1. The Metropolitan Medical Response System Olan Johnston Christine Tolis The New England Center for Emergency Preparedness The Northern New England MMRS

2. What is the MMRS? The Defense Against Weapons of Mass Destruction Act of 1996 directed the Secretary of Defense to enhance capability and support improvements of response agencies (in response to the Sarin gas attacks in the Tokyo subway) The Nunn-Lugar-Domenici Amendment to the National Defense Authorization Act for FY 1997 authorized funding for “medical strike teams” and the subsequent development of the MMRS program

3. What is the MMRS? MMRS program began in 1996 The purpose of the program is to provide Federal financial support to jurisdictions to engage multiple agencies and jurisdictions in ongoing disaster medical response planning Supports local jurisdictions in enhancing and maintaining all-hazards response capabilities to manage mass casualty incidents during the early hours critical to saving lives and protecting the population

4. What is the MMRS? National program from the U.S. Department of Homeland Security, Federal Emergency Management Agency, National Preparedness Directorate, Capabilities Division Policy and programming from a collaboration between FEMA and the Office of Health Affairs

5. What is the MMRS? The program is funded through Department of Homeland Security State Homeland Security Grant Program National appropriations have ranged from $28 - $50 million annually FY 07 funded at $32 million Flat amount provided to each jurisdiction Special projects

6. What is the MMRS? There are 124 jurisdictions across the country 6 jurisdictions in New England: –Northern New England (Maine, New Hampshire, Vermont) –Boston –Worcester –Springfield –Providence –Hartford

7. What does the MMRS do? Only Federal program that engages multiple disciplines, multiple agencies, and multiple jurisdictions in planning Provides a platform for interagency collaboration, planning, training, and exercising Provides Catastrophic Medical Incident Management and facilitates the integration of arriving outside resources (mutual aid, Federal DHHS & medical teams, etc.) Coordinates existing multi-agency resources to effectively and rapidly respond to an all-hazards mass casualty event within the first critical hours Provides pharmaceutical force protection to responders

8. The Northern New England MMRS (NNE MMRS) Started in 2003 Housed at the New England Center for Emergency Preparedness (NECEP) at Dartmouth Medical School Collaborative agreement between NECEP and U.S. Department of Homeland Security to provide the nation’s first multi-state MMRS Maine, New Hampshire, and Vermont have signed Memoranda of Understanding to be involved in the regional project Steering Committee is composed of representatives from public health, emergency management, EMS, & the private sector from all three states

9. The NNE MMRS Works collaboratively with the Homeland Security / Emergency Management Office and Health Department in each state Provides technical assistance and support to catastrophic response and public health emergencies in each state Provides guidance in medical surge and sub-state regionalization Works with the development and implementation of patient tracking and medical resource management systems Works with the development and implementation of secure medical resource management systems for Strategic National Stockpile programs Provides each state with a force protection pharmaceutical cache

10. The NNE MMRS Medical Strike Teams Each state also has a medical strike team Team is composed of physicians, nurses, EMS providers, other allied health professionals, and non-medical volunteers Teams are state assets and deployed through State Emergency Management

13. The Relationship Between MMRS and MRC Crosswalk –Both the MMRS and the MRC are systems to utilize healthcare professionals as volunteers –Both engage non-medical volunteers for logistical and other support services –Both will be utilized for healthcare related mission tasking during disasters –Both NEED to be aligned and fully supported with other response elements, including public safety and health systems for pre-event planning, training, and exercising

14. MMRS Collaboration with MRC Training and Education Exercises Planning

15. Integration of MMRS and MRC in an Event There has been a Hepatitis A outbreak in Cleveland, NH It has been reported that a food service worker at the local Taco Bell has Hepatitis A Local media campaign to alert the public that anyone who ate at the Taco Bell between Monday, Nov. 5 and Thursday, Nov. 8, and their household contacts, needs to receive a Hepatitis A vaccination

16. Integration of MMRS and MRC in an Event The Greater Cleveland AHHR opens a POD at the local high school The Greater Cleveland MRC is activated to provide staff to the POD The NH NNE MMRS Medical Strike Team has been activated as well

17. Integration of MMRS and MRC in an Event NNE MMRS Team members: –Subject matter experts (POD “experts”) –Assist in POD operations Cleveland MRC: –Provide most of the POD operations: screening, paperwork completion, injections, follow-up Personnel from both groups may be necessary to provide POD coverage for the full length of operation

18. Appropriate State Agencies AHHR Multi Agency Coordination Entity (MAC) Local EOC POD Unified Command MRC Volunteers MMRS Strike Team Chain of Command in the Cleveland AHHR POD

19. Olan Johnston, EMT-P and Christine Tolis, MPH The Northern New England MMRS The New England Center for Emergency Preparedness Dartmouth Medical School Colburn Hill, HB 7462 1 Medical Center Drive Lebanon, NH 03756 (603) 653-1189 http://www.nnemmrs.org