The Metropolitan Medical Response System (MMRS) is formerly a U.S. Department of Homeland Security Grant Program that provided funding to the 124 largest jurisdictions to support the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard.  The MMRS program reduces the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before the incident occurs.

The Hampton Roads Metropolitan Medical Response System (HRMMRS) was developed under the direction of the Hampton Roads Planning District Commission (HRPDC) in 1999. It includes the cities of Chesapeake, Franklin, Hampton, Newport News, Norfolk, Poquoson, Portsmouth, Suffolk, Virginia Beach and Williamsburg and the counties of Gloucester, Isle of Wight, James City, Southampton, Surry and York, and the Town of Smithfield. It covers an area of 2900 square miles and a population of approximately 1.7 million. The HRPDC contracts with the Tidewater EMS Council to manage the activities of the HRMMRS. Between 1999 and 2014 the Hampton Roads region received nearly $10 million in Homeland Security grants to develop and support the MMRS system. A local assessment from the Hampton Roads jurisdictions provides for ongoing program sustainment.

The HRMMRS supports and enhances Hampton Roads public safety, hospital, public health, and emergency management response capabilities to manage mass casualty incidents.

The HRMMRS supports, equips and trains a 44-member (213 member call group) Hampton Roads Metropolitan Medical Strike Team (HRMMST) that provides on-scene expertise and resources to the Incident Commander during a disaster. The HRMMST is a chemical, biological, radiological, nuclear and explosives (CBRNE) trained medical emergency response team that maintains a redundant response capability of personnel, trucks, trailers, equipment, supplies, and communications on the Peninsula and Southside.

The HRMMRS maintains a pharmaceutical cache of nerve antidotes, antibiotics and other medications that are immediately available in all EMS agencies, hospitals and public health departments in the Hampton Roads area.

The HRMMRS has purchased personnel protective equipment for public safety agency, hospital, public health and medical examiner personnel; decontamination systems for 15 hospitals; radiation detectors for fire/EMS and law enforcement vehicles; 11 Disaster Medical Support Units, 10 Mass Casualty / Evacuation Transport Units and 13 Shelter Support Units; CBRNE identification equipment for HAZMAT teams; emergency generators for shelters; communication equipment for hospitals, public health and HAZMAT teams; medication temperature control equipment for responder vehicles; and supplies/equipment for mass prophylaxis dispensing centers.

The HRMMRS funds and provides staff support for ongoing training and exercises in mass casualty incident and disaster response.

 For more information about the HRMMRS, contact David Long, MA, Program Manager, at (757) 963-0632, ext 304 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.hrmmrs.org.

The Hampton Roads Metropolitan Medical Response System (HRMMRS) is managed by the Tidewater EMS Council through an agreement with the Hampton Roads Planning District Commission.

The Hampton Roads Metropolitan Medical Strike Team (HRMMST) consists of 44 positions staffed from a 213 member call group. The HRMMST is trained and equipped to provide operational assistance and expertise to Incident Commanders in the region dealing with the medical effects of a mass casualty incidents or other incident types that place a similar demand on healthcare systems and resources in the region. The HRMMST is a regionally available chemical, biological, radiological, nuclear and explosives (CBRNE) trained medical emergency response team and can be deployed in one of four operational levels. Team membership consists of fire and rescue personnel, physicians, allied healthcare professionals, logistics and law enforcement personnel from accross the Hampton Roads region.  The HRMMST is a component of the Hampton Roads Metropolitan Medical Response System (HRMMRS).

View the HRMMST Orientation Video and/or download the Strike Team brochure by clicking on the document title shown next to "Download Attachments", shown below.

The Hampton Roads Metropolitan Medical Strike Team (HRMMST) consists of 44 positions staffed from a 213 member call group. Team membership consists of fire and rescue personnel, physicians, allied healthcare professionals, logistics and law enforcement personnel from accross the Hampton Roads region. It is a regionally available chemical, biological, radiological, nuclearand explosives (CBRNE) trained medical emergency response team and is a component of the Hampton Roads Metropolitan Medical Response System (HRMMRS).

