The parking lot of the Gulf Islands Water Park off of I-10 in Gulfport, Mississippi, is an unlikely spot for inspiration. But in the sweltering heat and humidity in late August 2005, just days after Hurricane Katrina made landfall, the parking lot was where Mark Gebhart and Jim Gruenberg would meet to swap stories about the dysfunction they saw daily as emergency responders helping in the rescue efforts.
They knew there had to be a better way.
Gebhart and Gruenberg knew each other from their days with the Kettering Fire Department, where Gebhart had served as medical director and Gruenberg as a captain. Both were dispatched to Gulfport as part of the federal response to the disaster. Mark Gebhart, M.D. ( ’ 97), CPM, was the medical team manager for Ohio Task Force One, a 35-member urban search and rescue team with the Federal Emergency Management Agency (FEMA). He was responsible for the health of the team and its four rescue dogs. Jim Gruenberg, EMT-P, CPM, and formerly a task force leader with Ohio Task Force One, was deployed as the executive officer for the operations section chief of FEMA’s incident support team in Mississippi.
It was just dumb luck
Gebhart and Gruenberg saw firsthand the lack of coordination and technology that became an infamous hallmark of the nation’s response to the disaster.
“We rescued one person,” Gebhart said. “And it was because we stumbled into her. A multimillion-dollar federal urban search and rescue team had no better technology than BlackBerries that didn’t work and tri-fold park maps of the community. Here we find this 85-year- old lady standing knee-deep in water in her house. No sensors found her. It was just dumb luck.”
With the skies filled with helicopters and planes, “it looked like everybody was doing something,” Gebhart said. “But the whole guidance, the command and control, was really disconnected. And it was at every level, whether it was fire, medical search and rescue, right down to the utilities people. It was all a totally uncoordinated mess.”
A lack of basic supplies also hindered their efforts. They had plenty of water, but no access to salt, which is vital in hot, humid conditions.
“We were putting people in the hospital because they were getting delusional hyponatremia,” said Gebhart. “The only way we could get salt was to drink hot sauce that we found in a grocery store that had been destroyed.”
Gruenberg, a former NYC firefighter who has been deployed to 13 missions, including the World Trade Center following 9/11, saw a problem with the searches. When missing person reports would come into the coroner’s office, Gruenberg would be asked if a particular neighborhood had been searched. There was no way for him to tell.
“The elite search and rescue teams of the United States of America could not quantify or qualify their performance,” he said. They had never dealt with the scope and scale of searches in 95 percent humidity at 95-degree-Fahrenheit temperatures. Gruenberg saw a profound need for training in realistic environments to prepare responders for the actual conditions they will face during search and rescue missions.
Vision becomes reality
In the parking lot, Gebhart and Gruenberg developed a shared vision for a better way. Four years later, their vision became a reality on September 28, 2009, when Wright State University and the city of Fairborn broke ground on the National Center for Medical Readiness Tactical Laboratory (NCMR-TL) at Calamityville. Today, Gebhart serves as NCMR director and Gruenberg as assistant director for human access care and evacuation.
The Boonshoft School of Medicine Department of Emergency Medicine, where Gebhart serves as an associate professor, created the Homeland Emergency Learning and Preparedness (HELP) Center in June 2005, two months before Katrina slammed into the Gulf coast. Its mission was to become an internationally recognized center of excellence in disaster preparedness and medical readiness. But it lacked a tactical laboratory, where all responders could come together to train in a realistic environment.
Working closely with then chair of emergency medicine, Glenn Hamilton, M.D., they crystallized their plans for Calamityville, which will eventually include:
- Large, high-profile commercial and residential debris fields
- Six-story building simulation platforms, including both interior and exterior patient evacuation capability
- A ground transportation mishap area, replete with rail and various vehicle crash scenarios and props
- Above- and below-ground confined space simulators n Interior and exterior hazardous materials simulators and spill area
- A 20,000-square-foot training and simulation building for classroom and patient simulation use
- Acres of open area for mobile command posts, base of operations set-up, and exercises
- Offices, conference areas, and research laboratory space
- An integrated sensors array to identify and track groups for command and control, and individuals for physiologic status in the simulated environment
“As a training site and research test-bed, the tactical laboratory at Calamityville will help prepare the civilian and military medical communities to participate and react effectively together and with traditional disaster responders,” said Hamilton, now the executive director of NCMR and professor of emergency complete approach to finding patients, offering initial care, and safely evacuating them from disaster sites. It will also serve as the site where the health care system, including hospitals, can research and identify best practices during highly stressful events. The tactical laboratory will be the first site in the United States to fully integrate the civilian and military medical and non-medical responses that occur in a disaster or other complex rescue situation.”
