I’ve been involved in planning for a Cascadia earthquake/tsunami event and a New Madrid earthquake event so I know what a catastrophe will look like. I have not been involved with planning for San Andreas but I regretfully saw the movie. Both the Cascadia and New Madrid will require a national and potentially international response over time.
One of the biggest challenges facing injured survivors is to receive life-saving care in a medially effective time frame. The majority of the life-saving response will be over within 72 hours. 
Key to meeting this need requires extensive pre-planning, dedicated response assets and pre-scripted response procedures at all levels of government. For both events we know where local responders will need significant medical support to meet the life saving mission.
One of the challenges for “traditional” response mechanisms will be the damage caused by the events. Survivors will be trapped in isolated communities. On the ground conditions will include:
- No potable water
- No electricity
- Damaged/destroyed infrastructure
- Damaged roads/bridges
- No Ground-based GPS
- No organic communications
This means that in many cases air assets will be the only viable means of moving critical supplies and personnel in and injured patients out. Both rotary and fixed wing, including float planes have a role. In March of 2011 I made a presentation on the medical consequences of a New Madrid at a ASPR/RHCC meeting in Chicago. At that time I proposed that what was needed to help meet the medical mission were teams were matched to fill the gaps we knew existed. These teams should be:
- Smaller (general, burn, surgical, pediatric, crush, mental health)
- Self-sustained
- Task Force versus Strike Team (security element critical with your medical team)
- Appropriately trained for the mission
- Appropriately equipt for the mission
- Pre-planned
- Pre-scripted
It was not until I served as the Senior Controller/Evaluator for the Oregon Disaster Medical Team (ODMT) at the Cascadia Rising 2016 exercise that I became aware of an ideal resource for these catastrophic events. The Medical Rapid Response Team (MRRT) is essentially a pilot program of the 173rd Air National Guard (ANG) Medical Group and the Oregon Disaster Response Team. Robert Gentry, MD recently retired as the Oregon ANG State Air Surgeon and Jon Jui, MD, MPH, FACEP are the main reasons this resource currently exists. Jon Jui is the EMS medical director for Portland and Multnomah County, OR. and the deputy team commander for Oregon Disaster Medical Assistance Team.
The MRRTS can be placed in any area of need and can gather intelligence, provide basic medical care and prepare for a larger follow-on medical package. The MRRTs are designed as an aid for Local Emergency Managers who would make their request to the state. The ODMT in conjunction with the 173rd Medical Group of the ANG have been conducting training and exercises to improve this concept for the past several years.
This year additional medical units from both Air National Guard and Army National Guard participated in the Cascadia exercise and were exposed to the MRRT concept. Units flew in from Idaho, Oklahoma, Nevada and Alaska. Just within the ANG are roughly 90 medical groups in all 50 states and across the country who could potentially be equipped, trained and tasked to support this mission. Add in support that could come from Army National Guard units and the potential becomes even more impressive.
Having this type of depth and redundancy is critical since the medical personnel who make up most of these units could potentially be victims themselves if their community or state was impacted. They may also be more valuable serving in their civilian medical capacity. Being able to have this type of quick response force from any non-impacted area fills a critical gap in meeting the medical needs of survivors. For the past three years we have had an average of 86 Presidential disaster declarations. Add in state declarations not rising to a federal level and the number of potential deployments of MRRTs could be fifty to one-hundred times a year. Having assets dedicated to “terrorism” response is great but opportunities for deployment are extremely small for the resources we spend annually.
In my assessment the MRRT is ideally suited to provide medical support at major events. Seeing this realized will require additional work, leadership and support at a national level. Without obtaining national level tasking for other ANG or medical assets as MRRTs and minimal financial support for the go-bags this program might not survive much longer.
I’m very interested to hear your thoughts on this potential game changer in supporting local government requests for medical support.
Well thought out and glad to see you are actually PRACTICING for it.
Exercise planners actually brought me in to add stress and realism Barbara. They are interested in getting it right and giving the personnel some idea what it is going to look like on the ground.
Thanks Jan! Another great and enlightening article. I think when you throw Rescue Wings, with PJs into the mix for more austere and challenging environments, that capability increases again. Also 19th and 20th SF Groups on the ARNG side with numerous 18Ds add great value and capability for those really challenging entries which can be done by Air Drop, etc.
304th PJs participated this year and in previous years as well as USCG assets.
Most excellent! I hope this concept continues to grow and evolve so that we may truly maximize our capabilities that are often forgotten or ignored.
Now there’s a very familiar world. Well done!
It’s a start Randy and I hope it does not die for lack of support.
What is most impressive to me about the MRRT concept is that it bypasses the usual excuse that people make for not delivering materials where they are needed is that the roads are not passable. For example, Anderson Cooper reported from Haiti that material had been sitting on the runway for six days, but no one could explain why it was not being delivered beyond the condition of the roads. Floods, fires, and earthquakes have a tendency to close surface areas to transportation, so having an airborne approach makes the best sense. Using the teams to provide real-time information about the evolution of events, from the perspective of trained responders, has the potential to lift the fog around the event so that something is being done while waiting for more support. This is long overdue. You are on to something very powerful here.
The potential is there Lawrence, now we need leadership at state and national levels to support the effort started in Oregon.
I would be interested in more specifics of skills, equipment etc deployed with each team, any additional links?
If you clicked on the link to Dr. Gentry’s video it should give you some idea. If you give me your email I can send you additional ones.
director a t pigeonlakeemergencyagency.ca
I sent you links to several videos Clinton.
Impressive article. As a Nurse I know that any kind of emergency planning is usually based on previous real situations and best practices. This makes the current program even more in need of future local support.