The HRMMST is trained and equipped to provide operational assistance and expertise to Incident Commanders in the region dealing with the medical effects of a mass casualty incidents involving CBRNE and other incident types that place a similar demand on healthcare systems and resources in the region.

The HRMMST can be deployed in one of four operational levels.

The Hampton Roads Metropolitan Medical Strike Team (HRMMST) is staffed, trained and equipped to provide the following:

• Mass casualty incident management an patient movement coordination
• Warm zone, triage, decontamination, monitoring and detection
• Responder rehabilitation and medical force protection
• Medical consultation and coordination
• Chemical weapon and toxic industrial chemical antidote administration
• Functional and medical sheltering assistance
• Mass fatality assistance

To learn more view the HRMMST Capabilities Video Series and/or download the Hampton Roads Metropolitan Medical Strike Team brochure by clicking on the document title shown next to "Download Attachments", shown below.

The Hampton Roads Metropolitan Medical Strike Team (HRMMST) conssts of 44 positions staffed from a 213 member call group. Team membership consists of fire and EMS personnel, physicians, allied health professionals, logistics and law enforcement personnel from accross the Hampton Roads region. View the video below to learn more about HRMMST Membership and Recruitment.

Personnel that are interested in joining the HRMMST must compete the following process:

1. Read the HRMMST Member Participation Policy
2. Download, read and sign the HRMMST Membership Application.
3. Submit the application for review, approval and signature by your supervisor.
4. Forward the application to your Sponsoring Organizations's Representative.
5. Submit the completed application with signatures to the HRMMRS Program Office.

If you hve any questions regarding the application process please call the HRMMRS Program Office at (757) 963-0632.

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The Hampton Roads Metropolitan Medical Strike Team (HRMMST) is trained and equipped to provide operational assistance and expertise to the Incident Commander/Unified Command regarding the medical effects of an incident whether CBRNE, conventional, or weather-related. As need or threat levels change, composition, organization, and mission of the team may change to meet the threat or need. The HRMMST mission is to close these gaps identified using regional threat and capability assessments. Consequently, the HRMMST has developed and continues to strengthen the following seven capabilities:

• Chemical Weapon and Toxic Industrial Chemical Antidote Administration
• Warm Zone Triage, Decontamination, and Monitoring & Detection
• Medical Casualty Management and Patient Movement Coordination
• Rehabilitation and Medical Force Protection
• Medical Consultation and Coordination
• Functional/Medical Needs Sheltering Assistance
• Mass Fatality Assistance

It is the mission of the HRMMST to supplement and enhance the local and mutual aid response to all-hazards incidents within the region, for up to 96 hours, with limited logistical support. This time frame allows state and federal assets time to mobilize and integrate into incident operations. 

The first capability of the Hampton Roads Metropolitan Medical Strike Team’s (HRMMST) is Chemical Weapon and Toxic Industrial Antidote Administration. In the
mid to late 90’s, the emphasis of the Metropolitan Medical Response System (MMRS) was to respond to a terrorist attack involving chemical weapons; specifically, nerve agents.
Nerve agents are chemicals that affect the nervous system. The health effects are similar to those produced by some pesticides. The main nerve agents are the chemicals sarin (GB),
soman (GD), tabun (GA) and VX. These agents are man-made and have been manufactured for use in chemical warfare.

The Hampton Roads Metropolitan Medical Response System (HRMMRS) oversees a regional cache of Weapons of Mass Destruction (WMD) Antidote Kits. Each kit contains
30 – DuoDote Auto-Injectors (pralidoxime 600 mg/2 ml + atropine 2.1 mg/0.7 ml) and three – sets of TEMS/PEMS Regional Medical Protocols on CBRNE (Nerve Agents –
Adult; Nerve Agents – Pediatric). The WMD Antidote Kits are issued to licensed emergency medical services agencies and stored in locked cabinets in stations, EMS vehicles or HRMMST equipment trailers, or in hospital pharmacies without CHEMPACKs. Additional information regarding the WMD Antidote Kits can be found by visiting http://education.tidewaterems.org/moodle/ and clicking on the 2013 WMD Antidote Familiarization Course.

