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December 26
What Happens Next? Federal, State & Local Partners Work Together to Identify and Address Public Health and Social Services Needs in Texas following Hurricane Harvey

The response to Hurricane Harvey was rapid and robust. In the days and weeks after the storm, over 1,000 public health and medical responders deployed to protect residents’ health and save lives. HHS worked alongside state agencies, disaster relief organizations and other federal partners as part of the response.

But what happens now?  How can communities across Texas recover?

To answer these questions, state and local health and human services officials needed more information and a better understanding of the health and social services needs created in the wake of the storm. In general terms, state and federal government staffs knew that the damage had been extensive, impacting about 60 counties and damaging more than 200,000 homes, plus businesses and schools. Yet they didn’t have enough information to focus recovery efforts, prioritize recovery activities, or target resources so they could be used effectively.

In Texas, recovery experts from the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) offered state officials a new approach: assistance with a health and social services landscape assessment. The assessment is used to help state and local officials better understand the impact the storm had on health and social services; identify the recovery resources that are available at the local, state and federal levels; and outline long-term recovery actions.

Texas Governor Greg Abbott understood that recovery is more than repairing roads and transportation services, more than rebuilding homes and businesses and removing debris. Beyond the “sticks and bricks” of recovery, you need to look at the health, social services, and environment needs of communities. He quickly requested federal assistance, activating the National Disaster Recovery Framework that includes the Health and Social Services Recovery Support Function (HSS RSF).

Between October 24-27, six multi-disciplinary HSS RSF teams – each including environmental, public health, social services, behavioral health, and health care system representatives from HHS, the U.S. Public Health Service Commissioned Corps, as well as the Texas Health and Human Services Commission and the Texas Department of State Health Services – visited 13 counties and 112 health and social services programs and schools. These counties and facilities were selected based on triaging information from 20 existing de-identified datasets, including FEMA’s Individual Assistance applications, private insurance claims, social vulnerability indices, floodplain and storm path maps and programmatic data from hospitals, nursing homes, community health clinics, schools, child care facilities, mental health authorities and FEMA Disaster Recovery Centers.

Each site received a recovery needs assessment. During the assessments, team members held informal, recovery-focused discussions with facility staff on disaster recovery challenges and successes. The sites provided a status update on their damages; discussed issues related to their staffing, patients and communities; environmental and safety concerns; and any other primary needs. During the visits, state and federal team members also had an opportunity to distribute important information to help facilities with their recovery efforts, including the quickest way to apply for federal assistance.

Following the site visits, members from all six teams debriefed. Analysts from the HSS RSF Team reviewed the data and within 48 hours issued a report to the state and its recovery partners. Based on the results of the analysis, Texas is implementing five new projects: peer-to-peer recovery training for school administrators, train-the-trainer programs for first responders and a train-the-trainer program in psychological first aid for educators.  The state will also establish a health care systems recovery workgroup and a children and youth recovery task force.

Activating the Recovery Framework also helped state officials establish relationships with key federal partners from each HSS RSF team. These relationships may prove invaluable when trying to navigate and access federal assets during disaster recovery. In turn, the federal government also is utilizing the data to improve the resources and services it offers states during the recovery phase.

If you aren’t familiar with the federal government’s Health and Social Service Recovery Support Function and what it can do for your state, check it out. State, local, territorial, or tribal officials with questions can reach out to the ASPR Recovery Team.

December 14
Keeping Facilities Open: Stabilizing and Restoring Puerto Rico’s Health Sector Following the Island’s Worst Hurricane Season Ever

In the aftermath of Hurricane Maria, the Department of Health and Human Services (HHS) immediately deployed thousands of staff members and health care providers to Puerto Rico. Almost daily, the national media highlighted work HHS Disaster Medical Assistance Teams did to save lives. Less known are the activities and programs HHS put in place that went beyond direct patient care. Hundreds of personnel, from logistics experts to security personnel, worked behind the scenes to help restore Puerto Rico’s health sector. Their mission: to assist local hospitals, dialysis facilities, clinics, and medical supply manufacturers in obtaining the resources needed to continue or restore operations. These businesses are the backbone of the local economy and, even more importantly, are essential in saving lives.

