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					ANNEX # : STATE MEDICAL RESPONSE SYSTEM

TABLE OF CONTENTS

OVERVIEW ............................................................................................................................................................................................... 2
    Purpose................................................................................................................................................................................................ 2
    Situation .............................................................................................................................................................................................. 2
    Planning Assumptions ................................................................................................................................................................... 3


CONCEPT OF OPERATIONS.............................................................................................................................................................. 3
    State Medical Assistance Teams ................................................................................................................................................ 3


ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES............................................................................................... 7


AUTHORITIES AND REFERENCES ................................................................................................................................................ 90
    Federal ...............................................................................................................................................................................................90
    State ....................................................................................................................................................................................................90
    Regional ............................................................................................................................Error! Bookmark not defined.10
    Tribal ................................................................................................................................................................................................ 101




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Annex # State Medical Response System


The following organizations and agencies support the State Medical Response System (SMRS).

State Agencies:       North Carolina Department of Crime Control and Public Safety
                      North Carolina Department of Health and Human Services
                      North Carolina Office of Emergency Medical Services
                      North Carolina Division of Public Health - Office of Public Health Preparedness &
                      Response (PHP&R)
                      Regional Response Teams (RRT)
                      North Carolina Disaster Response Network
                      North Carolina Department of Public Information

Federal Agencies:     Department of Health and Human Services
                      Department of Homeland Security
                      Federal Emergency Management Agency (FEMA)



OVERVIEW

Purpose
The purpose of Emergency Support Function 8 is to coordinate the medical and public health resources in
case of an emergency or disaster situation. The State Medical Response System (SMRS) Annex describes
the procedures and guidelines in place that will allow the Mountain Area Trauma Regional Advisory
Committee (MATRAC) to coordinate this supplement to local and regional medical care.


Situation
North Carolina has taken great strides in streamlining and improving its ability to respond to the medical
needs of its citizens in order to be better prepared for unexpected emergencies. Local, state, and regional
agencies have collaborated to form a tiered system called the State Medical Response System (SMRS).
The following North Carolina agencies have joined efforts to focus on the treatment and response phase
of natural and man-made disasters. These agencies represent the core systems responsible for
coordinating a disaster response, ensuring that treatment and prevention strategies are in place, and
ensuring the appropriate levels of disease surveillance and medical preparedness.
North Carolina Office of Emergency Medical Services (NCOEMS)
North Carolina Division of Emergency Management (NCDEM)
North Carolina Division of Public Health - Office of Public Health Preparedness & Response (PHP&R)




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Annex # State Medical Response System


Planning Assumptions
Resources within the affected disaster area will be inadequate to triage casualties from the scene or treat
them in local hospitals. Additional mobilized medical capabilities will be urgently needed to assist
response.
Primary medical treatment facilities may be damaged or inoperable. Assessment and emergency
restoration to necessary operational levels is a basic requirement to stabilize the medical support system.
As such, operational necessity may require:
Establishment of field medical stations
Further transportation by air of patients to the nearest metropolitan areas with sufficient concentrations
of available hospital beds where patient needs can be matched with the necessary definitive medical care
Assistance in maintaining the continuity of health and medical services


CONCEPT OF OPERATIONS
Decisions to initiate a request for state assistance in managing medical response events are made on a
community-by-community basis by local health authorities in coordination with local medico-legal
authorities, elected officials, and emergency management coordinators.
During an event in which it is anticipated that local and regional assets will be fully obligated or exceeded,
the State of North Carolina has developed the State Medical Response System in order to meet those
needs. This system consists of:
Special Operations Response Team (SORT) / State Medical Assistance Team (SMAT) I
SMAT II
SMAT III
Medical Reserve Corps


State Medical Assistance Teams

 SORT /     The Special Operations Response Team (SORT) is a private, non-profit organization located in
 SMAT I     Winston-Salem which can supplement and assist emergency services agencies that become
            overwhelmed in a crisis situation such as a manmade or natural incident. This organization is
            a federally supported Disaster Medical Assistance Team (DMAT) that responds to events
            nationwide. The SORT provides a dedicated set of equipment for response to incidences in
            North Carolina if federal committed resources are not available.
            The SORT responds as a disaster medical team and hazmat team both locally and statewide,
            is a member of North Carolina's State Emergency Response Team (SERT), and has been
            designated as the State Medical Assistance Team I (SMAT I).
            The SMAT I is a rapid medical statewide response team capable of a 4 to 6 hour response
            time when activated and is capable of responding to assist the citizens of North Carolina in a
            crisis situation. An SMAT I response would be augmented with personnel and additional
            response equipment from the Winston-Salem based Special Operations Response Team.
            SMAT I is prepared to respond to events ranging from an austere medical setup for a
            hurricane response to setting up a large scale decontamination area as a result of a terrorist




