On Aug. 17, 2007, the Federal Emergency Management Agency (FEMA) activated their contract with American Medical Response (AMR), requesting them to send at least 300 ambulances, 25 air ambulances and enough paratransit vehicles to move 3,500 ambulatory patients throughoutTexas in anticipation of Hurricane Dean. Expecting the storm to hit as a Category 5 hurricane, all of these resources had to be inSan Antonio within 24 hours.
Just 17 days earlier, AMR had signed a contract with FEMA to provide such EMS disaster resources toGulfCoast or Atlantic Coastal states. But AMR had already signed up ambulance services -- both public and private -- from around theU.S. to act as subcontractors in case they won the FEMA contract.
Steve Delahousey, RN, EMT-P, AMR vice president of emergency preparedness, reports that AMR and its subcontractors sent EMS resources from 28 states, including 317 ground ambulances, 51 buses (to transport paratransit passengers), 13 helicopters, 12 fixed-wing aircraft, numerous support vehicles (to handle logistics and communications) plus enough personnel to staff them all. All units were required to be self-sufficient for 72 hours.
˙AMR stockpiles ambulances in strategic locations,Ó he says. ˙We may not be able to get an ambulance fromWashington state toMiami in 24 hours, but we can fly personnel there within 24 hours.Ó For the Hurricane Dean response, AMR deployed ambulances from as far away asOhio and flew personnel toSan Antonio from as far away asConnecticut.
Other states sent resources via other mutual agreements, resulting in nearly 700 ambulances staged at Kelly Air Force Base inSan Antonio. ˙FEMA described this as the largest deployment of EMS resources in the history of theUnited States,Ó Delahousey says. As it turns out, Hurricane Dean bypassedTexas and made landfall inMexico on Aug. 20 instead, so the EMS resources stationed inSan Antonio were never used.
A federal after-action report concluded, ˙[The Department of Health and Human Service] and FEMA are extremely pleased with the current outcome.Ó However, some stateEMS officials worry such deployments could leave them short-staffed.
˙Oklahoma was concerned about flooding [from Hurricane Dean], but we found many of our assets gone,Ó Oklahoma EMS Director Sean Rogers said at the National Association of State EMS Officials (NASEMSO) annual meeting in October. ˙It's difficult for us to maintain coverage when there are financial incentives for assets to leave their area uncovered and go for the big money from FEMA.Ó
NASEMSO passed a resolution pressing FEMA ˙to require notification and coordination with the lead state EMS office in sending and receiving states prior to the movement ofEMS resources.Ó
Delahousey says, ˙There's no language in the current contract that requires us to notify stateEMS offices, but if they want us to do that, we will Ú. TheEMS needs of local communities are primary, and participation in the AMR [Disaster Response Team (DRT)] isn't intended to undermine these obligations.Ó
Although AMR appears to have enough resources to fulfill the terms of FEMA's contract for theGulfCoast andAtlantic states, the company continues to sign up ambulance services and individuals who want to become DRT members. (For more information, go tohttp://amr.net/contact/DisasterResponse.asp.)FEMA has yet to name a contractor to provideEMS disaster resources to the Western and Midwestern states.