Nerve agent poisoning can be treated by all members of the HRMMST, who are trained in using DuoDote autoinjectors. This autoinjection quickly injects the antidotes into muscular areas like the thigh or buttock. Repeated use of antidotes may be needed to treat some nerve agent victims. It might also be necessary to give nerve agent victims other drugs to control seizures or other effects. The HRMMST is also positioned to deploy assets from the CHEMPACKs located throughout the region. The CHEMPACK program is an ongoing initiative of the Centers for Disease Control and Prevention's (CDC) Division of Strategic National Stockpile (SNS) launched in 2003, which provides antidotes to nerve agents for pre-positioning by state, local, and/or tribal officials throughout the United States. The CHEMPACK Program is envisioned as a comprehensive capability for the effective use of medical countermeasures in the event of an attack on civilians with nerve agents.

Additionally, the HRMMST, in cooperation with the Southside and Peninsula Regional Hazardous Materials Teams, helped to review and revise the contents of the regional hazardous materials drug box and support box. Antidotes are stored in these boxes and are readily available to treat members of the hazardous materials (HAZMAT) teams from exposure to chemicals such as, cyanide, fluoric acid, and phenol. Guidance on the use of these antidotes can be found in Appendix J of the TEMS Regional Protocols.

The HRMMST is trained and equipped to provide warm zone triage, decontamination, and provide monitoring and detection services and supplement the capabilities of the regional hazardous materials teams and healthcare facilities in responding to a WMD/TIC incident. The HRMMST is available to all Hampton Roads’ public safety agencies and healthcare facilities when mass casualty support is required. It is critically important that victims exposed to nerve agents are decontaminated in addition to having the nerve agent antidote administered to them. HRMMST members are trained to provide WARM ZONE triage of, and lifesaving interventions to, victims exposed to WMD agents and toxic industrial chemicals. Interventions include antidote administration, airway management and hemorrhage control.

The HRMMST is also trained and equipped to operate a “decontamination corridor.” The decontamination corridor is a transition area from the HOT ZONE to WARM ZONE, an undress area, a decontamination area, a redress area, and finally a transition area from WARM ZONE to COLD ZONE. All HRMMST members have been trained in donning and doffing personal protective equipment with respiratory protection ranging from Level IV ensembles through Level II ensembles (IAW NFPA 1994) using N95, PAPR and SCBA respirators. The team is equipped with four ASAP Shelters, which serve as undress and redress facilities.

The HRMMST also deploys a TVI three-lane decontamination shelter (male ambulatory, nonambulatory, and female ambulatory). The decontamination corridor is supplemented with
barrier fencing, lighting, and a flash water heater and propane heaters for the undress/redress facilities. The HRMMST is equipped to provide both WET and DRY decontamination.
The HRMMST uses FIBERTECT Dry Decon wipes/pads, which are also used by the military.

The HRMMST decontamination equipment also includes monitoring and detection equipment that is expressly used for the purpose of identifying whether a victim is free of contamination. (Less emphasis is placed on recognition of the contaminate.) HRMMST members are also trained in the use and operation or pH paper, M8 paper, Photo Ionization Detectors (PID), AP2Cs, Gamma Rae dosimeters, Ludlum Response Kits, and Radiological Portal Monitors.

Finally, the HRMMST, in cooperation with the Southside and Peninsula Regional Hazardous Materials Teams and area hospitals, developed a regional Mass Casualty Decontamination Guide. The deconatmination guide provides a concise reference to set up and execute mass decontamination, by aligning terminology and operating procedures among public safety agencies and healthcare facilities. 

