Austere MedicineOK-1 DMAT
Arthur G Wallace Jr DO MPH FACEP
Objectives
• Training
• Infrastructure
• Team member fitness
OK-1 DMAT 1991
OKLAHOMA – 1DISASTER MEDICAL ASSISTANCE TEAM
Federal Deployments by year
92 Hurricane Andrew 03 Hurricane Charley95 OKC Murrah bombing 04 Hurricane Ivan95 Hurricane Marilyn 04 Presidential Inauguration96 Atlanta Olympics 05 Hurricane Katrina98 NY ice storms 05 Hurricane Rita98 Hurricane Georges 05 Hurricane Wilma99 OKC F5 tornado 06 New Orleans surge99 Kosovo refugee Ft Dix 07 Hurricane Dean01 Presidential Inauguration 08 Hurricane Gustav01 Tropical Storm Allison 08 Hurricane Ike01 World Trade Center NYC 09 Red River Basin ND02 Salt Lake City Olympics
Bold are full team deploymentsOthers are strike team deployments
Disaster Medicine = Austere Medicine ?
Training ………
Disaster Medicine ≠ Austere Medicine
Intact Infrastructure
OK-1 Pensacola Florida Hurricane Ivan 2004
Disaster Medicine ≠ Austere Medicine
↓ Infrastructure
St. Thomas USVI
Disaster Medicine ≠ Austere Medicine
• Austere Practice - ↓ Infrastructure
Disaster Medicine ≠ Austere Medicine
• Standard Practice – Intact Infrastructure
• Standard Practice - ↓ Infrastructure
• Austere Practice - ↓ Infrastructure
HARRM• BMI
• CAD
• HTN
• DM
• Asthma COPD
HARRMcondition Hazard Risk Modifiers Decision
points
CADCVDCHF
Exertion Time to definitive care
Time to definitive care < 30 minutes
Angina or NTG use in past year CMO only
Diet High Na diet Local resources
Hx of hospitaliztion for CHF
Stress Several post deployment events
Stable bypass / stents
Lack of rest PCP has provided parameters
HARRMcondition Hazard Risk Modifiers Decision
points
Overweight BMI 26 - 30
Medevac Injury Operational airport < 30 min
Obesity BMI 30 – 39.9
Heat Heat illness Documented tolerance
BMI 30 – 39.9 waived at level of Reg CMO
Morbid BMI >40
Trauma Death BMI > 40 waived by CMO
HARRMcondition Hazard Risk Modifiers Decision
points
HTN Hi Na diet stress exertion
Increased risk of CVA MI
30 day med supply
Diuretics heart – blocking Rx
dehydration Parameter provided by PMP
Heat Illness Documented experience
Unlimited water supply Air conditioning
HARRMcondition Hazard Risk Modifiers Decision
points
DM Blood sugar control
Hyperosmolar dehydration
Controlled on diet or orals
Use of need for insulin in past year only by CMO
Hi carb diet Less heat tolerance infection
PMP provides parameters
Irregular meals and exertion
Increased water demands
Lack of refrigeration
HARRMcondition Hazard Risk Modifiers Decision
points
Asthma COPD Dry air in flight Bronchospasm status asthma death
Short flight no recent use of rescue MDI
Limited valid information about conditions on the ground
Smoke, soot, dust, mold, insecticides, chemicals
Delayed access to definitive care
Definitive care < 30 min
Use of or need for daily Tx ony by CMO
Lack of C-PAP vent
No fire, smoke, soot, dust
URI croweded living conditions
Limited Medevac
OKLAHOMA – 1 DMAT HURRICANE GUSTAV
MONROE, LA 2008