Within days after Maria’s landfall, HHS and other response partners began conducting site visits to healthcare facilities across the island to identify their capabilities after the storm and determine what they needed to provide patient care. Did hospitals and dialysis centers have supplies and equipment their patients would need? Did the facilities have generators, and if so, how long could those generators run? Did laboratory equipment survive the storm? Did the facilities have diesel to run those generators? Did medical suppliers, such as oxygen manufacturers, have the resources they needed to continue production and delivery? Did pharmaceutical companies – a major employer in the territory and critical to the rest of the U.S. – have power and necessary resources, such as industrial gases to continue the production of critical healthcare products?

One of the most immediate needs across the health sector was power restoration. HHS worked with the Federal Emergency Management Agency, the Department of Energy, and the Army Corps of Engineers to communicate the importance of assisting hospitals, other healthcare facilities, and medical manufacturers and distributors with power restoration, generators, and generator fuel.

HHS identified medical and industrial gas production as another priority need for the health sector in Puerto Rico. Hospitals, home healthcare providers and pharmaceutical companies require medical oxygen as well as other gases to support patient care and healthcare product manufacturing. Due to the challenges of shipping gases long distances, Puerto Rico usually receives all its medical gases from two manufacturers on the island, Both of these manufacturers lost power in the immediate aftermath of Hurricane Maria, threatening the supply of gases for healthcare and creating the potential for a serious risk to public health. HHS quickly convened a task force composed of representatives of the two impacted manufacturers and other federal response partners in order to identify solutions to the gas supply disruption. This task force developed a system for shipping large containers of liquid oxygen and liquid nitrogen to Puerto Rico from the Continental United States. The federal members of the task force assisted the companies with regulatory and permitting issues as well as prioritization of on- and off-loading of cargo vessels.

Sodium chloride, also known as saline, also ended up in short supply due to disruptions to a critical manufacturing facility in Puerto Rico. This shortage impacted not only the healthcare system in Puerto Rico, but hospitals and other healthcare providers across the Continental United States who rely on the saline produced on the island. HHS assisted the impacted company with transportation and other needs in order to facilitate the movement of product off the island and held calls with healthcare system partners to discuss strategies they could implement to help conserve and replenish this essential medical supply.

Diesel fuel for generators became another priority to help stabilize the health infrastructure. HHS staff learned that diesel trucks were not reaching their destinations. The staff immediately reached out to the appropriate federal agencies to arrange for law enforcement escorts to ensure diesel got where it was supposed to go.

HHS also held daily teleconferences with hospitals, healthcare suppliers, and pharmaceutical companies to understand the impacts of the storm and to provide the latest federal information on response activities. In addition, we worked with the National Volunteer Organizations Active in Disasters and its partner Healthcare Ready. These organizations processed and distributed donations to help strengthen healthcare supply chains.

While having the right size generator is a basic preparedness step for many businesses in the health sector, one of the lessons emerging from this year’s hurricane seasons is that generators typically are built to run for a week or two not long-term, and they require regular maintenance. Private physicians’ offices, too, need to talk with their building owners about whether the building has a generator maintained regularly and of suitable size to allow the offices to remain open in long-term power outages.

Recovery is a marathon, not a sprint. Immediate after the storm, our goal was to help health care organizations jumpstart the process by helping the health sector obtain the resources they needed to get or keep their facilities running. The health sector continues to work toward full recovery, and HHS will be there to help every step of the way.

December 01
Filling the Gaps: Planning for the Disaster Health Needs of Patients Taking Opioids and People Using Illicit Drugs

When a disaster strikes public health and medical responders need to be ready to treat recreational users of opioids who are suffering from withdrawal, opioid patients who are in recovery, and patients who rely on opioids for pain management. Public health and health care professionals need to include the management of issues related to opioid use and addiction as part of their overall disaster preparedness, response and recovery plans.

Amid this year’s historic hurricane season, for example, some of the health care facilities, including opioid treatment centers, in the impacted areas struggled to reestablish services. Some area residents who relied on opioids for pain management or were being treated for opioid addiction had to manage the stress of the storm and the symptoms of opioid withdrawal at the same time.

Many of those patents also relied on emergency shelters in the wake of the storm. HHS medical responders who provided support to emergency shelters saw a number of patients who did not have their medications with them or ways to get replacements. In addition, some people in the shelter were non-medical opioid users who were unexpectedly cut off from their regular supplies and were suffering from withdrawal.

