The one-hundred twenty-four most densely populated cities of the United States house a Metropolitan medical Response system (MMRS). The programs are delegated the responsibility to develop strategies, handle training exercises, and stockpile drugs and equipment for personal protection in readiness for massive casualties as a result of an act of terrorism using a weapon of mass destruction (WMD)(Homeland Security, 2006). Originally called the Metropolitan Medical Strike Team, the name was changed to reflect focus less on chemical agents than on enlisting the assistance of fire, police, and emergency medical personnel (Manning & Goldfrank, 2001).
History of the Program
The concept of the Metropolitan Medical Response Systems was originally created in the area of Washington, D.C. in 1995 (Manning & Goldfrank, 2001). Using combined resources from the Maryland counties of Price Georges and Montgomery, the Virginia county of Arlington, and from Washington, D.C., individual team members were trained in the use of supplied and equipment developed to respond effectively to an incident of terrorism using a bomb capable of mass destruction. The group that would answer to the large number of casualties expected was called the Metropolitan Medical Strike Team (MMST). As the first organization of this type of to be placed within a civilian population, the MMST was developed to provide first-response activities for medical and mental health following exposure to chemicals, radioactive agents, or biological warfare.
Following the bombing of the Alfred P. Murrah Building in Oklahoma City by domestic terrorists in 1995 and the Sarin gas attack in the mass transit system in Tokyo by Aum Shinrikyo, the Defense Against Weapons of Mass Destruction Act of 1996 gave the Secretary of Defense the power to improve the abilities of local agencies for response activities (Home Security Publications, 2015). After the MMST was created the following year, it was placed under the supervision of the Department of Health and Human Services, but was transferred to the Department of Homeland Security, Emergency Preparedness and Response Directorate/Federal Emergency Management Agency on March 1, 2003 (Homeland Security, 2006). On October 3, 2004 it was subsequently placed in the internal Office of State and Local Government Coordination and Preparedness (SLGCP) to better allow for application for state and local grant funding. The SLGCP was later named the Office of Grants and Training.
The original plans for the MMST was to coordinate activities with government and non-government agencies including private healthcare organizations, local public health personnel, and the National Guard (Manning & Goldfrank, 2001). However, the contracts first put into place were quickly changed to allow more focus on how to effectively deal with the consequences of biological agents; it was at this time the program was re-named the Metropolitan Medical Response System. It was felt the new title promoted the intentions of using the systems already in place to supplement the strengths of the MMRS members; the agencies included in the strategies include HAZMAT, the American Red Cross, organizations from the private sector, public and private hospitals, law enforcement, clinics, public health agencies, independent doctors, laboratories, and emergency medical services.
Program Objectives
Emergency preparedness is a process that constantly analyses necessary sequences, evaluates planning, and prepares individuals to work alone and with a team through training, drills, and consistent evaluation. The Metropolitan Medical Response Systems were developed under the premise that emergencies begin and end in local areas. The MMRS uses local assets and expands on this in four ways (Home Security Publications, 2015). First, the individual agencies that typically respond to emergencies are brought under the coordination of the MMRS, particularly in terms of hospitals, emergency medical services, fire and police departments, and the state and local public health agencies. Second, the MMRS provides funding to allow local resources optimum coping with an overload of demand. Next, pharmaceutical stockpiles in the community are made available for use. Finally, the MMRS program promotes integration of all services with state and local planning for emergencies, including the National Response Plan and the National Incident Management System.
Other activities would be required in the event of the use of radioactive materials. The MMRS would find and identify the agent or agents involved, manage the decontamination of patients, coordinate medical treatment and triage, transport patients to appropriate healthcare facilities both locally and to more distant care through the use of the National Disaster Medical system, and provide for the disposal of fatally wounded individuals (Manning & Goldfrank, 2001).
Annual Program Funding
Funding of the Metropolitan Medical Strike Team was originally authorized in 1997 by the Nunn-Lugar-Domenici Amendment to the National Defense Authorization Act (Home Security Publications, 2015). Today, the MMRS programs in 124 jurisdictions are awarded grants through Congress; the grants allow for activities to prepare in case of need including the purchase of equipment and training exercises (Rivcophepr.org, 2015).
Availability of funds was first provided in anticipation of possible activities during the Summer Olympic Games in 1996 (Manning & Goldfrank, 2001). The main program for financial assistance for the MMRS is the State homeland Security Grant program at local and state levels for the express purpose of allowing preparation for the goals provided in the State Homeland Security Strategies and initiatives in the State Preparedness Report (Rivcophepr.org, 2015). In both 2003 and 2004, $50 million was granted; the years 2005 and 2006 saw grants for $30 million each. In 2006, each of the 124 jurisdictions received $232, 030 for continuance of the program as part of the Homeland Security Grant package (Homeland Security, 2006).