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           event involving weapons of mass destruction.
           Mi s s i o n :
           Rapidly deploy a medical response team capable of providing medical care in a disaster or
           special event statewide
           Establish a 150 bed alternate care facility
           Assist at a Strategic National Stockpile (formerly National Pharmaceutical Stockpile) receiving
           site
           Establish drug distribution and immunization sites
           Establish a field medical station capable of seeing 250 patients within a twenty-four hour
           period
           Provide specialized rapid decontamination and medical care of victims exposed to both
           chemical industrial products and weapons of mass destruction agents
           Provide rapid 4-5 person strike-team medical assistance
           T ea m Co m pos i ti o n :
           Team deploys with 12-54 members
           Physicians
           Nurses
           Paramedics
           Physician Assistants
           Nurse Practitioners
           Veterinarians
           Firefighters
           Law Enforcement
           Other Medical Professionals
           T ea m Ac ti va ti on :
           Team can be deployed within four to six hours statewide
           Team is self-sustainable for 72 hrs
           Team is prepared for a seven day mission length
SMAT II    A SMAT II team is a team of medical professionals established to provide patient
           decontamination, mass medical care, alternate care facilities, and mass drug distribution
           points. North Carolina currently has eight SMAT II teams. SMAT II focuses on hospital-based
           capabilities (medical surgical capabilities). The team is responsible for responding to the
           treatment and surge capacities needs for the region and state by providing mobile medical
           and decontamination resources in the event of a disaster. The team houses a standardized
           mobile package that includes the basic equipment needed for a response. A SMAT II is
           hosted by each RAC’s lead trauma center.
           Lo ca ti o n:
           The MATRAC SMAT II is based in Flat Rock, NC. The MATRAC region is serviced by public
           and private local EMS. The region is served by Mission ‘s Mountain Area Medical Airlift
           ((MAMA I and II). Mission hospital is designated as Western North Carolina’s only level II



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Annex # State Medical Response System


           trauma Center.
           Mi s s i o n :
           Assist in hospital staffing
           Establish a 40-bed alternate care facility
           Establish a mass immunization/drug distribution center
           Maintain operations for at least three days
           T ea m Co m pos i ti o n :
           Physicians
           Nurses
           Paramedics
           Nurse Practitioners
           Physician Assistants
           Pharmacists
           Pediatricians
           Surgeons
           Obstetricians
           Psychologist
           Psychiatrists
           Interpreters
           Other Support Staff
           Most SMAT II teams seek volunteers from all hospitals and other medical agencies within
           their RAC’s.
           Al l S M A T II m em b ers mus t be re gi s te re d o n S er vn c .or g




           T ea m Ac ti va ti on :
           For a local response, SMAT II team can be deployed by Mission Hospital(s). For a regional or
           statewide response, the SMAT II teams may be requested through the North Carolina
           Department of Emergency Management, in accordance with the base plan. The SMAT II
           teams can also be deployed nationally through an EMAC Agreement.
           The SMAT II is deployable within the RAC within six hours and statewide within twelve to
           twenty-four hours.

SMAT III   An EMS- or Fire Department-based team that is designed to be the first line of response in
           support of local agencies in the event of a decontamination event or mass medical care
           event. There are currently twenty-nine SMAT III teams across the state.
           Lo ca ti o n :

           Within the MATRAC, SMAT III teams are located at Buncombe, Henderson, Cherokee Tribal,



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Annex # State Medical Response System


           McDowell and Cherokee Counties.