The opioid epidemic is a problem that has spread to communities throughout the country. According to the Substance Abuse and Mental Health Services Administration, in 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use was prescription pain reliever misuse rather than heroin use; there were 11.5 million pain reliever misusers and 948,000 heroin users.

Planning for Disruptions in Treatment and Potential Increases in Illicit Drug Use

Disruptions in service are a reality in many major disasters. The disruption of steady-state systems needed for medical care, such as pharmacies, medical facilities, and treatment centers, could result in an increase in people seeking alternatives to prescribed opioids, such as illicit drugs like heroin and illegally made fentanyl,that may be more readily available. It could also lead to people suddenly having to manage the symptoms of withdrawal when other support systems may be weakened or non-existent.

Public health, healthcare and emergency management planners and responders need to consider they can minimize the adverse effects of addition withdrawal on the community, residents in emergency shelters, and protect responders. Before a disaster affects your community, plan to address the needs of people who are addicted to opioids, recovering from opioid addiction, or require opioids for pain management.

HHS agencies are available to assist states and localities in contingency planning for disasters that disrupt systems, including having important supplies such as naloxone available at shelters, having shelter staff trained to respond to addiction withdrawal or overdoses, and engaging local and regional partners to share information about the availability of medical infrastructure. To get assistance with planning, contact the HHS Substance Abuse and Mental Health Services Administration or the HHS Office of the Assistant Secretary for Preparedness and Response.

In addition, state and local health agencies and health care providers can collaborate with law enforcement agencies to monitor and deter the use of illegal substances in communities that have suffered an emergency event. Such partnerships can help protect communities that may be vulnerable after disasters.

Protecting Responders from Accidental Exposure

According to the Drug Enforcement Administration, law enforcement officers, K9 units, emergency medical service personnel, and fire rescue professionals are also being adversely affected by accidental opioid overdose and particularly by the shift in the use of prescription opioids to the more potent illicit fentanyl into many communities.

Illicit fentanyl, although similar to prescription opioids and heroin, is 50 to 100 times more potent. Exposure to even a small amount can be fatal. First responders need resources and guidance to reduce and prevent occupational exposure to this dangerous substance in the field.

The first defense to treat an opioid overdose, whether intentional, accidental or occupational, is naloxone. Naloxone can reverse opioid-related overdoses and is administered by intranasal spray, intramuscular, subcutaneous, or intravenous route. Because fentanyl is extremely potent, multiple doses of naloxone may be needed to overcome the overdose. There are other precautionary steps that can be taken to reduce exposure to fentanyl, such as personal protective equipment.

Next Steps: Planning and Response

Federal agencies created the following resources to help local and state responders and planners:

As efforts to address this epidemic unfold, federal, state, local, and community organizations will need to work together in planning for and responding to crises. Saving lives amid our nation’s opioid crisis requires a multidisciplinary approach.

Let’s get the conversation going among public health, behavioral health, law enforcement, and emergency management professionals to develop best practices in assessing risks and in planning to protect the health and safety of responders and the people they serve. Doing so can protect health and save lives not just during disasters but every day.

November 20
BARDA Supports a Rapid, Deployable, Sensitive Diagnostic Platform to Diagnose Anthrax

In the wake of an anthrax attack, medical responders need to quickly determine who has been infected so that they can be effectively treated. A rapid, accurate diagnostic test is an essential tool for doctors and other health professionals to effectively triage people who may be infected with anthrax. Such a tool has been long requested by medical responders as a critical component of anthrax preparedness.

On September 27, 2017, BARDA awarded a $3,199,221 base period of a contract to Tangen BioSciences Inc. of Branford, CT to further advance and expand the ability to combat the threat of Bacillus anthracis with the TangenDx Molecular Diagnostic System (TangenDx™ System), which is a rapid, sensitive, low cost, and field deployable diagnostic assay.

If approved, the TangenDx™ System could be used to determine whether a symptomatic patient had been infected with anthrax-causing Bacillus anthracis bacteria in as little as 15 minutes. Preliminary data indicate that the TangenDx™ System could be as sensitive as current blood cultures with results hours quicker. The test can be based on a wide range of specimen types, including blood, sputum, and other methods of specimen sampling.

