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TitlePreparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program
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Page 2

Preparing for Terrorism
Tools for Evaluating the Metropolitan Medical

Response System Program

Frederick J. Manning and Lewis Goldfrank, Editors

Committee on Evaluation of the Metropolitan Medical Response
System Program

Board on Health Sciences Policy


Washington, D.C.

Page 165


12. Transportation of Victims

Preparedness Indicator

List of available sources of vehicles and drivers for use in mass-casualty
event, including those available through mutual-aid agreements, state
agencies, and local federal facilities.

• The lead agency provides current contracts and other agreements
with public and private entities for emergency transport (buses, vans, and

• The lead agency provides evidence of periodic communication
with managers of anticipated transportation assets.

• Standard operating procedures reflect state laws and local policies.

Preparedness Indicator

Interviews with one EMS contracted emergency medical transport pro-
vider, one noncontracted medical transport provider, and one nonmedical
transport agency to confirm knowledge of MMRS plan, including the cir-
cumstances in which personal protective equipment and decontamina-
tion of patient transport vehicles are required and the means of acquiring

Preparedness Indicator

Availability of anticipated transportation assets on short notice for ran-
dom check, planned exercise, or actual mass-casualty emergency.

Preparedness Indicator

Awareness of plan and procedures for movement of patients to other ar-
eas of the region or nation by EMS and hospital officials and when and
how to initiate them.

• Two hospital officials and an EMS official satisfy the site-visit in-
terviewer if a previous exercise has not demonstrated knowledge of the
MMRS plan and procedures.

• The lead agency provides evidence of NDMS support for the
MMRS plan and procedure for activation.

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13. Distribution of Supplies, Equipment, and Pharmaceuticals

Preparedness Indicator

Evidence from drill, actual event, or questioning by expert peer reviewer
that local distribution of MMRS program pharmaceuticals and equipment
will be rapid enough to maintain local supplies for at least the initial 24
hours of an event.

• EMS and hospital systems understand the predetermined protocol
in the plan for the distribution of pharmaceuticals, supplies, and equip-
ment, including:

° the quantity and type of supplies and equipment available,
° the locations of the primary and secondary storage sites,
° the need for 24-hour accessibility to all storage sites,
° the priorities for distribution,
° the person who has the authority to order and distribute sup-

plies and equipment,
• the means of transport of supplies and equipment to affected sites,

• the means by which trained staff at the affected sites are to receive

and use the equipment.

Preparedness Indicator

Evidence from drill, actual event, or questioning by expert peer reviewer
that local distribution of National Pharmaceutical Stockpile (NPS) sup-
plies will be rapid enough to maintain local supplies after the initial 24
hours of an event.

• EMS, hospital systems, and responsible local or state officials un-
derstand the predetermined plan for requesting, receiving, and distribut-
ing NPS supplies, whether they are from push packages or the vendor-
maintained inventory, including:

° the chain of command for requesting NPS supplies,
° the quantity and type of pharmaceuticals available,
° the plan for receiving NPS supplies and the availability of per-

sonnel to repackage NPS supplies for distribution to affected sites,
° the transportation of NPS supplies to affected sites,
° the distribution of NPS supplies to affected hospitals, and
° the receipt and use of NPS supplies by appropriate personnel at

the sites receiving the supplies.

Page 330


sion to look for clues and extract the remains of the radioactivity disper-
sion device.

Questions, Scene III

1. How will you conduct extended response operations? Are local
personnel and equipment resources adequate for the extended opera-
tions that will be required?

The EOP should account for around-the-clock operations. Many jurisdic-
tions plan to send a portion of the EOC staff home after the initial incident assess-
ment reveals the need for extended operations. Determine who will be responsible
for each function on multiple shifts.

Each agency will likely be overwhelmed. The real questions are how much
state, federal, National Guard, and mutual-aid support is needed.

2. What are your procedures for integrating state and federal re-
sources into your management organization?

The EOP should outline the procedures for state and federal integration.
State and federal assistance is supplementary to the local response; and as the

DFO is established the federal coordinating officer and state coordinating officer
will coordinate the activities of the state and local governments, the American
Red Cross, the Salvation Army, and other disaster relief organizations.

Follow-up Questions:

How will your agency coordinate its action with other agencies (fed-
eral, state, and local) and public interest groups?

The federal coordination officer is the primary federal coordinating authority
for consequence management; the FBI handles crisis management.

With the arrival of state and federal assistance and the formation of
a Joint Information Center, how will media inquiries be handled? Who
in your jurisdiction is responsible for authoring media releases?

Media releases must be coordinated with the FBI, FEMA, and state and local
authorities once the Joint Information Center has been established.

The EOP should provide a detailed communications and public relations

3. What continuing assessments should be enacted when the
cleanup phase is complete? Who will make these determinations?

Long-range health issues are of great concern.
Hazmat sites, especially decontamination stations, should be examined peri-

odically until it is determined that there is no longer an environmental hazard.

Page 331


The EOP should provide an overview of how continuing assessments and
long-term monitoring are accomplished; allow the participants in the group to
discuss their areas of concern and propose priorities.

4. What are the environmental concerns related to this incident?
There are numerous concerns related to plutonium, for example, it is a heavy

metal and is toxic in its own right beyond the long-term effects on humans, ani-
mals, and other forms of life. The local responders might also identify some issues
particular to their area.

Materials used during the response will continue to present hazards until
they are neutralized.

Follow-up Questions:

What steps will be taken by your agency to ensure adequate sanita-
tion measures throughout the affected area?

The local hazmat plan should identify sanitation procedures related to radio-
logical operations.

What local requirements exist for reentry to an evacuated area due
to a hazmat incident?

The hazmat annex to the EOP should outline reentry procedures.
After the release of radioactive materials, the local emergency management

team should consider the need for safe certification, that is, having a third-party
laboratory verify that the area is free from contamination.

5. Within your jurisdiction, what psychological traumas may be
anticipated? How will your agency deal with these traumas?

Many agencies have teams already designated to assist in such cases. In most
instances, the teams will not have the capacity to handle the expected number of
cases in an incident of this magnitude.

Discuss the availability of crisis counseling. Also, refer participants to Sec-
tion 416 of the Stafford Act.

Follow-up Questions:

How will your agency participate in notification of the deaths of
civilians and your colleagues? Are personnel in your agency adequately
trained in the process of death notification?

Death notification is always a difficult issue. The EOP should provide guid-
ance to managers. However, at a minimum someone in the supervisory chain
should be involved with the actual notification.

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