October 2019, Volume XXXIII, No 7

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Minnesota Mobile Medical Teams

A statewide disaster safety net

t is a sunny, summer day in Minnesota with storms predicted for later in the day. The sun starts to be covered by clouds, which eventually turn dark and look full of rain. There is thunder and lightning in the distance. As the storm moves towards the community, the tornado sirens start. A few minutes later the winds pick up, rain seems to be blowing sideways, and it sounds as if a train is approaching. Everyone who can do so has sought shelter. Eventually the noise subsides, things seem to be back to normal, and people begin re-appearing.

Once back in the light, what once was a quiet community is now in shambles. The destruction seems surreal. As people start to head towards the local hospital with injured and scared loved ones, they find that the local hospital was not spared from this carnage. Its roof was torn away, the power was destroyed, and the water supply was damaged. It is no longer capable of functioning as a hospital.

When disaster strikes

This scenario may seem improbable, but it has happened in more than a few communities in the United States. Most notably in 2011, a hospital in Joplin, Missouri, was destroyed. Here in Minnesota, there was a near miss on the medical community in Wadena. The community was severely impacted but, luckily, the hospital was able to continue operations. Across the country, hospitals and community health care facilities have a history of being impacted, whether by a tornado, straight-line winds, flooding, blizzards, or wildland fires. Natural disasters do happen and seem to be happening at an increasing pace. Weather is the most common type of disaster, but these events and others—albeit less common—can render a health care setting unusable.

Natural disasters do happen and seem to be happening at an increasing pace.

Minnesota is rich in health care resources in comparison to many other locales. We are also fortunate to have an internal resource known as the Minnesota Mobile Medical Team (MN MMT), which exists to provide continued health care to a community that has been impacted by a disaster or other unplanned events. The MN MMT is a group of highly trained medical personnel, all of whom are currently practicing. The 53-person roster consists of providers from across the medical field, including physicians, nurse practitioners, nurses, paramedics, respiratory therapists, lab technicians, pharmacists, and other support personnel located throughout the state. Disasters are dynamic and ever-changing, and the diversity of our staff allows us to use their expertise and knowledge to better fit the needs of the disaster at hand. From level-one trauma physicians to rural providers, we have a team that can fit the mold in most situations.

Quick responses

In the immediate aftermath of a disaster, local health care, EMS, and other responders will work to care for those immediately in need. The disaster may impact the existing health care facility structurally, requiring the MN MMT to come in within 24 hours of the event and set up at a location identified through consultation with local emergency management and facility staff. We have the ability to set up to a 50-bed unit including three critical care beds, and can provide services such as portable ultrasound, labs, X-ray equipment, and more. We have a full pharmaceutical formulary provided by St. Cloud Hospital that is ready to be pulled and re-supplied upon request. Our team has its own internal, self-contained command center that includes secured internet, 800Mhz/single band radio systems, logistics, and supply areas.

If there is no structural damage to the health care facility—but the circumstances in the wake of the crisis have left it without adequate personnel available to function—the MN MMT can integrate with the facility and provide resources to ensure the facility has the staff to provide care.

The response team is self-contained and able to operate independently, but the goal is to work with local health care personnel, since they know their patients and community better than anyone else. Integrating them into this operation is something we encourage if so desired by the facility. The MN MMT is intended to be a buffer while local personnel can get back up and running and ensure that the community maintains access to health care.

Funding and operations

The MN MMT operates through a federal grant managed by the Minnesota Department of Health (MDH). The grant is through the federal Assistant Secretary for Preparedness and Response (ASPR)’s office, which supports states and territories. MDH divides up the funding to the eight regional health care coalitions in Minnesota. Each health care coalition gives a portion of its funds off the top to support the MN MMT. Because of this relationship with the coalitions, the MN MMT is also in touch with the coalition located in the region where an incident might occur. These coalitions are well connected in their region as well as with the other regions and therefore have a wealth of support capabilities that the MN MMT can draw upon, such as the potential for additional supplies, communication abilities, EMS, and more.

While the team hopes it never has to deploy, it is capable and confident in its abilities.

These relationships have been a great success for all involved. While there are definite positives to these assets and relationships, there are limitations that make utilization of the team restrictive to true emergent situations. If a true emergency were to happen, the MN MMT would be allowed to mobilize quickly once the request has been approved by the governor. The team exercises at least once a year, and sometimes twice yearly, during which periods the team will work with a local facility, community, and others in simulating an event and doing a functional or full-scale exercise. Since team members are all actively practicing health care professionals, these exercises and team educational times are designed to allow for team building and developing team expectations. Several of these exercises last two to three days rather than the usual one-day events.

Success stories

As mentioned previously, Minnesota is very fortunate in its rich health care assets and has been fortunate to have had very few disasters that have impacted health care facilities. Those that have occurred have been mitigated quickly.

The team was deployed in 2009 when a skilled nursing facility was evacuated due to the Red River floods. Once beds in the state were exhausted, there were approximately 30 residents that still needed care. The team was asked to care for these individuals at a shuttered wing of a hospital. The team received these residents and cared for their needs for seven days prior to them being able to return to the facility they came from. The MN MMT also was asked to participate by local personnel at a Minnesota air show, where it provided first aid services. The care given by a team of medical personnel was lifesaving for at least one person in attendance. While the team hopes it never has to deploy, it is capable and confident in its abilities. The team has also been held up as a model for other states that are looking to develop similar programs.

The federal government has a marvelous National Disaster Medical System that includes Disaster Medical Assistance Teams, which provided the model for the MN MMT. Their assistance should never be dismissed, but having an internal, local team ready and able means that responders typically can mobilize faster, know the local personnel, have strong identified local relationships, and can act as the stop gap until additional assistance can be brought in if needed. The mechanism for utilizing the team is through Minnesota Responds, part of the national Medical Reserve Corp. While there are many volunteers in Minnesota, this system allows us to cover liability and workers compensation once we are activated. Since all team members are currently practicing health care personnel, they are up to date on current standards and skills.

Health care personnel wishing to learn about the teams or to join either the Central MMT (based out of the Central region) or the Metro MMT (based out of the Metro region) may visit https://tinyurl.com/mp-mobile-medical-teams. This webpage also includes a link to online training materials.

Donald Sheldrew, MSW, LICSW, is the Central Minnesota Healthcare Preparedness Coalition Readiness and Response Coordinator and regional coordinator for the Central Minnesota Healthcare Preparedness Coalition. An active paramedic for more than 30 years, he has worked with the development and implementation of many coalition activities throughout the state. He also currently serves as the co-leader of the Minnesota Mobile Medical Team. 

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(612) 728-8600

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Donald Sheldrew, MSW, LICSW, is the Central Minnesota Healthcare Preparedness Coalition Readiness and Response Coordinator and regional coordinator for the Central Minnesota Healthcare Preparedness Coalition. An active paramedic for more than 30 years, he has worked with the development and implementation of many coalition activities throughout the state. He also currently serves as the co-leader of the Minnesota Mobile Medical Team.