Detecting anthrax infections allows for effective treatment. BARDA’s portfolio includes supporting three anthrax antitoxin drugs approved by the FDA.

BARDA also supports advanced development of vaccines to prevent illness after exposure to anthrax and improvements to the only anthrax vaccine licensed for use post-exposure so that fewer doses are needed to protect human health.

Rapid diagnostic capabilities are critical to saving lives. That’s why BARDA is committed to developing diagnostics that are fast, accurate, and able to be used in a wide array of settings.

November 03
Local Students, DJ Help NDMS Connect and Communicate with Puerto Rico Communities

In Fajardo, Puerto Rico, Hima-San Pablo Fajardo Hospital was severely damaged due to Hurricane Maria. Power was lost and the primary and acute care needs of patients in and around the community were not being met. The U.S. Department of Health and Human Services immediately deployed several Disaster Medical Assistant Teams (DMAT) from the National Disaster Medical System (NDMS) to the area. Setting up tents just outside HIMA-San Pablo Fajardo Hospital, the nurses, physicians, paramedics, pharmacists, and other healthcare professionals immediately began providing services.

One problem. Very few patients sought the services being provided. But why?

Turns out, years ago, similar medical tents had been set up in the same area. However, those tents were used for quarantine of an infectious disease. Because of the history of the tents and their location, people were unwilling to seek medical care because they were worried they would be quarantined and separated from their families.

Local Students Come to the Rescue

Nursing and medical students as well as several Boy Scouts began volunteering their time to talk to the community, letting their friends, families, and listeners know what services were being offered and how DMAT could help. As an added measure, the students also volunteered to help Fajardo residents better undertand DMAT medical professionals.

Student volunteer 

As a result, the students quickly developed a friendly rapport with DMAT members. The students were also the first people patients saw when they arrived at the tents; since residents knew and trusted them, they immediately felt at ease in a new environment, and began trusting the medical staff.

A radio DJ who personally received care at the site also began talking on air about the care he received. Between the DJ talking on the air and the students working with the community and putting patients at ease, more and more residents in need of medical help came to the DMAT tents and received the care they needed.

“Every day these students would show up at our tents looking for ways to help,” said Rachael Wennekamp, a paramedic with New Mexico 1 DMAT. “These young volunteers are amazing future assets to their community. They have provided us a tremendous service, and I am honored to be working with them.”

Student volunteer 

On November 2, each student volunteer and the local DJ personally received Certificates of Appreciation from Acting Health and Human Services Secretary Eric Hargan, as part the Secretary’s two-day tour of Puerto Rico and the U.S. Virgin Islands this week.

Acting Secretary Hargan with student volunteers


November 03
The Needs after A Disaster Are Many: Alabama DMAT Jumps into Action, Responding to Half Dozen Missions During 20 Day Deployment

On September 27, a team of Gulf Coast medical personnel deployed to Puerto Rico as members of the National Disaster Medical System’s (NDMS) Disaster Medical Assistance Team (DMAT). Although DMATs typically deploy for 14 days, the Alabama 3 DMAT stayed in Puerto Rico for 20 days and carried out a half dozen missions. The extended deployment saved many lives and forever changed the lives of those who received the care and those providing it.

Upon arrival, DMAT AL 3 was assigned to Ryder Memorial Hospital in Humacao, Puerto Rico. Their task was to set up a temporary medical site outside the hospital to help augment the facility’s services. Within days, the hospital’s backup generator malfunctioned and stopped working.

DMAT unloading supplies 

Thinking quickly, the DMAT members and hospital staff developed a plan to evacuate 32 patients being treated in the hospital, including one ventilator-dependent patient, three patients from the intensive care unit, 10 patients recovering from surgery, and 18 patients suffering from various illnesses and injuries.

Various DMAT Teams 

According to Paul Randy Smith, commander for the DMAT, the evacuation involved two military helicopters to transport the ventilator patient and ICU patients to USNS Comfort, a military hospital ship circulating the perimeter of Puerto Rico to support U.S. disaster relief operations on the island and the U.S. Virgin Islands.

The remaining patients were evacuated by ground ambulance provided by the Department of Defense (DOD) or local private ambulance companies. Smith and his team worked quickly with Centro Medico in San Juan and HIMA Hospital in Caguas to determine which patients should be sent where. Decisions where based on the needs of each patient and the receiving hospital’s capabilities and patient load.