           Mi s s i o n :
           Provide a first line of defense locally, assist at hospitals, or respond regionally or statewide at
           the request of the North Carolina Department of Emergency Management.
           Provide local decontamination/medical treatment teams that can rapidly assist/start
           decontamination operations on victims of chemical exposures or other incidents that would
           require decontamination.
           Team Composition:
           Each team consists of at least seven members during a deployment. At a minimum there
           must be one paramedic and six EMT’s or higher on each deployment. Each team should be
           trained three deep for each position, to provide for three complete shifts.
           Other medical professionals and support staff may be added in support of the team’s
           operation.
           T ea m Ac ti va ti on :
           SMAT III teams can be activated to provide rapid victim decontamination and mass casualty
           medical care on a local, regional, or statewide level.
           Teams are deployable locally within one hour and may be ready to deploy statewide within
           two hours.
           For a local response, SMAT III teams may be activated by the local host agency. For a
           regional or statewide response, the SMAT III teams may be activated through the North
           Carolina Department of Emergency Management under the Statewide Mutual Aid
           Agreement.
Medical    Within North Carolina, the Medical Reserve Corps (MRC) consists of medical and non-
Reserve    medical volunteers who contribute to local health initiatives and supplement existing
 Corps     response capabilities in time of emergency. The MRC provides the structure necessary to
           pre-identify, credential, train, and activate medical and public health volunteers. The MRC
           program is administered by HHS.

           Mission:
           Provide a pool of volunteer personal prepared to respond to disaster and community events
           across the state and beyond as requested by North Carolina Emergency Management.
           Strengthen communities by allowing medical, public health, and other volunteers to offer
           their expertise throughout the year as well as during local emergencies and other times of
           community need.
           Work in coordination with existing local emergency response programs and also supplement
           existing community public health initiatives, such as outreach and prevention, immunization
           programs, blood drives, case management, care planning, and other efforts.
           Within the MATRAC region, the MRC supports the region’s SMAT II, one of eight Regional
           SMAT teams across North Carolina. The MATRAC SMAT Regional MRC unit, the Mountain
           Regional Medical Reserve Corps (MRMRC) is a team of volunteer health care professionals
           and auxiliary personnel who are trained to respond and to assist the local emergency
           responders and public health professionals in the eighteen counties comprising the Western
           North Carolina Region. These volunteers will be pre-identified, organized, trained, and


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Annex # State Medical Response System


            credentialed.
            The MRMRC primarily serves 17 counties in Western North Carolina.
            Clay, Cherokee, Graham, Haywood, Jackson, Swain and Macon and
            the Eastern Band of the Cherokee Indians
            Avery, Buncombe, , Henderson, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania,
            and Yancey.
            T ea m Co m pos i ti o n :
            Currently, the Mountain Regional MRC is composed of personnel with the following types of
            skills: Physicians, Physician Assistants, Nurse Practitioners, Nurses, Pharmacists, Dentists,
            Veterinarians, Mental Health Professionals, EMS Professionals, Respiratory Therapists, other
            Public Health/Medical skills, and non-Public Health/non-Medical skill sets.
            T ea m Ac ti va ti on :
            No MRMRC member will self-deploy. Activations will be initiated through MATRAC and/or
            MRMRC command staff via ServNC contact.




ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES

  Agency/Department/Position                                       Responsibilities

 STATE

 North Carolina Division of              Maintain the State Emergency Response Team (SERT).
 Emergency Management                    Manage and operate daily state Emergency Operations Center.
                                         Approve requests for activation of SMAT teams, MRCs, and Field
                                         Hospitals.

 North Carolina Office of                Direct deployment of SMRS resources as required.
 Emergency Medical Services              Provide leadership in coordinating and integrating the overall state
                                         efforts that provide medical assistance to a disaster-affected area.
                                         Coordinate and direct the activation and deployment of state
                                         resources of medical personnel, supplies, equipment, and
                                         pharmaceuticals (with Public Health as needed).
                                         Assist in the development of local capabilities for the onsite
                                         coordination of all emergency medical services needed for triage,
                                         treatment, transportation, tracking, and evacuation of the affected
                                         population.
                                         Establish and maintain the cooperation of the various state medical
                                         and related professional organizations in coordinating the shifting of
                                         Emergency Medical Services resources from unaffected areas to


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Annex # State Medical Response System


                                     areas of need.
                                     Coordinate with the SERT to arrange support for military installations
                                     and/or tribal nation to arrange for medical support as applicable.
                                     Coordinate the evacuation of patients from the disaster area as
                                     necessary.
                                     Coordinate the catastrophic medical sheltering response by
                                     implementing the Medical Support Sheltering Plan.

