EMS Care Teams In Disaster Response

Issues of Concern

Local Response

Local responders form the foundation of initial disaster response efforts in both the U.S. and Europe. These efforts often begin at the scene, where community members or bystanders may act as immediate responders, providing lifesaving interventions such as bleeding control before professional help arrives.

The formal medical response typically begins with local EMS, including emergency medical technicians (EMTs) and paramedics. Local authorities manage the incident and request additional support when necessary.

In the U.S., locally organized disaster teams include the Medical Reserve Corps (MRC) and Community Emergency Response Teams (CERTs). The MRC comprises hundreds of teams nationwide, often consisting of active or retired nurses, EMTs, paramedics, nursing assistants, physicians, pharmacists, and public health professionals. CERT members may come from both medical and nonmedical backgrounds.

These volunteer teams receive structured training and may be activated to support a wide range of disaster response roles. These roles include providing medical care, assisting with mass vaccination efforts, offering first aid at large events, monitoring health at disaster shelters, and performing nonmedical support tasks.[6][7][8][9][10][11][12][13]

State and Regional Response

When a disaster exceeds local capacity, the next level of response is typically coordinated at the state or regional level. In the U.S., each of the 50 states maintains an emergency management agency responsible for planning, training, and coordinating both local and state-level responses. In both the U.S. and Europe, the structure of regional and state responses varies by jurisdiction. However, coordination generally takes place through a regional or state emergency operations center or agency.

In the U.S., state emergency management agencies organize response teams that may include the National Guard, EMS districts, public health departments, and nongovernmental organizations such as the Red Cross. Some states also maintain dedicated State Medical Assistance Teams (SMATs), which may be deployed to support disaster response efforts. While SMATs vary in structure and capability by state, they are typically composed of trained volunteers and are designed to deliver rapid medical support in disaster settings.[14][15]

Federal Response

When large-scale or regional disasters exceed local and state capacity, a federal response may be initiated at the request of state authorities. In the U.S., governors can request a federal disaster declaration, which the president must approve. Once declared, federal medical resources become available to support response efforts.

The National Response Framework (NRF) defines the federal government’s approach to disaster management. Public health and medical services fall under Emergency Support Function No. 8 (ESF-8), coordinated by the U.S. Department of Health and Human Services (HHS) through the National Disaster Medical System (NDMS).

The NDMS oversees a range of specialized disaster response teams. These teams include the Disaster Medical Assistance Team (DMAT), the Disaster Mortuary Operational Response Team (DMORT), the National Veterinary Response Team (NVRT), and the Trauma Critical Care Team (TCCT). Additional teams include the Victim Identification Center Team (VIC), the Federal Medical Station (FMS) Support Team, the National Nurse Response Team (NNRT), the National Pharmacist Response Team (NPRT), the Burn Specialty Team, the Behavioral Health Response Unit, and various Logistics and Technical Support Units.

DMATs are typically deployed within days and can establish freestanding medical treatment sites. A standard 35-member DMAT comprises physicians, physician assistants, nurses, pharmacists, paramedics, EMTs, and personnel responsible for logistics and communications. When activated, members serve as intermittent federal employees. Each team arrives with its own personnel, shelter, supplies, and medications, and remains fully self-sustaining for up to 72 hours.

Other NDMS teams provide specialized capabilities. DMORTs offer forensic and mortuary services during mass fatality events, supported by VIC teams. NVRTs focus on animal health and zoonotic disease surveillance. TCCTs deliver advanced trauma and critical care, often including surgical capacity. FMS Support Teams operate temporary shelters for low-acuity patients. NNRTs and NPRTs support mass prophylaxis, vaccination, and medication distribution. Burn teams and Behavioral Health Units address specific clinical needs, while Logistics and Technical Support Units ensure operational continuity throughout deployments.

Similar models exist internationally. In Japan, 5- to 6-member DMATs may deploy and remain self-sufficient for up to 3 days. In Israel, disaster response integrates both military and civilian reservists. In Turkey, 5-member NMRTs deliver specialized care tailored to regional risk. Although federal-level response models vary across countries, they are typically reserved for large-scale or complex disasters.

Nongovernmental Organizations

Nongovernmental organizations (NGOs) constitute a significant part of the disaster response and recovery workforce. The contributions of these groups are essential to supporting affected communities. Although the overall management of a disaster remains the responsibility of government authorities, NGOs often operate within this framework to deliver critical services such as health care, shelter, and long-term recovery assistance.

NGOs are typically independent of government oversight, are primarily composed of volunteers, and operate on a nonprofit basis. Prominent examples include the International Federation of Red Cross and Red Crescent Societies (IFRC), the American Red Cross, and Médecins Sans Frontières (Doctors Without Borders).

Note on the International Committee of the Red Cross

Although often grouped with nongovernmental humanitarian actors, the International Committee of the Red Cross (ICRC) holds a distinct legal status. Unlike conventional NGOs, the ICRC is an independent, neutral organization with a formal mandate under the Geneva Conventions to protect and assist victims of armed conflict. The ICRC plays a central role in International Humanitarian Law, particularly in conflict zones, and serves as a core component of the International Red Cross and Red Crescent Movement, alongside the IFRC and national societies.

Clinical Significance

Disaster care teams support response efforts from the initial impact through the recovery phase. The first response, often by community members or local EMS, can occur within minutes. State or regional resources may require hours to mobilize, while federal support, such as DMATs, may take several days to arrive.

In the U.S., all levels of disaster response operate under a unified framework known as the Incident Command System (ICS). The ICS coordinates emergency operations across key functions: command, operations, logistics, planning, finance, and administration. Understanding ICS operations and how disaster care teams integrate into this structure is essential for effective response.

Clinicians involved in disaster care must recognize the levels of response and follow the ICS-defined chain of command. Preparedness to adapt to austere environments and evolving needs is essential. Familiarity with available disaster teams and ICS principles ensures an effective response within the hospital or community.