I think one needs to also appreciate the impact of our economy on trying to keep any federalized response package truly ready to respond as an emergency entity.  It is said all response is local, and that is where tax payers have balanced capacity and capability against their ability to fund (e.g. rural/frontier America does not have the same EMS capability as most cities) yet an MI is an MI and heart muscle dies in the same amount of time regardless of where you live.

NDMS, DMAT and other federalized teams also have constraints. Many Type 1 DMAT teams have seen their equipment caches become “regionalized” due to budget constraints. This does not improve response times without close coordination with FEMA logistics to move the packages in sync with the personnel. People without communications, supplies, equipment and the wrap-around services provided by FEMA are well-trained observers.

This country does not have a health care “system”, nor do we have a disaster response “system”.  We have well-intentioned, passionate and highly skilled individuals who manage to develop these pockets of excellence.  When we start investing as a country in national disaster hospitals like other countries such as Japan, we can start talking about our disaster response system. Until then, we are paying for predictable but less-than medically efficacious results.