Until 2004, funding was made available to the Metropolitan Medical Response Systems through contracting. At that time, it was necessary to provide work statements that required specific times for delivery. They only provided $600,000 per jurisdiction and payment was determined by completion of the required deliverables. It was decided this was not a realistic method of funding based on the concept of the program and in 2004, financing was received through grants. Announced on September 30 of that year, $46 million in a total of 110 grants were awarded to the 114 MMRS areas that had requested them. There were three areas in which funding was provided: 1) $250,000 per jurisdiction was awarded to prepare local agencies for the possible event of the release of a weapon of mass destruction, 2) $150,000 per jurisdiction was awarded to allow for the planning, equipment, and training of personnel to keep readiness in place for response to a large number of casualties; if other grants are needed to sustain preparedness, they are available, and 3) Special Project Awards ranging from $25,000 to $640,000 are available for jurisdictions that provide innovation answers to problems locally; sixteen of the awards have been granted. To access information on grant awards, visit: http://mmrs.fema.gov/Main/Events/fy2004awards.aspx.
Program Relationship to State and Local Emergency Management
An effective working relationship between the Metropolitan Medical Response Systems and local agencies is crucial. For that reason, the approach of the program is systematically assessed and evaluated (Manning & Goldfrank, 2001). Approval of the baseline capability enhancements are necessary and most of the MMRS jurisdictions have met specifications with the remainder almost finished (Homeland Security, 2006). The unique aspect of the MMRS program is that it is a resource of the federal government designed to work with local communities to create the best mechanism for response to catastrophic events. Not only state and local agencies work in cooperation with the MMRS, volunteers give their time and efforts to assist in planning and training in the event they are needed (Home Security Publications, 2015). By periodically contacting all response options, the MMRS promotes a high level of awareness within the local population while also reinforcing regional capabilities.
It must be emphasized that the activities of the Metropolitan Medical Response Systems are not meant to replace local response endeavors. Traditional agencies with a history of response within local communities have a record of effectiveness. The MMRS strives to create a partnership between these teams and itself in order to blend current and innovative response strategies with the latest technology and science. This is accomplished in a number of ways; for instance, while public health agencies receive thorough planning ideas, first responders are also included. Pharmaceutical programs identify the location and availability of drugs providing antidotes for nerve agents and biological agents. Leadership teams are trained and skills reinforced. The MMRS is not evaluated on the basis of the amount of equipment available or the amount of drugs on hand, but by the level of cooperation and training in place among the MMRS and the local first-response teams.
Conclusion
A system of emergency preparedness is more successful when it has effective systems in place (FEMA, 2015). While the first goal of the first-responders is to promote the safety and health of the team and the public, it is also necessary to promote protection of property and the environment surrounding the disaster with as little impact of the normal functioning of the community. It is this aspect that requires the attention of fire fighters and law enforcement. While medical personnel are attending to the wounded, other agencies strive to maintain and regain regular activities of the unwounded including the services of communication, electricity, and water supplies. The MMRS works with these agencies to prepare for the possibility that loss of community services will occur; to increase the effectiveness of health actions, it is important for local services to remain intact or be reinstated.
The nuclear reactor incident at Three Mile Island in 1979 and the accidents with chemical plants in 1984 in Bhopal, India and Institute, West Virginia in 1985 demonstrated the serious effect of inadequate systems for emergency operations (FEMA, 2015). Protective action and communication with agencies offsite were impeded seriously. The Mount St. Helens volcanic eruption displayed the same negative consequences with loss of life, injuries, and the destruction of property. The pressure of severe situations and complex needs show disasters require strict systems and personnel trained for stress. Each emergency situation has a degree of originality to it and, while it is true that first-responders must adapt creatively to specific situations, it is necessary for systems to be in place and practiced sufficiently to allow personnel to perform required actions without much thought and no hesitation. When an individual improvises emergency response, time is lost and the possibility of duplication exists. It is for this reason that the MMRS trains responders to act in a manner in which they have been trained and planning has the goal of decreasing the need for improvisation. By identifying the functions necessary in specific disaster situations and how to provide the resources for those functions, MMRS planning allows for the fastest and most effective response times.
It is widely recognized that the purpose of the MMRS is to coordinate planning, training, and provision of equipment and medications in the event of an act of terrorism, it should be understood that these resources are also available in case there is an outbreak of a disease epidemic, a natural disaster, or a radiologic incident such as a nuclear power plant incident. It is vital in the first few hours of these types of events that the local resources of the Metropolitan Medical Response Systems are made available until assistance arrives from outside agencies.
References
FEMA. (2015). Preparedness for Emergency Response, Chapter 9. FEMA.
Homeland Security. (2006). Metropolitan Medical Response System Overview. Retrieved 18 July
2015, from https://www.springsgov.com/units/fire/OEM/MMRSOverviewFeb_06.pdf
Home Security Publications. (2015). The Capitol Region Metropolitan Medical Response System
(MMRS). Retrieved 18 July 2015, from http://www.crcog.org/publications/HomeSecDocs/MMRS/MMRS_Intro0806.pdf
Manning, F., & Goldfrank, L. (2001). Tools for Evaluating the Metropolitan Medical Response
System Program. National Academies Press (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK223813/
Rivcophepr.org. (2015). Homeland Security and MMRS. Retrieved 18 July 2015, from
http://www.rivcophepr.org/index.php/programs/homeland-security-and-mmrs