The global building materials company CEMEX donated the facility and surrounding 54-acre property to Fairborn in June 2009 to serve as the future site of the NCMR-TL. The project has garnered more than $13 million in state and federal support to fund the Phase I development of the NCMR-TL.
Connecting the dots
“Calamityville helps connect the dots,” said Gebhart. “People can experience these things in a very realistic simulated environment before they’re ever thrown into that for real. At Calamityville, you can push the stop, the start, and the pause button. If you push the pause button as the dots are not being connected, you have the opportunity to show people what went wrong.” Disaster training often fails because it’s not realistic. Tabletop exercises are typically held from 9 a.m. to 4 p.m., with breaks for coffee and a nice box lunch.
“When we went to Hurricane Katrina, we had no earthly idea where a coffee pot would be,” said Gebhart. “And whatever was for lunch was in your backpack. So the realism in these events is very, very important.”
Gebhart envisions around-the-clock exercises running up to four days at a time that are meant to stress the participants, showing them what it’s like to work under extreme pressure. To improve emergency response at all levels, from the EMT to the ER physician, up through the command and control structure, the laboratory will develop individual training for each group and bring them all together for a culminating exercise at the end of the week.
In 2008, the HELP Center underwent a name change and became the National Center for Medical Readiness to better reflect its medical mission. Building on research and the experience at Katrina, NCMR plans to focus on five critical areas:
Emergency and disaster medicine
Current training often focuses on how to extract an injured person from a collapsed building or other difficult environment, but it does not always address the best medical care for the patient. The center will train physicians and nurses to go into difficult situations to guide the rescue from a medical perspective.
NCMR will be researching how to identify those best-suited to make life-saving decisions in a disaster situation, how best to get critical information to command and control, and the effects of extreme fatigue and the emotional challenges facing first responders. The relocation of the U.S. Air Force’s 711th Human Performance Wing to Wright-Patterson Air Force Base brings new opportunities for military and civilian collaboration.
In July 2009, the Air Force Research Laboratory awarded Wright State $2.7 million to enhance collaboration between the Air Force School of Aerospace Medicine and NCMR. The award supports the development of the NCMR-TL and provides education, research, and development projects in disaster response and medical readiness.
The conditions after Katrina were so horrific that rescuers sometimes just gave up.
“We need to apply technologies that eliminate the human in some cases where the human cannot perform, and even on a good day, are unlikely to find what they’re sent to find,” Gruenberg said.
The center will explore technologies to remotely detect victims in a disaster, evaluate their life signs, and detect hazardous materials and biological threats.
Information technologies and systems engineering
The center will work to strengthen information sharing and collaboration during emergencies and explore ways to apply military methodology to enhance civilian command and control during disasters.
Logistics and supply chain management
After Katrina, resource managers were unable to determine what resources were needed, which were available, and where they were at any given point in time. NCMR is already helping to find solutions with its Modular Emergency Medical System (MEMS). MEMS was established to expand a community’s surge capacity for patient care during a disaster. MEMS consists of 250-bed Acute Care Centers (ACC) and 1,000- bed Neighborhood Emergency Help Centers (NEHC).
An ACC can be located near a hospital to facilitate the transfer and referral of patients, while the NEHC was developed to provide evaluation and treatment for 1,000 patients a day. Each ACC or NEHC fits into a 53-foot semi-trailer and includes everything physicians need, including hospital beds, computer systems, generators, medical supplies, and food. The Ohio Department of Health (ODH), with funding from the U.S. Assistant Secretary for Preparedness and Response in the Department of Health and Human Services, has designated regions statewide for the initial pilot program and for ACC implementation sites. MEMS has been transformed into a working plan for the Northwest, Southeast, and West Central regions of Ohio, becoming a model that can be replicated throughout the state of Ohio and beyond.
The center is already serving as a test-bed for new and improved technologies.
“We found in developing the surge capacity project that there wasn’t an adequate portable hospital bed,” Gebhart said. “So we talked with an Ohio-based business about that, and they developed a surge capacity bed.”
Following the devatating earthquake in Haiti, the NCMR team was placed on alert status by Ohio Govenor Ted Strickland and ODH for possible deployment to Haiti to set up a 500-bed field hospital to care for the injured.
The nation needs emergency leaders, not emergency managers said Gruenberg.
“Management is a skill set that’s very vulnerable, because it’s only as good as the bureaucracy that supports it,” he said. “I hope we start raising a generation of emergency leaders who have courage to go beyond the management phase and into making very difficult, but very important, decisions.” VS
For more information, visit medicalreadiness.org
Cindy Young is director of the medical school’s Office of Marketing and Communications. She can be reached at firstname.lastname@example.org