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U.S. Department of Health and Human Services


Modernizing the National Disaster Medical System to Meet the Health Security Threats of the 21st Century

Author: Ron Miller, Acting Director for the National Disaster Medical System within the Emergency Management and Medical Operations Division at the Office of the Assistant Secretary for Preparedness and Response
Published Date: 9/4/2018 4:03:00 PM
Category: Public Health Preparedness; National Health Security;

In 2017, our nation suffered three back-to-back hurricanes that caused catastrophic damage in Florida, Texas, Puerto Rico, and the U.S. Virgin Islands. That experience highlighted the importance of the National Disaster Medical System (NDMS) – a federally coordinated system that augments the Nation's medical response capability during times of disasters or public health emergencies. ASPR, the government agency overseeing NDMS, deployed more than 4,600 personnel and 944 tons of medical supplies and equipment to treat approximately 40,200 patients affected by the hurricanes.

NDMS is called into action at the request of state or local authorities or by a federal department, such as the Federal Emergency Management Agency, to provide medical personnel, supplies, and equipment to a disaster area for the purposes of providing patient care, patient movement, and definitive care; contributing veterinary services; and furnishing fatality management support.

Last year’s multiple deployments stretched our resources almost to the breaking point. Yet, these larger and more frequently occurring storms are just one of many 21st century health security threats our nation faces; terrorist activities and naturally occurring infectious disease outbreaks (think Ebola, Zika, SARS, and pandemic flu) are also on the rise. The increasing demand to provide public health and medical infrastructure support to states and territories in need drove ASPR’s decision to modernize its NDMS capabilities. The changes described below will better position NDMS to respond to these 21st century health security threats

The Future of NDMS

Increase Workforce. ASPR is seeking to increase by 2,500 the number of NDMS responders – including physicians, nurses, first responders, and logistic personnel – who are trained, exercised, and equipped with the resources needed to respond to the growing list of health security threats. NDMS teams will be trained and exercised to meet the demands of a variety of disasters, whether naturally occurring or man-made, no matter their scope, complexity, or consequences. If you are interested in becoming one of these highly trained disaster response professionals, check out the NDMS open opportunities and apply today.

Eliminate Operational Gaps. We are working with state and local health and disaster response officials to identify and address operational gaps. For example, NDMS will be increasing engagement with the National Emergency Management Association (NEMA) to identify the response shortfalls within each state and territory and the measures needed to fill these gaps. These measures could enhance a state’s Emergency Management Assistance Compact (EMAC) Exit Icon mutual aid agreements and/or working with other states to collaborate on how they meet their shortfalls.

Increase Partnership Engagement. Understanding the capabilities of all entities involved in a disaster response – both at the federal, state, and local government levels as well as with private-sector partners – is critical to establishing and maintaining awareness and in reducing duplication of efforts and assets.

For example, states can better plan, train, and exercise for an emergency knowing NDMS’ capabilities and what federal personnel and resources can do to support or supplement local efforts.

Become More Modular and Agile. NDMS’ response must be scalable, flexible, and adaptable to ensure that our response efforts are the right size. Over the past two years, NDMS has adjusted its team and caches to be modular. Now state governors and health officials can request and receive the resources they need tailored to a specific mission versus receiving a standardized resource package that exceeds their needs. Standardized resource packages could be overwhelming for emergency managers to work with during a response whereas mission-specific resources fit the space and the need and can reduce the cost of response and recovery efforts to taxpayers.

ASPR is an organization that is mission driven and results oriented. The role of NDMS is based on that mission: assist state and local authorities to save lives and protect Americans. To achieve its greatest impact, NDMS must commit itself to continuous improvement, identifying any deficiencies or shortfalls that exist and addressing them promptly. The hurricanes of 2017 taught us a lot. The lessons learned are helping us prepare for and respond to the health security threats of the 21st century and beyond.

For more information about NDMS, the different teams that comprise the federal NDMS response, or how to call on an NDMS team, visit


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