America Needs a National Medical Evacuation Response

In 2011, America is not yet capable of mounting an effective national medical evacuation response to a disaster of the scale of Japan’s tsunami. We are striving to overcome 60 years of EMS, emergency management, and hospital response history within America’s federalist system of government. Our federalist system gives to local and state governments those responsibilities which are not expressly given to the federal government by our constitution. Federalism has served its constitutional purpose, but has made delivery of large-scale, emergency services much more difficult.

During the last six decades, after national emergencies, each of America’s presidents capitalized on America’s temporary disaster urgency to push America through its federalist trenches toward a national capability. Yet 60 years of presidential bully pulpits have still left us short of mounting an effective national response.

Americans want a national capability to protect our citizens in times of emergencies. Well before the next great disaster strikes, America must resolve to overcome the last of our federalist obstacles to create a truly effective force. Below is an abbreviated history of our development thus far. Notice that progress occurs after disasters. Note especially that President Clinton used another Japanese incident as a catalyst. Let us resolve that Japan’s tsunami can be the catalyst to take deliberate steps toward a comprehensive national medical evacuation capability before America’s next great disaster.

•1949 – Soviets successfully detonate a nuclear bomb.

•1950 – Congress passes the Federal Civil Defense Act, the first act that encourages interstate compacts between states to share disaster resources. However, with minimal funding, the program fades.

•1964, Hurricane Betsy floods New Orleans, at the time the costliest hurricane in our history.

•1964, Without federal tools, President Johnson works tirelessly and uses immense political capital to introduce temporary legislation to aid states.

•1964, The United States has no capacity to respond to a major disaster. Ground and rotor ambulance industries are just beginning. The country’s federal emergency response capabilities are spread over 100 disparate agencies that do not cooperate.

•1969, Hurricane Camille devastates the Gulf Coast.

•1970, President Nixon signs the Disaster Relief Act, making Johnson’s efforts permanent.

•1971, San Fernando earthquake rocks southern California.

•1971, Nixon submits bill to consolidate federal disaster assistance.

•1974, Tornado “super outbreak” of 148 tornados rips through 13 states.

•1974, Later amended as The Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988, Nixon’s legislation finally passes and gives the President the right to declare a federal emergency upon request from a Governor and to give grants to states to prepare for emergencies.

•1974, The bill leaves unresolved the issue of over 100 federal agencies involved in disparate aspects of disasters and emergencies.

•1979, With support from the National Governor’s Association, President Carter creates the Federal Emergency Management Agency (FEMA) to consolidate federal emergency operations.

•1984, With the goal of strengthening cold war national defense, President Reagan establishes the National Disaster Medical System (NDMS), as a cooperative partnership of the Departments of Health and Human Services (HHS), Veterans Affairs (VA), and Defense (DOD) with a primary emphasis of overseas military operations, but with a secondary goal of providing a civil disaster response.

•1986, NDMS refocuses on domestic response to large-scale civil disasters. Yet, NDMS has shortcomings. DOD cannot cede control of its own operation, adding time. With military emergencies as its primary mission, its assets also may not be available when a civil emergency erupts.

•1992, Hurricane Andrew devastates South Florida.

•1992, States recognize that they need compacts for times of emergencies. Several steps lead to Emergency Management Assistance Compacts (EMAC).

•1995 Terrorists attack Tokyo subway with sarin gas.

•1996 Congress ratifies EMAC.

•1996, In response to the sarin gas attack, President Clinton signs the Weapons of Mass Destruction Act and merges functions of civil defense and emergency management. His new FEMA cabinet position receives authority for counter-terrorism.

•2001, The World Trade Center and Pentagon are attacked.

•2002, President Bush signs the Homeland Security Act creating the Department of Homeland Security (DHS), consolidating 40 federal agencies under DHS, and reducing 2,000 separate Congressional appropriations accounts.

•2003, DHS absorbs FEMA and disperses functions such as preparedness within DHS.

•2003, President Bush issues a series of Homeland Security Presidential Directives that establish DHS as the lead agency responsible for domestic incident management, directs joint operations to use the National Incident Management System (NIMS), and directs DHS to prepare a national plan for incident management.

•2005, America lives through Hurricane Katrina. With losses exceeding $200 billion and over 2,500 lives, Katrina exposes disaster management weaknesses at all levels: federal, state, and local. It also highlights the difficulties of mounting a national emergency response.

•2005, During Hurricane Katrina, 66,000 personnel are deployed under EMAC, straining its capacity to administer resources, and exceeding the receiving states’ abilities to effectively use the personnel that are sent. EMAC begins efforts with FEMA to support larger future missions.

•2005, Then-Senator Obama introduces S.1685 which would have directed DHS to ensure that each state plan for realistic evacuation of individuals with special needs in emergencies.

•2006, President Bush signed the Post-Katrina Reform Act, re-focusing FEMA’s responsibilities within DHS to lead the nation in developing a comprehensive emergency management system.

•2006, FEMA signed an ambulance contract to provide ground transportation to NDMS mobilization centers. DHS entered into a regional ambulance contract later expanding this to a national contract. Yet, with a limited contractual function, our nation’s ambulance services still are not capable of effective national coordination.

•2008, the National Response Framework (NRF) replaced the National Response Plan. It is the core document for the new emergency management structure, and includes annexes that outline emergency support functions. Some key policies and associated plans to implement these policies are yet developed. The NRF represents a significant change in guidance that has helped direct the nation toward a more comprehensive national response capability.

•2011, nationally we have over 15,000 ambulance companies, 800 rotor wing operations, 100 fixed-wing air ambulance companies in the United States, capable of eventually being co-opted into an effective national emergency medical services strategy. America still cannot adequately transport special patients during national emergencies. We have over 5,000 Hospitals and 12,000 nursing homes that must be given realistic options for evacuating during large scale emergencies. And our network of medical facilities, transporters, and emergency management must be tied together into a real time network of emergency receiving facilities. The national task is ahead of us.


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Filed under American Governance, Bureaucracy

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