Wilma. Rita. Katrina. The disasters just keep coming and the country’s Disaster Medical Assistance Teams (DMATs) stand ready to respond. However, there is always a need for more qualified nurses who can jump into action when the worst happens. The rewards of working in disaster relief are many — if you think you have what it takes to be a DMAT nurse. Key qualities include commitment, flexibility, preparation, and fortitude.
“When a disaster happens, you cannot just run out and go,” says Karen Hamilton, RN-C, CEN, CCRN, CFRN, MICN, PCCN, NREMT-P, CCEMT-P, 2001 Nursing Spectrum Nurse of the Year and supervisory nurse specialist with the Virgina-1 DMAT. “You have to prepare ahead of time and make the commitment of putting in those hours.”
DMATs are designed to be a federal medical rapid-response element to be deployed anytime disaster overwhelms local or state medical system resources and federal assistance is requested, or to back up Veteran’s Affairs Hospitals or the U.S. Department of Defense in response to military casualties as a result of an armed conflict. DMATs can respond to any kind of disaster, both natural and man-made, that happens at the local, regional, national, or international level.
At the drop of a hat
Being ready to effectively respond to a wide variety of incidents at the drop of a hat means committing to training and preparation far in advance of a disaster. Nurses interested in joining a DMAT team should have experience in emergency and/or critical care, although nurses with other backgrounds may also be able to participate. Certification as an emergency nurse and a subspecialty, such as pediatrics, obstetrics, or intensive care, are plusses. It is also recommended that DMAT nurses have Advanced Cardiac Life Support and Pediatric Advanced Life Support certifications.
Prospective team members can anticipate volunteering a good chunk of time to unpaid training before their first deployment. The initial training takes approximately 30 hours to complete. The program is available online and can be completed from any location that has Internet access. After initial preparation, ongoing online education, regular meetings, and hands-on training are also required.
“There is a lot of training involved with being a member of a DMAT team,” says Hamilton. “You have to be extremely committed to what we are doing.”
DMATs and Specialty Teams are organized by a sponsor, usually a major medical center, health department, or disaster organization, which are responsible for coordinating local team training. Once prospective team members become qualified and are deployed, they are paid as intermittent federal employees. “We are actually Federal Emergency Management Agency (FEMA) employees during a deployment,” says Hamilton.
Disaster deployments require a two-week commitment. Members receive written orders for deployment from the federal government, which also makes the arrangements and foots the bill for travel to disaster sites.
Although members often use their vacation time at work to go on deployments, their primary employers must agree to sponsor the employee as a DMAT member. Once employers make that commitment, they are obligated to release DMAT members for disaster deployment duty when called and to retain the member’s position upon his or her return to the facility.
Team participation also requires a yearly physical examination and keeping immunizations up to date, including hepatitis A and B, tetanus, and flu vaccines. Members must also have valid passports and submit to background checks.
Today’s MASH unit
DMATs are part of the Department of Homeland Security, FEMA, and the National Disaster Medical System and are located and deployed from all over the country. A 35-member DMAT is mobilized during a disaster to set up a tent field hospital and stay until other federal or contract resources can be mobilized or until the situation is resolved. A team consists of a mix of nurses, physicians, paramedics, and pharmacists and also includes specialists in command, administration, logistics, planning, communications, safety, and security.
Karen Hamilton, RN
“DMATs are set up much like a military MASH unit,” says Hamilton. “We can go into terrorist-induced events and can cover natural disasters ranging from wildfires to tornados, earthquakes, and floods.”
In mass casualty incidents, DMAT responsibilities may include triaging patients, providing high-quality medical care despite the adverse and austere conditions often found at a disaster site, and preparing patients for evacuation. In other types of situations, DMATs may provide primary medical care and/or may serve to augment overloaded local health care staffs. To supplement the standard DMATs, there are also highly specialized DMATs that deal with specific medical conditions, such as crush injuries, burns, and mental health.
What to pack
DMAT medical tents, equipment, and supplies are provided by the state or federal government. Individual teams usually provide uniforms, but individual members are responsible for outfitting themselves and carrying personal and survival gear essential for deployment, such as sleeping bags and first-aid kits.
“Members must be able to be self-sufficient for 72 hours, including having enough food and water,” says Hamilton. “You have to be ready to adapt to all kinds of situations.”
In addition to survival essentials, DMAT nurses also need to pack along an undying spirit. As a veteran disaster relief nurse, Hamilton has put in many long hours at such disaster sites as Ground Zero at New York City’s Twin Towers after the terrorist attack in 2001 and Hurricanes Rita and Katrina.
“In eight days, I put in 120 hours of work after Hurricane Katrina,” she says.
Team members must also accept team deployment decisions and jump in where they are most needed.
Caring for victims of a disaster tests every skill nurses have, from stabilizing a critical trauma patient, to refilling a prescription, to giving a Band-Aid, a hug, and a toy to the child with a simple skinned knee.
“You may be a nurse, but they might have you work in supply for a day,” says Hamilton. “You have to be extremely flexible to help out in other areas.”
Hamilton says that if you are ready to tackle the challenges and demands of working in disaster relief, helping people who have lost everything can be a valuable life-altering experience.
“Experiencing an event like Hurricane Katrina makes you take a step back and evaluate your own life and what it means to be in nursing,” she says. “No task is too small to help out these folks. Just the little bit of relief you could see in their faces because they were able to get something as simple as a prescription refill makes it all worthwhile.”
DMATs and NNRTs
A Disaster Medical Assistance Team (DMAT), a part of the federal National Disaster Medical System, is a group of specially trained professional and paraprofessional health care personnel, including nurses, designed to provide medical care during a disaster or other event. The National Nursing Response Teams (NNRTs) also need skilled nurses who would be available for situations specifically requiring nurses – and not full DMATs.
NNRT scenarios might include assisting with mass chemoprophylaxis (a mass vaccination program) or a scenario that overwhelms the nation’s supply of nurses in responding to a weapon of mass destruction event. For more information about the National Disaster Medical System or becoming a member of a DMAT or NNRT, visit the website at http://ndms.dhhs.gov.
Catherine Spader, RN, is a freelance writer.