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

CAD

CVD

CHF

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

HARRM

condition 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