DMAT leadership meeting with 2 Star General Lee Ryder Hospital Humacao. 

Thanks to the knowledge and experience gained through their local, state, and regional disaster training exercises, the DMAT successfully evacuated 29 of the 32 patients within a few hours. (The remaining three patients were treated onsite and did not need to be transported; they were later released.)

Ryder Memorial Hospital was just one of the DMAT’s missions. The team – which included physicians, nurses, paramedics, pharmacists, safety specialist, and other administration specialists primarily from Alabama – was assigned two joint missions with Urban and Search Rescue to locate, triage, and treat patients from Utuado, one of many remote mountainous areas that are in dire straits due to destroyed housing, disrupted utilities and a wretched electrical system. (For more information about these missions, read “From Cut-Off to Connected: HHS and the U.S. Army Work together to protect health in Utuado, Puerto Rico following a landslide”).


The team also worked with DOD to treat and transport more than 10 patients, including the first neonatal transport.

NDMS Neonatal transport via military littr and ambulance is tested. 

Prior to the loss of the hospital’s generator, the DMAT worked with Ryder’s emergency department to treat critical patients, including two patients suffering from cardiac arrest, a gun shot victim, a stabbing victim and a local police officer who was injured by a chain saw.

On October 25, Ryder Memorial Hospital began operating at 100% thanks to a generator supplied by the Federal Emergency Management Agency. Prior to that time, the hospital was not able to admit any patients. Now they no longer need federal assistance to care for patients, and federal medical personnel have been assigned to other locations in Puerto Rico where help is still needed.

October 31
With Help from HHS More than 6,000 Dialysis Patients Get Life-Saving Treatment after Hurricanes Irma and Maria in Puerto Rico and the U.S. Virgin Islands

Staff checking on a dialysis patient 

Dialysis. A life-saving medical treatment for millions of people in the United States who suffer from kidney disease or renal failure. Without it, the life of a person is measured not in years, months, or even weeks, but in days. In Puerto Rico and the U.S. Virgin Islands (USVI), approximately 6,200 people rely on treatment two to three times per week through more than 51 dialysis facilities. This hurricane season, the U.S. Department of Health and Human Services (HHS) and its partners undertook an unprecedented effort to save lives and help this very vulnerable population (and the centers they rely on) manage as their island territories recover.

When Hurricane Irma hit USVI in early September, both dialysis centers on St. Thomas suffered severe damage. Working together, personnel from several HHS agencies, the Department of Defense (DoD) and the Department of Veterans Affairs evacuated approximately 100 dialysis patients and their caregivers from St. Thomas to Puerto Rico.

Less than two weeks later, Hurricane Maria hit USVI and Puerto Rico, bringing mind-boggling destruction. One of the two St. Croix dialysis centers was destroyed and the two on St. Thomas remained closed, further limiting the number of patients who could be treated. In Puerto Rico, dialysis centers suffered varying degrees of damage; those remaining open began operating on generator power.

What happened to those dialysis patients who evacuated from St. Thomas to Puerto Rico? Before Hurricane Maria made landfall, HHS and its partners relocated those patients to Miami, Florida, where HHS personnel were staffing a medical shelter. When this shelter closed, the patients were relocated to Atlanta, Georgia. This work also included coordinating services with other federal agencies and non-governmental community organizations to help patients register with FEMA’s individual assistance program and to provide patients hotel accommodations, transportation to and from dialysis, emergency financial assistance, food specified for renal diets, and medications.

In addition, with the damage Maria caused in USVI, HHS, VA, and DoD worked together to evacuate all dialysis patients who wanted to go from St. Croix to Atlanta.

DOD staff helping to evacuate dialysis patient

One week prior to Maria hitting Puerto Rico, the Centers for Medicare and Medicaid Services (CMS) worked with the Kidney Community Emergency Response (KCER) center and major dialysis providers to reach out to the 6,065 dialysis patients in Puerto Rico. The centers had coordinated “pre-dialyzation,” an emergency measure that ensures all patients, outside their normal treatment schedule, received shortened length of dialysis right before the storm. Pre-dialyzation helped ensure all patients could go without treatment for a few days immediately following the hurricane.

