On this second anniversary of Hurricane Katrina, we must not only think of those still in the recovery, those still displaced from New Orleans and Gulfport and homes and businesses all across the Gulf Coast of the United States. Among those who were the first to provide aid and assistance to the survivors of Hurricane Katrina who were the unsung heroes of the National Disaster Medical System (NDMS). Few in the United States have heard of the men and women of NDMS. These healthcare professionals shied away from the public eye and publicity of any kind. They strive to always observe the first lesson of the disaster field office: “Don’t get in front of the camera!” Yet those who serve in the various divisions of the National Disaster Medical System are perhaps heroes in the truest sense of the world because it is these men and women who place their lives on hold often on as little as two hours notice and travel to communities not their own to help those in need, to help people whom they do not even know and will likely never see again.
The National Disaster Medical System has existed for over two decades, beginning as a single unit of field responders under the United States Public Health System. Since its simple beginning NDMS has grown to include units dedicated to providing medical assistance to disaster survivors through Disaster Medical Assistance Teams (DMAT); domestic animals and pets through Veterinary Assistance Medical Teams (VMAT); and the respectful care of those not fortunate enough to survive a disaster through Disaster Mortuary Operational Response Teams (DMORT).
Why are NDMS teams and the people that serve on them unsung heroes? It is because not only do they shy away from publicity, but they choose to serve rather than to self-promote.
NDMS members exist in a unique place in our federal government and our federal response to disaster. Although they serve in uniform and operate within a command structure that closely mimics that found both in the fire service and in our esteemed military, NDMS personnel are not technically reservists. NDMS began at the volunteer program functioning more like AmeriCorp, the Peace Corp or the American Red Cross than like a government agency. Over time however, the need to provide these intrepid rescuers with the basic protections of workers’ compensation, liability insurance and malpractice insurance spurred the federal government to make them “intermittent part-time employees.” At times of nationally declared disaster, NDMS personnel respond to deployment request within as little as two hours. NDMS personnel maintain equipment that they have paid for in deployment ready condition at all times, often carrying that equipment in their automobiles and even on vacation with them. Three months out of the year NDMS teams place themselves on call, notifying employers that in the event of a national disaster they may have to leave their workplace almost immediately. Yet unlike all other federal assets, in those times between disasters NDMS personnel receive a biweekly federal pay stub for zero dollars. They receive no benefits, no retirement, no reservist pay, none of the other benefits, discounts, or protections afforded those who serve in the United States Military, the National Guard, the Military Reserves, or as federal employees.
While deployed NDMS personnel are protected from employer discrimination and retaliation for their service just as those in the National Guard or the Military Reserves are protected. During times of deployment, they are full-time federal employee but they receive pay that is seldom more than 25 percent of their usual civilian wage. For most NDMS members, each week of deployment takes 2-3 months of personal financial recovery. Informal surveys of NDMS teams responding to the hurricanes of 2004 (Charley, Frances, Ivan, Jeanne) and 2005 (Katrina, Rita and Wilma) found that most team members were still financially recovering as of this writing in 2007.
Because an employer is required to hold the job open but not for maintaining the employee on the work schedule, upon an NDMS team member’s return it is not unusual for that team member to spend one or even two weeks off the job waiting for the next work schedule to begin. This means that after returning from a two week deployment where they earned 25% of their usual wage, they go without pay at all until their employer can integrate them back into the schedule. In 2004 and 2005 this meant that individuals deployed to all seven major hurricane, spent on average seven months away from work in only a 14 month period of time. In that same time period, few made more than the equivalent of three weeks of their regular civilian pay. Despite the fact that in that 14 month period of time, every team in the nation was deployed repeatedly and most deployed for all seven events, the loss of team members across the nation was surprisingly low.
The heroes of the NDMS system are not the typical field responder that most citizens would envision. These are ordinary doctors and nurses, respiratory therapists, supply personnel, paramedics, EMT’s, physicians’ assistants, nurse practitioners, administrators and accounting personnel from the whole spectrum of the healthcare workforce. They are most accustomed to working in nicely appointed offices for well-equipped hospitals. In their civilian lives — like most Americans, they sleep in a comfortable bed in an air-conditioned or heated home with pillows and blankets, an alarm clock and a hot shower. However, in addition to the financial hardships that they gladly endure, they deploy into a field environment where one trip may they sleep on the floor in an airport or on the baggage conveyor belts and the next, they sleep in a tent in a sleeping bag or in the seats of vans and buses. Although their treatment areas are air-conditioned for patient benefit, seldom if ever do they enjoy air-conditioning in their own billet or bivouac. A once a week shower is a luxury and since resourcefulness and creativity are the hallmarks of NDMS personnel, it is not unusual to see them washing uniforms in a bucket, in the rain or even in an unmonitored dishwasher, in the first class lounge of the Louis Armstrong International Airport.
Despite the hardships and the lack of personal benefits beyond that satisfaction of having served their fellow American, an increasing number of healthcare professionals from all areas of healthcare, both clinical and nonclinical are seeking to join not just NDMS but the state equivalent medical response teams in all 50 states and US Protectorates. Those not willing to leave their homes are joining Medical Reserve Corps Teams in order to afford themselves an opportunity to assist their own communities in the event of disaster.
But it is the members of the National Disaster Medical System, those first out the door, first in the field, first on scene, this first line of the nation’s medical and rescue response who are truly the unsung heroes and truly most deserving of our gratitude and praise on this second anniversary of Hurricane Katrina.
Dr. Maurice A. Ramirez is co-founder of Disaster Life Support of North America, Inc., a national provider of Disaster Preparation, Planning, Response and Recovery education. Through his consulting firm High Alert, LLC., he serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple medical specialties, Dr. Ramirez serves the nation as a Senior Physician-Federal Medical Officer in the National Disaster Medical System DMAT-FL3. Cited in 24 textbooks and the author of numerous published articles, he is co-creator of C5RITICAL and author of You Can Survive Everything, Everywhere, Every Time. His website is www.High-Alert.com