The HRMMST is trained in Mass Casualty Incident (MCI) response and follows the guidelines set forth in the Hampton Roads Mass Casualty Incident Response Guide. In a declared MCI, the HRMMST is capable of providing resources to supplement and the response of the local jurisdiction. For large, complex incidents, the HRMMST is capable of staffing and equipping the Medical Branch to perform the functions of triage, treatment, transportation, and morgue operations.

HRMMST members are trained in S.T.A.R.T and JumpS.T.A.R.T. triage, using medical equipment to address life threats, such airway management and hemorrhage control (using tourniquets and hemostatic products like Quick Clot). The HRMMST has uniquely packaged medical equipment and supplies to support patient treatment in Immediate (red),
Delayed (yellow), and Minimal (green) Treatment Areas. For example, the HRMMST designed a “Patient Self-Care Kit” for those victims with minor injuries. This allows victims
to engage in self-care until sufficient manpower arrives. The HRMMST equipment cache can be supplemented by one or more of the 11 Disaster Medical Support Units (DMSU) sustained by HRMMRS, as each DMSU carries the same medical equipment. TO support patient/victim transportation, the HRMMST will usually respond with four of the 10 Mass Casualty/Evacuation Transport Units (MCI buses) located throughout the Hampton Roads region.

Use of the Mass Casualty/Evacuation Transport Units (MCI buses) allows for the transportation of 70 stretcher victims and another 40 seated victims to area hospitals. The HRMMST
is also trained and equipped to assist the Chief Medical Examiner’s Office and local law enforcement with morgue operations, decontamination of the deceased and/or the recovery of remains.

The HRMMST is also capable of providing patient movement coordination and assistance in three distinct patient movement categories:

1. Physical patient movement – the MMST will use equipment and manpower to relocate patients to a treatment area or to transportation assets as directed by the Medical Branch Director.
2. Coordination of patient movement – the MMST and the Regional Healthcare Coordinating Center (RHCC) will develop a transportation plan that will distribute patients from the scene to the appropriate health care facilities throughout the region by incorporating a variety of transportation assets.
3. National Disaster Medical System (NDMS) – Patient Reception Area (PRA) – the MMST in coordination with the Federal Coordinating Center (FCC) will assist with PRA operations, which includes; triage, treatment, physical patient movement, and coordination of patient movement with the FCC and RHCC.

The HRMMST is capable of responding to large, complex all-hazard incident types, which in turn require a large number of first responders and first receivers to resolve the incident. Working for extended periods and exposed to austere environments, responders need rest and recovery periods and access to medical care. Emergency incident rehabilitation (rehab) is the process of providing rest, rehydration, nourishment, and medical evaluation to responders who are involved in extended or extreme incident scene operations. Proper rehabilitation operations preserves and ensures that the physical and mental condition of responders does not deteriorate to a point that jeopardizes the safety or effectiveness of responders or incident operations.

The HRMMST members (emergency medicine physicians, nurse practitioners, physician assistants, paramedics, and EMTs) are trained in accordance with the National Fire Protection Agency Standard 1584: Standard on the Rehabilitation Process For Members During Emergency Operations And Training Exercises. The Team also incorporates the Tidewater EMS Council Rehabilitation protocol in our rehabilitation operations.

The HRMMST is capable of providing medical expertise and resources to assess and treat first responders and first receivers at the scene of the incident. The HRMMST equipment cache includes medical supplies, durable medical equipment, pharmaceuticals, suture kits for wound closure, tourniquets and hemostatic agents for hemorrhage control, ophthalmic kits for foreign bodies in the eye, ultrasound for conducting Focused Assessment with Sonography in Trauma (FAST) exams for traumatic injuries, video laryngoscopy and 12-Lead ECG for cardiac arrest management. This equipment coupled with an emergency physician and physician extenders provide the highest level of care possible to our first responder and first receivers in the pre-hospital environment.