HHS agencies worked with KCER and the dialysis facilities to track the status of Puerto Rico’s dialysis patients to ensure they had access to care after Hurricane Maria hit the island. The facilities heard from 99 percent of the 6,065 patients that they were alright and receiving treatment. Most of the remaining one percent had left Puerto Rico prior to the storms.

Immediately after Maria hit, the government of Puerto Rico instituted a curfew so dialysis facilities had a shorter amount of time each to provide treatment. The island’s dialysis facilities ran short on treatment supplies, clean water and generator fuel. The end result: some facilities could provide only shortened treatments in order to provide at least some dialysis to everyone.

In a moment of crisis, HHS worked with the Department of State and the British Ministry of Health to transfer treatment supplies from a dialysis facility in the British Virgin Islands to a Puerto Rico facility to keep the facility open.

To benefit all dialysis facilities, HHS agencies worked with FEMA and other agencies and the private sector to ensure that dialysis centers and hospitals received priority for deliveries of water, supplies, and fuel. As high priority facilities, their supplies are offloaded immediately from incoming ships, and HHS arranged for law enforcement officers to travel with truck drivers to ensure delivery trucks reached their destinations. When needed, HHS staff members pushed to prioritize the delivery of replacement generators to help dialysis centers remain operational.

Interagency partners have worked together continuously to make sure that dialysis patients could continue to receive care despite the damage to facilities and loss of power across the island. Thirty days after the two massive storms, all but two dialysis centers were open and providing full dialysis treatments.

HHS is helping the facility staff members, too. In collaboration with the Puerto Rico Department of Health and other federal and private partners, HHS is working to develop and implement a process for credentialing nurses and technicians from the mainland to relieve dialysis facility staff as necessary and make sure that this workforce has the supplies they need to get to and from work each day.

As an a longer-term measure, HHS, DoD, and the Army Corps of Engineers are coordinating the implementation of temporary hospitals in the U.S. Virgin Islands while the local hospitals are rebuilt. CMS is providing consultation on dialysis medical needs and equipment to ensure that these resources are available in both the temporary and rebuilt hospitals.

Saving the lives of dialysis patients takes planning, partnerships and coordination. If you or someone you love relies on dialysis, learn about alternative treatment centers in your area in case of a disaster and find out what you can do before, during and after a disaster to stay healthy. If you operate or coordinate with a dialysis center, learn about best practices for keeping your patients safe when disaster strikes.

October 31
Local Paramedic’s First Deployment is to Help Family, Friends, & Neighbors After Hurricane Maria: Now He Says, “I’m NDMS for Life!”

Rafael Baucage has lived his entire life in Aguadilla, a community of 60,000 on the west coast of Puerto Rico that, before Hurricane Maria, was best known for its beautiful beaches and its very popular Parque Acuático Las Cascadas, the only aquatic theme park in the Caribbean.

Post Hurricane Maria, his beloved community is in shambles. Rafael’s’ home was located in the middle of the hardest hit area in Aguadilla. More than three feet of water seeped through the walls of his home, which he shares with his wife Maria and their 15-year-old twins.

On September 22, two days after Hurricane Maria struck, Rafael was able to locate his NDMS administrative officer. His first question was, “Are you ok?” His second question: “What can I do? I’m here. I’m ok. My wife and children are ok, and I’m ready to help.”

Patch from the National Disaster Medical System, Puerto Rico 1 Team 

The hurricane marked Rafael’s first deployment as a paramedic for the U.S. Department of Health and Human Services (HHS), National Disaster Medical System (NDMS). Although he has been a member of NDMS’ Disaster Medical Assistance Team (DMAT) since 2009, this is the first time his team has been deployed to a federal disaster zone, and it just happens to be in their own backyard.

Since his deployment, Rafael has been doing what he is most passionate about: working as a paramedic on an ambulance. Four days ago, Rafael found a patient outside unconscious just around the corner from where his team set up a medical area on the town’s main street. “I got the doctors and nurses who stabilized him and then I transported him to Centro Medico in San Juan. It was my birthday that day, and helping that patient was my best birthday gift.”

Rafeal helping to treat a patient 

For the last three weeks, Raphael has helped many patients, often transferring them down a mountain and across debris-filled streets to Centro Medico more than 90 miles away or bringing patients from his community back to the medical tents set up on main street. During these transports he sees people from his neighborhood doing everything they can: cutting up trees, removing debris, repairing their homes and cleaning the streets. Everyone is working together to help each other and make things better.

