, the deployment of clinical services, the administration of field operations, and the further development of the civilian-federal disaster response capacity during times of national emergency.
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