Will you be able to invite some politicians to some of the drills?
VIP visitors to the exercise were above my pay grade Joan but I know at the site I was at there were actually foreign dignitaries. I believe Governor Kate Brown was scheduled to visit exercise play in the City of Portland. In speaking with those more in the know than I the feeling is this needs backing at a federal level to ensure both the tasking and some funding (the MRRT go-bag is cheap in the world of logistic packages). I wrote the article as I was very impressed with the resource and hope that we can crowd source it’s continued existence if not expansion. Thank you for your comments.
Excellent rapid response concept. Have you considered partnering with your local Medical Reserve Corps Unit? I see a synergistic effect for both units. Your organized medical focus and the MRC capability to marshal additional highly organized/trained in ICS, and skilled licensed medical practitioners with disaster preparedness/response training and experience. The State Registry will also be available for deploying the MRC to support your response.
Great minds think alike Steve. In Cascadia Rising 2016 we did make MRRT consisting of Air Guard members, our state disaster medical response team and personnel on the MRC. Joint training such as this is just starting and needs to continue to be exercised and field operating guidelines developed.
I know of several resources that could potentially be mobilized more quickly then any National Guard unit. That is, the South Caroline State Guard is organizing into RRTs, including a Medical Unit (I don’t know that status of the medical RRT now but I know there are plenty of people in capable hands), and the other resource is an organization called Aerobridge, which was very instrumental in getting supplies via air during hurricane Pam to the NorthEast coast, especially NJ. I like the ideas of having maximally mobile MRRTs and pre-scripted and trained units, and also the fact of the matter is that, as you pointed out, these resources must be redundant because the area where this unit lives could very well be affected by such an MCI.
Jeff that is great to hear. Do you think there would be interest in joint participation down the road in training that has been developed by the 173rd? I think what would be awesome is to see some momentum added to the efforts of individual units. I’m ready to write the Field Operation Guide if such a tasking could be authorized by some entity. Waiting until after a catastrophic event to get our act together means hundreds if not thousands of lives that could have been saved will perish.
Jan, several years ago, I deployed to Little Rock Arkansas on a New Madrid Fault drill.
It was the 100 year anniversary of the New Madrid’s 7.0M slip that resulted in the Missouri River stopping for seven minutes which created a lake that still exists today and killed thousands of people.
During the drill, I spoke with emergency managers from all across Arkansas, Kentucky, Tennessee, and five states surrounding the area around the New Madrid.
Almost all of the EM’s involved told me the same thing. When the New Madrid goes again, the same scenario that happened the first time, will occur again. The area will be destroyed, roads and bike paths will become impassable and thousands of people are still going to die because response teams will not be able to arrive to the areas where these people live and work. Most ALL areas, towns and cities will be cut off, much like they were 100 years ago. The ONLY was these areas will be able to be reached will be by air. Medical teams and First Responders will have to be air dropped into these remote areas and deployed quickly. Several of the EM’s that I spoke with will be cut off by that lake that I previously mentioned. A way out of that area that has been proposed as way to evacuate people from that area still has not been built and the cities, towns in that area and the State still does not have the money to build the bridge to evacuate the people.
The other issue is that a lot of the people in those small towns have not upgraded their homes and buildings to meet earthquake standards and mostly likely will never do so. These people will be seriously injured or killed either in the first quake or the subsequent aftershocks of the original incident.
As much as we have drilled in this area, unless people like you and I get in there and get the funds that are necessary to get the job done, no amount of “disaster drills” will be enough to prepare those people and states for what is to surely come, absolute and utter devastation on the New Madrid Fault.
As you know Ron I wrote the ESF-8 and other annexes for FEMA Region V’s Catastrophic Earthquake plan so I know exactly what you are talking about. Some of the medical response gaps I identified in my planning with FEMA could be met by funding the MRRT concept. I have the interest and passion to help effect change but we need horsepower behind us to enable this type of project. Appreciate the comments.
There are teams in place to serve all the needs mentioned, as any experienced responder knows that “too many cooks” and adding more agencies than neccessary can hinder not help a situation . I would love to know how many agencies and or teams have already table topped New Madrid, I myself have participated in one or two, it’s a shame to have people think that these areas have not been covered.
Would you care to elaborate on teams available to meet all the medical needs identified in a New Madrid or Cascadia within 72 hours? Having done detailed planning for both I am not aware of these teams you mention.
I believe that FEMA reps and others said the same thing after the TTX before Katrina: water is covered, trans has been planned for, resources are available, etc. Then when it hit, and various levels of government had given different guidance (stay, leave, prepare, you’ll be fine, etc.), and in the end, we saw how that went.
Too many cooks can be a problem but, that is why we must plan TOGETHER. practice TOGETHER.and figure out how the pieces organzie and fit TOGETHER before it happens
I agree Dusty, the training together is key, particularly in an event like we’re talking about. I’m not worried response personnel won’t know what to do, I’m worried event management won’t manage well to give the response community the support they need to keep the body bag request to a minimum.
Agreed 100%
An excellent Mass Casualty Incident Field Operations Guide can be found at:
http://www.sandiegocounty.gov/content/dam/sdc/oes/emergency_management/plans/op-area-plan/2014/2014-OA-EOP-Annex-D-Mass-Casualty-Incident-Operations.pdf
At 69 pages it’s a little big for a Field Guide but represents California MCI organization well.
Great concept. I am tasked with developing an All Hazards Response Team for our agency and this is similar to the concept I came up with. I would be very interested in more information and collaboration. jason.greany@uchealth.org