Although as awful as this storm is, Rafael says serving his community with NDMS has been a great experience for him. “The doctors, nurses, and EMTs on my DMAT are great.” According to Rafael, the best part about serving on the team is that he got to work with NDMS team members from California and New Jersey. These folks have been deployed to many disasters, and have a great deal of experience that they to share.

This may be Rafael’s first deployment, but he says: “I’m NDMS for life! I’m so glad I have this knowledge for my future job and deployments are one way to get even better at what I do.”

Rafael’s story is just one of many from NDMS responders helping patients get the care that they need and supporting the health care system as it recovers from Hurricane Maria. There are many great ways for both medical and non-medical professionals to help communities in the wake of a disaster, but the best time to choose to serve is before a disaster strikes. Are you up for the challenge? Take a few minutes to learn how you can help the next time disaster strikes, visit

DMAT PR-1 member signing flag 

October 26
Dedication and Deployment: A Couple Chooses to Serve with NDMS

Ever since we were fifteen, Don and I have loved to do things together. We even deploy together with the National Disaster Medical System (NDMS).

Susan and Don Wyatt 

This time, we deployed to Comerío, Puerto Rico, where I helped set up and staff the pharmacy and served as a nurse. The community was truly devastated by the storms. Most of the medical facilities were concentrated in one part of town. When that area flooded, it wiped out most of the town’s healthcare resources. Comerío has been completely cut off from grid power – any power that we have here comes from generators.

When I’m deployed, I get to connect with my patients on a very deep level and I get to stretch my limits. I give a part of myself to these patients and I get to do the hard stuff. I’ve worked as a nurse for a long time and I’m proud to be good at my job, but it is rarely really challenging. When I deploy, I take on tough challenges and see the rewards in the faces of the people that I help.

I also love being able to connect with patients and helping them become healthy enough to face the challenges that lie ahead. I don’t just want to give them a pill or quickly stop the bleeding. I want to help heal the patient.

I am honored to be able to touch people during some of the most vulnerable times in their lives. My patients back home in Modesto, California, have their own homes to go back to and a few area hospitals to choose from. Many here in Puerto Rico don’t. I get a chance to help not only our patients, but also their families who are worried and scared. It is an amazing experience.

Service is a wonderful thing to share. My husband and I deploy together, so he gets it. He understands how elated I feel when I’ve helped heal one of my patients. He knows how hard it is to deploy to a place that is devastated and how rewarding it is to help take away some of that pain. NDMS is both a really special part of my life and a very important part of our marriage.

Deploying together has some practical benefits too. When you are deployed, you usually work long days, and it can be hard to call home. When you deploy together, you get to see each other and reconnect.

Of course, you don’t have to be married and deploy together to be called to serve with NDMS. You don’t even need to be a medical professional. Medical professionals don’t work in a vacuum. They need temporary medical facilities with electricity and communications; people to handle logistics; and much, much more. It takes many different kinds of expertise to protect health and save lives in a disaster.

There are many different ways to serve with NDMS. If you think that you are up for the challenge, take some time to learn more. Visit

October 19
Providing care and restoring health services in Puerto Rico

October 20 marks thirty days since Hurricane Maria barreled through Puerto Rico, stripping the lush forests of their leaves, limbs, and even bark and toppling utility poles like fallen dominoes in a line. Pictures can’t do justice to the damage. The devastation looked much like a war zone. Federal, territory and private sector partners steadily are making progress in restoring healthcare services to the island after the destruction wrought by the storm.

Initially, 100 percent of the island was without electrical power. Today, roughly 17 percent of the island has power and major roads are open, although back roads are still being cleared. I had the opportunity to witness this firsthand, and I was overwhelmed by the resilience of the people of Puerto Rico. They survived the storm and are moving forward steadily to rebuild their communities.

Dr. Kadlec receiving briefing from NDMS DMAT 

Most people think of the federal government as swooping in to save the day. In reality, all disaster responses are led by the local, state and territorial officials. When the needs go beyond their resources, they request federal assistance. As the lead agency for the federal government’s public health and medical response, we have three priorities in Puerto Rico: save lives, stabilize the health care infrastructure, and restore health care services.

