The premise for the Metropolitan Medical Response System (MMRS) was to provide enhanced plans, equipment resources, and personnel specially trained in CBRNE to respond
to large, complex incidents of all hazard types. As previously explained, the magnitude of these incidents likely exceed the capabilities of routine mutual-aid. A Type 4 HRMMST (an
eight member team) is trained in Medical Consultation and Coordination and may serve in an advisory role for the local Incident Commander/Unified Commander, Medical Branch
Director, or Hazmat Branch Director.

Medical Consultation involves detecting medical symptoms or other indicators when a large number of patients are encountered with symptoms that may be associated with
exposure to CBRNE materials and providing advice to health care entities following a release.

The Type 4 Team is trained to provide assessment of immediate medical needs, coordination of disaster medical resources, coordination of patient distribution, medical evaluation, and coordinating the establishment of temporary field treatment sites. Upon arriving on-scene, the Type 4 Team will immediately obtain a briefing from the Incident Commander/Unified Commander.

The focus of the HRMMST will be the collection, evaluation, dissemination and use of the medical information related to the incident and determining the availability of regional resources to address the following:

• Current Situation, use of Weapons of Mass Destruction
• CBRNE Agent(s) involved/signs and symptoms of patients
• Victim rescue issues
• Patient decontamination issues
• Local EMS/Medical issues (Triage, treatment and transportation)
• Hospital issues
• Physical location of the Incident Command Post
• Location of the HRMMST Base of Operations
• Current meteorological conditions
• Develop protective measures for the region’s medical infrastructure
• Predict probable courses of incident events and develop protective measures and or medical care for the affected population(s)
• Prepare alternative strategies and medical control options for the incident

The HRMMST can be incorporated into existing shelter plans to assist emergency managers and shelter planners in meeting access and functional needs in general population shelters and medical needs in medical shelters. Functional Needs Support Services (FNSS) are services that enable children and adults with or without disabilities who have access and functional needs to maintain their health, safety, and independence in a general population shelter. This includes personal assistance services (PAS), durable medical equipment (DME), consumable medical supplies (CMS), and reasonable modification to common practices, policies and procedures.

Individuals requiring FNSS may have sensory, physical, mental health, cognitive and/or intellectual disabilities affecting their ability to function independently without assistance.
Additionally, the elderly, women in the late stages of pregnancy, and individuals requiring communication assistance and bariatric support may also benefit from Functional Needs Support Services.

The HRMMST In conjunction with ESF #6 (Mass Care, Housing, and Human Resources) and ESF #8 (Public Health and Medical Services) the HRMMST can supplement and enhance existing capabilities to provide care to those with medical and functional needs before, during, and after an incident. To enhance this capability, the HRMMST when deployed with one or more Shelter Support Units (SSU) will provide much needed equipment and personnel to provide these essential services.

When incorporating the HRMMST and the SSU operations into a shelter, additional considerations should include:

• Easy access for those that are stretcher bound to be brought in and out of the facility
• Areas for the plcement of surge beds to include a cot for care-givers
• Privacy areas to provide medical interventions
• A designated “emergent care” area
• A staging area for placing medical equipment and medications
• A triage/medical screening area
• Communications procedures
• The provision of additional power outlets for medical equipment

The HRMMST can be incorporated into existing mass fatality plans to assist medical examiners and local law enforcement agencies in processing human remains in reponse to a mass fatality incident. The HRMMST is capable of providing a public trust work force of physicians, physician extenders, law enforcement officers, paramedics and EMT’s, durable medical equipment, consumable medical supplies, and logistics support equipment that can assist the Chief Medical Examiner to create the infrastructure needed to process a large number of human remains, both contaminated and non-contaminated.

The HRMMST, with guidance from the Chief Medical Examiner, is can provide human remains and personal effects tracking at an incident morgue. The HRMMST is can also assist morgue personnel with document management and assist with human remains accountability and tracking. HRMMST personnel HRMMST can assist with the progress and movement of remains through morgue stations.