 North Carolina Health and Human     Provide leadership in directing and coordinating state efforts to
 Services                            provide public health assistance to the affected area.
                                     Support the distribution of the Strategic National Stockpile.
                                     Support the appropriate conditions for quarantine and isolation in
                                     order to prevent further transmission of disease.
                                     Provide the issuance of guidelines for prophylaxis and treatment of
                                     exposed and affected persons.
                                     Establish monitoring systems for the protection of public health.
                                     Provide guidance and assistance to local public health departments,
                                     health care entities and the general public.
                                     In coordination with the SERT Infrastructure Branch, test water
                                     supplies.
                                     Investigate disease outbreaks.

 North Carolina Division of Public   Protect the health and safety of residents and visitors within the
 Health - Office of Public Health    state before, during, and after public health emergencies.
 Preparedness & Response
 (PHP&R)

 REGIONAL

 Regional Emergency Response &       Assume overall responsibility for coordination of all region ESF-8
 Recovery Coordinator                resources during a disaster.
                                     Coordinate RAC disaster activities during any SMAT deployment or
                                     other event where the OEMS activates the SMRS assets and/or
                                     resources.
                                     Serve as official liaison between local ESF-8 agencies and the state,
                                     coordinating RAC ESF-8 resources during disaster/mass casualty
                                     events.
                                     Educate the healthcare system partners on the SMRS mission, SMRS
                                     capabilities, benefits, and responsibilities of participation.
                                     Assist the OEMS with RAC Hospitals and EMS Systems with the
                                     development/maintenance of North Carolina Medial Communication
                                     Network (NCMCN) and/or VIPER Medical Network issues related to
                                     operations, training, or questions.
                                     Plan, coordinate, and facilitate regional ESF-8 exercises annually.
                                     Provide exercise development assistance to the SMAT teams within



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Annex # State Medical Response System


                                       the RAC as requested.
                                       Provide annual inventory of SMAT equipment and supplies,
                                       including critical shortfalls.
                                       Oversee and report on all of the regional team SMRS assets that are
                                       available for deployment in accordance with current policies.

 SMAT II Team Leader                   Attend meetings as requested by the OEMS or the RERRC
                                       Serve as the region’s liaison with the Medical Reserve Corps (unless
                                       there is another full- or part-time position dedicated to MRCs) and
                                       SMAT IIIs.
                                       Perform all duties of the SMAT II Team Leader as defined by the lead
                                       hospital with input from the RAC’s Disaster Preparedness Committee
                                       and the OEMS.
                                       Assist the ERRC in facilitating consistent and executable All-Hazard
                                       Health and Medical Response and Recovery Plans for hospitals, EMS
                                       systems, local health departments (LHDs), local Emergency
                                       Management, community health centers (CHCs), Rural Health
                                       Centers (RHCs), long-term care facilities, Public Health Regional
                                       Surveillance Teams (PHRSTs), assisted living facilities, college and
                                       university health centers, dialysis centers, and all related emergency
                                       response agencies located in the RAC.
                                       Add line concerning training & education responsibilities as listed in
                                       base plan.

 County Emergency Management           Transmit requests for assistance through the appropriate Branch
                                       Office to the State EOC.



AUTHORITIES AND REFERENCES
Appropriate references identified in the base plan apply to this annex. In addition, the following should
be used.


Federal
Emergency Management Assistance Compact


State
Continuity of Operations Planning Manual (available online at: http://www.nccrimecontrol.org)
Disaster Assistance Recovery Guide (available online at: http://www.nccrimecontrol.org)
North Carolina Emergency Management Information on Tornados
http://www.nccrimecontrol.org/Index2.cfm?a=000003,000010,000025,000203
North Carolina Emergency Management Mutual Aid Agreement (Senate Bill 300)
North Carolina Emergency Operations Center Standard Operating Guide, dated July 2009 (available online
at: http://www.nccrimecontrol.org)




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Annex # State Medical Response System


North Carolina Emergency Operations Plan (NCEOP), Annex A, Appendix 4, Tab B, Weather Support;
dated April 2009 (available online at: http://www.nccrimecontrol.org)
North Carolina Hospital Association (NCHA) Mutual Aid Agreement (MAA)
VIPER Talk Group Procedures (available online at: http://www.nccrimecontrol.org)



Regional
Mountain Area Trauma Regional Advisory Committee (MATRAC), available online at:
http://www.matrac.com/index.html


Tribal
FEMA Tribal Policy (Online at: http://www.fema.gov/government/tribal/natamerpolicy.shtm




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