To save lives, we have coordinated with the Puerto Rico Department of Health (PRDOH) and local hospitals to overcome unprecedented challenges and make progress. We dispatched medical equipment, supplies and personnel from our National Disaster Medical System and U.S. Public Health Service to areas where they were needed the most – where hospitals were struggling to provide care after the storm. Initially half to a third of local medical professionals were unable to report to work. That’s changing as roads clear.

NDMS DMAT deploying to remote town in Puerto Rico 

As I toured our sites throughout Puerto Rico, I saw HHS teams performing in the most austere conditions. They set up tents near emergency departments at hospitals with no power, no air conditioning, and some with significant structural damage. They worked together with local doctors and nurses to provide the care residents needed after one of the worst disasters in Puerto Rico’s history.

View from inside a medical tent 

At one point after the storm, our teams were working at a hospital that completely lost power while they had more than 50 patients. Our team began to manually ventilate several ventilator-dependent patients to keep them alive. Four other patients at the hospital were in an operating room when the power went down, and they, along with more than two dozen others with critical needs at the facility had to be transported by helicopter to USNS Comfort, a Navy hospital ship with excellent trauma care for patients. Patients are transported to Comfort or a medical facility in Puerto Rico when they need a level of care beyond what is available at their local hospital or clinic.

USNS Comfort Navy Hospital Ship 

Our teams went into communities to find people who needed medical care but didn’t know that temporary medical facilities had been set up to care for residents. Smaller health and medical task forces walked through communities and knocked on doors to let people know care was available. In the first 30 days, HHS, along with the Departments of Defense (DoD) and Veterans Affairs (VA) collectively cared for over 8,700 patients in Puerto Rico.

NDMS DMAT personnel caring for a patient 

Now, in some locations, we are working alongside medical professionals from New York hospitals – volunteers who were coordinated by the Greater New York Hospital Association and deployed under an emergency medical assistance compact, an agreement between Departments of Health in New York and Puerto Rico.

To help in the emergency situation, VA clinics even opened to civilians as well as veterans and their families.

Some patients need care after they’re discharged from a hospital and with their homes destroyed have no safe place to go. Working with our partners at the Centers for Disease Control and Prevention and VA, we have set up Federal Medical Stations in key locations to care for patients like these until they can return home or reunite with family elsewhere. These sites are being staffed by our outstanding U.S. Public Health Service Commissioned Corps officers, medical professionals from the VA, and Puerto Rico Medical Reserve Corps volunteers.

 NDMS responder provides patient care at Federal Medical Station
One of the common reasons people visit hospitals or our temporary medical facilities after disasters is lost or damaged medication for chronic health conditions. To help, we activated the Emergency Prescription Assistance Program, which pays for prescription medications for people without health insurance who are affected by disasters. In Puerto Rico, 750 pharmacies are participating and more than 900 prescriptions have been filled so far.

To stabilize the local health care infrastructure, we are working with PRDOH to help restore public health and health care services so they become self-sustaining.

We worked with federal partners so that medical supplies and fuel delivery to hospitals and dialysis centers received priority. This includes fuel for hospital suppliers as well as hospitals.

About 60 percent of hospitals are on grid-power today; almost all others are on generator power and a few are still closed due to structural damage. Rebuilding the island’s electrical grid will take months. To help hospitals remain continually open, we are working with the state and with federal partners to provide generators designed for long-term use as back up to the short-term generators the facilities have.

Large Mobile Generator 

We continue to work with private sector to get fuel and supplies to dialysis centers and clinics. Today, almost all dialysis centers report that they are fully operational (although on generator power) and they have returned to providing full treatment sessions for dialysis patients.

We’ve done much more behind the scenes for pharmaceutical manufacturers and health care facilities so they in turn can help the people of Puerto Rico. We have been working closely with manufacturers of critical medical products to identify potential disruptions and to support their efforts to maintain the availability of critical healthcare products upon which residents of Puerto Rico and the continental United States rely. HHS’s Food and Drug Administration also worked with private sector partners to cut through red tape to allow pharmaceutical manufacturing to be shifted from impacted facilities to facilities outside the areas hit by the storms.

We are committed to continuing to work with the governor, mayors, the Puerto Rico Department of Health, local health care providers, and the private sector to help communities in Puerto Rico recover.

HHS NDMS Medical Tents 

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