HRMMST personnel are trained to operate in Class 2 Ensemble PPE to provide for support work in rotating shifts. Additionally, the HRMMST can provide decontamination equipment, water resistant triage tags to assist in remains tracking, remains pouches in various sizes and tents that will keep the remains from public view.

When incorporating the HRMMST into remains processing, some additional capabilities are:

• Recovery
    – Able to perform remains recovery under Medical Examiner supervision
    – Able to triage remains
    – Able to establish and manage an Entry Control Point
• Holding Morgue
    – Able to establish private area to perform evidence collection, identification check, etc.
    – Able to collect samples for monitoring and detection of hazardous materials
    – Able to establish an area and perform decontamination, and mitigate run-off from the decontamination operations
    – Able to double bag remains
• Transportation and Storage
    – Able to move remains to and from storage
    – Assist in obtaining transportation resources
• Morgue Operations
    – Able to perform detailed decontamination and monitoring of remains for hazardous materials
• Family Assistance Center
    – Hotline/Helpline support
    – Assist with information dissemination
    – Assist establishing security for all aspects of morgue operations

The HRMMST has established a Code of Conduct that applies to all team members.  The Code of Conduct is set forth in Standard Administrative Policy (SAP) 107. The Code of Conduct may be downloaded using the link at the end of this article. 

PURPOSE

To provide general rules of conduct for all team members and intended to protect the integrity of the HRMMST.

POLICY

All HRMMST personnel are required to read, understand and comply with all rules, regulations, policies, and procedures of the HRMMST and the Hampton Roads
Metropolitan Medical Response System. It shall be the responsibility of the team member to seek clarification from the Strike Team leadership as to the meaning or application of any law, rule or regulation, policy or procedure, written or verbal order.

HRMMST CODE OF CONDUCT

It is understood that members are representatives of their respective agency, jurisdiction, and state organizations. Further, it is understood that all members represent the Hampton
Roads region and the Commonwealth of Virginia. Members must constantly remember that their actions will reflect on these agencies and that they will be held accountable for
those actions.

With this in mind, it is incumbent on all members that they act in a professional manner while performing their respective duties and assignments. Members will always ensure that
they are in proper uniform and in a ready state while under the obligation of a deployment. Members will treat other Strike Team personnel, local responders, and the citizens they
serve in a courteous and considerate manner. Any situations or conditions that would precipitate confrontations or serious disagreements will be reported to the Strike Team
Leader or Team Manager immediately.

Members will only procure equipment through appropriate channels and any emergency procurement will be reported at the earliest possible opportunity to the Strike Team Leader
or Team Manager.

Members are restricted from carrying firearms (except law enforcement personnel) or being in possession of non-prescribed or illegal drugs. Further, members are restricted in the
possession of alcohol while under the obligation of a deployment.

As a basic guide, Strike Team members will base all actions and decisions on the ethical, moral, and legal consequences of those actions. It is in this manner that positive and
beneficial outcomes will prevail in all disaster deployment events.

Individual team member training is broken into three categories: pre-deployment, core-component and additional training. Training is also specific to the position held by an individual team member.  As the name implies, pre-deployment training must be completed before the individual team member can be deployed with the team.  These training requirements are reviewed annually and are set forth in the HRMMST Training Matrix.  The training matrix may be downloaded as an attachment using the link below.

The training matrix clearly defines the training required by each position and shoud be used as a resourse for current team members looking to promote into other positions on the team. 

Team Members are encouraged to contact the HRMMRS Program Office at (757) 963-0632 if you have questions regarding your individual training requirements.

Some of the training listed in the HRMMST Training Matirx requires the completion of on-line courses. Download the list of on-line training courses using the link shown at the end of this article. 

As a HRMMST Member you are encouraged to contact the HRMMRS Program Office at (757) 963-0632 if you have questions regarding your individual training requirements.