Tuesday, February 9, 2010

HR 4580 Introduced

Last week Congressman Markey (D,MA) introduced HR 4580, the Metropolitan Medical Response System Act of 2010. This bill would authorize the currently existing MMRS program that is administered under FEMA. The program was started under the Department of Health and Human Services (HHS) in 1996 and currently funds programs in 124 jurisdictions around the country. According to the findings section of this bill:
“The Metropolitan Medical Response System (MMRS) is the only program at the Federal level that supports the integration of local emergency management, law enforcement, and health and medical systems into a coordinated response to a mass casualty event caused by a weapon of mass destruction, an incident involving hazardous materials, an epidemic disease outbreak, or a natural disaster.” {§2(2)}
The bill notes that MMRS program “provides tangible benefits in the form of increased operational capacity and communication, improved personnel training, stockpiled pharmaceuticals, and adequate supplies of personal protective equipment and other specialized response equipment” {§2(5)}. The FY 2010 funding for this program was provided by the Homeland Security Grant Program (HSGP). A total of $39,359,956 in MMRS grants will be split evenly between the 124 agencies currently enrolled in the program. CFATS and Emergency Response While the bill lists a variety of federal programs that are supported by the existing MMRS grants, there is, unfortunately, no mention of how the program could support emergency response planning for high-risk chemical facilities covered under CFATS. This is somewhat surprising since Congressman Markey was so involved in the development and passage of HR 2868, a bill to extend the scope of CFATS authorization, in the House. I have often commented that emergency response planning has got to be a key component of any security plan. When most people think of emergency response they think of police, fire, and EMT personnel. What is typically missed is what happens after casualties are removed from the incident scene. After all, don’t doctors know how to treat casualties? Casualties from a chemical incident (terrorist or accident, it doesn’t make any difference) are going to present a wide variety of injuries and symptoms depending on the chemical involved. Toxic chemicals may present special challenges because of the wide variety of potential effects the patients will experience based on the type and extent of the exposure they experience. Lacking specific training for proper detection, diagnosis and treatment for the exposure to the specific chemicals involved, medical personnel may not be able to provide adequate medical care. It is absolutely critical that the medical personnel that will be performing triage, diagnosis and treatment are trained in advance on the proper responses to the chemical exposure for the potentially wide variety of chemicals found at a modern chemical facility. This can only happen when the medical management team is aware of the chemicals found at facilities within its service area and that requires communication with the chemical facilities. While all chemical facilities should be communicating with their supporting services as part of their facility emergency response planning, there is a special responsibility for facilities covered under CFATS regulations. By definition they have been identified as being at high-risk for a terrorist attack and their emergency response planning takes on a special significance because of that. High-risk facilities with release-toxic chemicals of interest (COI) should expect that terrorists would attempt to conduct an attack that would result in the release of those toxic COI. Thus, the medical community absolutely needs to be informed in advance of those COI. CFATS and MMRS Since the MMRS program is designed to provide support for mechanisms for coordinated emergency response functions to include the whole response community, specifically including hospitals, this legislation might be an appropriate place to address requirements for emergency response planning for CFATS facilities. Suggested provisions for CFATS emergency response planning would include:
Requiring each MMRS organization to establish a CFATS planning team, members of the team would include emergency response and medical members who have completed Chemical-Terrorism Vulnerability Information (CVI) training/certification; Requiring each CFATS facility with release-toxic COI on site to provide a list of all such chemicals to the local MMRS CFATS planning team; Requiring the MMRS CFATS planning team to develop a plan for dealing with chemical casualties for exposure to each of the release-toxic COI that have been identified in the team’s service area; Requiring the MMRS CFATS planning team to be involved in the planning for emergency response exercises conducted at CFATS facilities in the team’s service area; and Requiring DHS Chemical Facility Inspectors to include a review of MMRS CFATS planning team efforts in any inspection/evaluation of a CFATS facility containing release-toxic COI.

1 comment:

Edward said...

Mr. Coyle,

As always, most interesting discussion. The transition from emergency care to definitive care is often times the weak link on the system. Look at the issue with decontamination and the underwear bomber. Many hospitals want patients involved in incidents of unknown intent to be decontaminated prior to arriving at the Hospital. This is especially important for Level 1 Trauma Centers. if these get slimed, its bad news for everyone.

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