How prepared is your agency for a mass-casualty disaster response? The Metropolitan Medical Response System can assist your agency during such an incident — if the program continues to exist.

MMRS is the only federal WMD response program that originally directed funds into an integrated, systematic approach for local government planning and response to a WMD event. MMRS now provides pass-through funding and support from state governments to local governments for plan development, training and exercises, as well as pharmaceutical and equipment purchases for enhanced mass-casualty event response. MMRS enhances the local government's preparedness to respond to a mass-casualty event using immediately available resources for the critical initial hours until federal resources can arrive.

But MMRS is under attack. The attack isn't being led by either a domestic or international terrorist, but by the federal government. MMRS has received reduced funding since FY '05 and no funding in FY '06. During a time of increased prevention funding, MMRS, which is the only federally funded local mass-casualty preparedness program designed to coordinate all aspects of a disaster at the local level, is fighting to stay alive.

Concept to reality

MMRS began as a partnership between local emergency medical services, law enforcement, public health, emergency management, and the Department of Health and Human Services. The concept development began in 1995 to enhance planning and response capabilities for WMD preparedness. Presidential Directive 39 and the Nunn-Luger-Domenici Initiative were enacted during this time, and the DHS was tasked as the lead federal agency for health and medical consequence management for chemical, biological, radiological, nuclear, and explosive incidents.

HHS acknowledged that a WMD event was primarily a local issue. The agency also determined that local agencies required specialized training, equipment and organization to provide a uniform consequence management response to save the lives of victims involved in a CBRNE event.

In 1997 HHS initiated the MMRS program, a systems-based approach to health and medical consequence management for local first responder, medical, and public health planning and response. The primary directive of MMRS aligns with the federal government's initial priority of protecting the public health of all communities throughout the United States.

The president has directed the Department of Homeland Security to increase the capability of our country to prepare for political terrorist attacks. A critical component of this mission is to enhance a local government's response capabilities to a terrorist attack through implementation of the MMRS. The MMRS principal edict is to prepare the local community and to prevent the loss of life for mass-casualty events.

Local preparedness

MMRS identifies how first responders, first receivers, and public health and health services professionals, as well as local volunteer agencies would respond to a WMD event. This system approach helps to strengthen identified weaknesses in all of the organizations, while also establishing relationships and trust at the point of potential impact.

WMD event preparedness planning and response includes:

• A proposed response approach.
• Initial and continuing education for all response personnel.
• Mass-fatality management plans.
• The notification of definitive health care facilities.
• Planning preparation in place to provide definitive health care and expand the existing health care system to include the DHS National Disaster Medical System and the Centers for Disease Control and Prevention Strategic National Stockpile, Chempack and Cities Readiness Initiative.
• A capability to identify the weapon materiel or agent; extract victims; administer the appropriate antidote; decontaminate victims; and provide triage, treatment and transport to a treatment facility.
• Management of adequate local pharmaceutical and equipment caches.
• Treatment protocols and medical capabilities.
• Integration with local, state, and regional biological event response capabilities, including early detection and recognition, mass immunization and prophylaxis, mass-casualty patient care, mass-fatality management, and environmental surety.

MMRS in Arizona, for example, functions as a statewide mutual-aid response to also assist non-MMRS jurisdictions, and other MMRS jurisdictions are following suit. The MMRS also provides program support and response capability for the DHS NDMS and Disaster Medical Assistance Team Programs. If MMRS is not sustained, the programs mentioned above will be negatively affected, as the local planning and implementation facet will be dissolved.

Program needs

In the spring and fall of 2004, several members of MMRS from across the country hit Capitol Hill in an effort to keep funding for the MMRS program. An example of the lack of knowledge for local needs around the Beltway was illustrated by many Congressional members who felt that the SNS plan was “taken care of” by the CDC, when in truth the program drops off the 94,000 pounds of equipment and pharmaceuticals to the local jurisdiction, which has to develop the plan to receive, store and stage the entire cache and prepare it for local mass dispensing sites. MMRS has been charged to do this at the local level.

MMRS has developed into an effective organization through initial funding and program management, but requires the following to remain effective:

• Funding assurance

  Beginning in FY 2005, sustainment funding for the MMRS program has not been allocated in the federal budget plan.

• Response program recognition

  MMRS has survived year to year through due diligence of MMRS program administrators and congressional support. The program should be officially recognized as a DHS consequence management program, like Urban Search and Rescue and NDMS.

Both of these requests correspond with the president's commitment to terrorism prevention. The FY 2006 Budget Priority of Protecting America stated, “The 2006 Budget restructures DHS grant programs to ensure funds are targeted to address the greatest risks, vulnerabilities and needs. Over $2 billion in state and regional grants previously awarded through formulas will instead be allocated through a discretionary process based on the House-approved Faster, Smarter, First Responder Act. States and eligible regions will gain more flexibility to request the funding they need, while the Secretary of Homeland Security will have greater authority to allocate funds based on need, risk and the achievement of national preparedness goals.”

In the grand scheme of federal spending this is a small program (originally a one-time contract of $600,000 for each city, but as of last year only $227,000 for program sustainment). This program has provided the federal government with the best bang for their buck. MMRS has evolved from a medical strike team into a coordination and implementation platform for various federal programs. MMRS has transitioned into not only a critical support structure for the SNS program, but for the newer Chempack and Cities Readiness Initiative programs as well. MMRS delivers the only DHS mass-casualty response program with an immediate consequence management capability.

Budget attack

A contingency from Arizona and California MMRS representatives traveled to Washington, D.C., in February to request congressional support for the lack of sustainment funding identified in the president's 2006 budget. The congressional members and their staff elicited tacit support for the program, but they also expressed support of the current budget-reduction philosophy being introduced in the federal government. The congressional members suggested that the MMRS contingent reinforces the request for sustainment funding through additional local, county and state support document submission to their respective congressional offices.

The MMRS program is requesting mutual aid assistance throughout the United States. Chiefs can help MMRS fulfill the program justification by contacting their congressional representatives and advising them of the preparedness gap that will occur without the program. Chiefs can best accomplish this validation by soliciting local, county and state supporting documents and forwarding these documents to their congressional representatives.

The MMRS program is the foundation for local efforts in a disaster and will assist you in your time of need. Will you assist us now? Let your voice be heard, call your congressional members to support MMRS and disaster preparation at the local level. For more information, e-mail cdechant@glendaleaz.com or Les.caid@rmetro.com.

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Chris DeChant is a captain/paramedic for the Glendale (Ariz.) Fire Department, where he has served for eight years. He currently is the Metropolitan Medical Response System Coordinator for the City of Glendale. DeChant holds an associate degree in applied science — fire science and a bachelor degree of science — public safety administration.

Les Caid is the fire chief of Rural Metro Fire Department for Pima County, Ariz. He retired in 2004 from the Tucson Fire Department after 25 years. In 1999, Caid was assigned as the project manager for the Metropolitan Medical Response System, where he led the community's emergency preparedness efforts until he retired. He was nationally recognized by the secretary of the U.S. Department of Health and Human Services in 2002 for his efforts with the Tucson MMRS. Caid currently sits on the National MMRS Program Review Working Group, established by HLS-ODP to help redefine the national MMRS program.