title: How will military/civilian coordination work for reception of mass casualties from overseas?
abstract: BACKGROUND
  In Maryland, there have been no military/civilian training exercises of the Medical Mutual Aid Agreement for >20 years. The aims of this paper are to describe the National Disaster Medical System (NDMS), to coordinate military and civilian medical mutual aid in response to arrival of overseas mass casualties, and to evaluate the mass-casualty reception and bed "surge" capacity of Maryland NDMS Hospitals.
  
  
  METHODS
  Three tabletop exercises and a functional exercise were performed using a simulated, overseas, military mass-casualty event. The first tabletop exercise was with military and civilian NMDS partners. The second tested the revised NDMS activation plan. The third exercised the Authorities of State Emergency Medical System and Walter Reed Army Medical Center Directors of Emergency Medicine over Maryland NDMS hospitals, and their Medical Mutual Aid Agreement. The functional exercise used Homeland Security Exercise Evaluation Program tools to evaluate reception, triage, staging, and transportation of 160 notional patients (including 20 live, moulaged "patients") and one canine.
  
  
  RESULTS
  The first tabletop exercise identified deficiencies in operational protocols for military/civilian mass-casualty reception, triage, treatment, and problems with sharing a Unified Command. The second found improvements in the revised NDMS activation plan. The third informed expectations for NDMS hospitals. In the functional exercise, all notional patients were received, triaged, dispatched, and accounted in military and five civilian hospitals within two hours. The canine revealed deficiencies in companion/military animal reception, holding, treatment, and evacuation. Three working groups were suggested: (1) to ensure 100% compliance with triage tags, patient accountability, and return of equipment used in mass casualty events and exercises; (2) to investigate making information technology and imaging networks available for Emergency Operation Centers and Incident Command; and (3) to establish NDMS training, education, and evaluation to further integrate and support civil-military operations.
  
  
  CONCLUSIONS
  The exercises facilitated military/state inter-agency cooperation, resulting in revisions to the Maryland Emergency Operations Plan across all key state emergency response agencies. The recommendations from these exercises likely apply to the vast majority of NDMS activities in the US.
authors.affiliation: National Study Center for Trauma and Emergency Medical Systems, Univeristy of Maryland, School of Medicine, USA. cmack003@umaryland.edu
authors.forename: Colin
authors.initials: C
authors.lastname: Mackenzie
authors.forename: John
authors.initials: J
authors.lastname: Donohue
authors.forename: Philip
authors.initials: P
authors.lastname: Wasylina
authors.forename: Woodrow
authors.initials: W
authors.lastname: Cullum
authors.forename: Peter
authors.initials: P
authors.lastname: Hu
authors.forename: David M
authors.initials: DM
authors.lastname: Lam
mesh_terms: D000818:Animals; D016208:Databases, Factual; D004189:Disaster Planning / Q000458:organization & administration*; D004285:Dogs; D014943:Global Health; D006801:Humans; D038622:Internationality; D054527:Mass Casualty Incidents; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D014218:Triage / Q000458:organization & administration*; D014481:United States