Origins - Metropolitan Medical Response System (MMRS)

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Origins of MMRS

The Metropolitan Medical Strike Team (MMST) systems concept began in the Washington Metropolitan area in 1995. Using the combined personnel and equipment resources from Washington, DC, Arlington County, Virginia and Montgomery and Prince George´s County, Maryland the MMST was the first of its kind in the civilian environment. Primarily a chemical response team, the MMST was capable of providing initial, on-site, emergency health and medical services following a terrorist incident involving a weapon of mass destruction (chemical, biological, radiological and/or nuclear). The team can provide emergency medical services, decontamination of victims, mental health services, plans for the disposition of non-survivors and plans for the forward movement of patients to regional health care facilities, as appropriate, via NDMS.

Building from the initial efforts of the Washington Metropolitan Area MMST, OEP sought to develop a similar team in the city of Atlanta in preparation for the 1996 Summer Olympic Games.

As a result of the initial successes of the Washington Metropolitan Area and Atlanta MMSTs, Congress, as part of the Defense Against Weapons of Mass Destruction Act of 1996 (more commonly known as Nunn-Lugar-Domenici), authorized HHS to develop twenty-five (25) additional MMSTs. The legislation allowed OEP to contract with the cities of Boston, New York, Baltimore, Philadelphia, Miami, Memphis, Jacksonville, Detroit, Chicago, Milwaukee, Indianapolis, Columbus, San Antonio, Houston, Dallas, Kansas City, Denver, Phoenix, San Jose, Honolulu, Los Angeles, San Diego, San Francisco, Anchorage and Seattle.

In an effort to show the importance of the system, OEP changed the MMST name to Metropolitan Medical Response System or MMRS. This name change reflected OEP´s ongoing effort to bring together not only the fire, EMS and HAZMAT communities, but also the public, private and mental health communities. An effective systems response to chemical, biological, radiological or nuclear incidents will require coordination among hospitals, pre-hospital providers, laboratories, public health officials, poison control centers, mental health professionals, infectious disease experts, surrounding communities, states and the Federal Government.

On March 1, 2003, MMRS joined the Federal Emergency Management Agency (FEMA) and other programs from the Departments of Health and Human Services, Energy, and Justice to become the Emergency Preparedness and Response Directorate of the new Department of Homeland Security.

Today, OEP continues to work with cities and their surrounding communities to develop enhanced response systems.

ILLUSTRATIVE CHEMICAL INCIDENT SCENARIO WITHOUT AN MMRS

Through the development of the local Metropolitan Medical Response Systems (MMRS), HHS/OEP has focused on enhancing the local health and medical capability and capacity to respond to terrorist incidents involving weapons of mass destruction. This systems development process involves unique planning requirements for both chemical and biological incident responses.

Chemical Incident Scenario without an MMRS

Incident occurs
- First responders arrive without the personal protective equipment (PPE) and become casualties
- HAZMAT team arrives with minimal PPE but no ability to detect the agent
- Patients self-refer to area hospitals without treatment or decontamination
- Contaminated patients are transported to hospitals and contaminate the facility
- Hospitals do not recognize the need to decontaminate patients or control access to the facility
- Insufficient pharmaceuticals or knowledge of medical management criteria complicate the response
- Healthcare system is overwhelmed and eventually collapses

Chemical Incident Scenario with an MMRS

Incident occurs
- First responders arrive with appropriate PPE and identify the agent
- HAZMAT team decontaminates victims
Hospitals notified of the incident and control access to their facilities
- On-scene triage and treatment begins
- Decontaminated patients are transported for definitive care
- Mutual aid from Federal, state and local agencies requested
- Patients are transported using NDMS and local resources to regional healthcare facilities

Goals for Biological Preparedness with an MMRS

Enhance local, regional and national surveillance systems (detection and laboratory identification)
- Develop plans for response:
Mass prophylaxis of exposed or potentially exposed populations
Mass patient care
Mass fatality management
Environment health surety

THE MMRS SYSTEM DEVELOPMENT PROGRAM

Contracting with twenty-seven (27) cities in 1997¹ and additional cities in 1999, HHS/OEP is working to develop a coordinated systems response (fire, police, EMS, hospital, public health, etc.) to WMD incidents. HHS/OEP has approached MMRS development from two perspectives: chemical and biological. Although the two planning approaches focus on different areas, they converge at the same point: greater focus on health systems response.

Current MMRS Efforts

Focus on immediate site-specific response capability
- Enhances existing capabilities
- Develops overall systems plans
- Raises awareness of WMD agents
- Develops enhanced capability to operate in contaminated environments
Develops specialized treatment protocols for WMD victims.

Goals for MMRS Enhancement

Integrate biological preparedness into the overall planning process
Develop plans for mass prophylaxis of exposed and potentially exposed populations
Develop plans for mass patient care
Develop plans for mass fatality management
Develop plans for environment surety

By contractually requiring metropolitan areas to develop these elements, we are assuring that the overall system will have a coordinated response capability. At the local level, this not only means that communities will be capable of responding to WMD incidents, but they will also be better prepared for the more common hazardous materials incident and the possibility of a naturally occurring outbreak (e.g., pandemic influenza).

MMRS CAPABILITIES

Initial identification of agents
Ability to perform operations in OSHA levels A, B and C personal protective equipment avoiding secondary responder casualties
Enhanced triage, treatment and decontamination capabilities at the incident site and definitive care facilities
Maintains local caches sufficient to treat 1,000 patients exposed to chemical agents
Ability to transport uncontaminated/decontaminated patients to area hospitals for definitive care
Ability to maintain a viable health system
Ability to transport patients to participating NDMS hospitals throughout the nation
Mechanisms to activate mutual aid support from local, state and Federal emergency response agencies
Ability to integrate additional response assets into the ongoing incident command structure

MMRS - THE DIFFERENCE MADE AT THE LOCAL LEVEL

Requires development of response plans unique for each city
Creates integrated immediate response structure
Creates additional local and regional support network
Integrates with local mass casualty plans
Brings together and encourages city planning agencies to interact where they never interacted before
Encourages and initiates hospital NBC planning
Encourages local healthcare providers to develop appropriate medical treatment protocols

¹Boston, New York, Baltimore, Philadelphia, Washington DC, Atlanta, Miami, Memphis, Jacksonville, Detroit, Chicago, Milwaukee, Indianapolis, Columbus, San Antonio, Houston, Dallas, Kansas City, Denver, Phoenix, San Jose, Honolulu, Los Angeles, San Diego, San Francisco, Anchorage, and Seattle.