National Study Center for Trauma and Emergency Medical Systems, Univeristy of Maryland, School of Medicine, USA.
Prehosp Disaster Med. 2009 Sep-Oct;24(5):380-8. doi: 10.1017/s1049023x00007184.
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.
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.
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.
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.
在马里兰州，已经有超过 20 年没有进行过《医疗互助协议》的军民训练演习了。本文的目的是描述国家灾难医疗系统（NDMS），协调军民医疗互助，以应对海外大量伤亡的到来，并评估马里兰州 NDMS 医院的大规模伤亡接收和床位“激增”能力。
使用模拟的海外军事大规模伤亡事件进行了三次桌面演习和一次功能演习。第一次桌面演习是与军民 NMDS 合作伙伴进行的。第二次测试了修订后的 NDMS 激活计划。第三次演习了马里兰州 NDMS 医院的州紧急医疗系统当局和沃尔特里德陆军医疗中心急诊医学主任的权力，以及他们的医疗互助协议。功能演习使用国土安全部演习评估计划工具评估了 160 名名义患者（包括 20 名活体、模拟“患者”）和一只犬的接收、分诊、分类和转运情况。
第一次桌面演习发现了军民大规模伤亡接收、分诊、治疗的操作协议缺陷，以及统一指挥方面的问题。第二次发现了修订后的 NDMS 激活计划的改进。第三次为 NDMS 医院提供了信息。在功能演习中，所有名义患者在两个小时内都被五家军民医院接收、分诊、调度和核算。犬只暴露了在接收、关押、治疗和撤离伴生/军用动物方面的缺陷。建议成立三个工作组：（1）确保在大规模伤亡事件和演习中 100%遵守分类标签、患者核算和归还使用的设备；（2）调查为应急行动中心和事故指挥提供信息技术和成像网络；（3）建立 NDMS 培训、教育和评估，以进一步整合和支持军民行动。
演习促进了军民机构间的合作，导致马里兰州所有关键州应急响应机构的应急计划进行了修订。这些演习的建议可能适用于美国绝大多数 NDMS 活动。
