The National Disaster Medical Service is a group of trained medical and public health professionals who are supposed to supplement local first responders during a disaster/emergency. The NDMS is designed to have boots on the ground ASAP and be able to operate autonomously for up to 72 hours, assisting with triage and evacuation. At least, that was their mission when they were still a subdivision of the Department of Health and Human Services. A few years ago, they were moved into the Department of Homeland Security where they answered to the Director of FEMA (and were separated from the DHS director by about 5 levels of bureaucracy). A January 2005 report quotes an official, "There are no nationwide protocols on what to do or how to do it...In FEMA, rules take priority over getting the job done." Considering what happened in August and September of that year, this quote seems frighteningly prescient. The report goes on to confirm the findings of an internal HHS report from 2002 - the NDMS was repeatedly stripped of large segments of its budget and poorly run, to the point that very few NDMS teams were capable of deploying, had the supplies to deploy completely, and were generally unable to meet their mission. This, and other scary government reports can be downloaded from Representative Waxman's website.

What kills me about this is we keep hearing that Katrina was such a disaster because local first responders were so rapidly overwhelmed, and yet they were precisely who most disaster plans rely on, at least through the first few days, before the big federal troops can be rallied and move in. Yet, that's exactly what the NDMS is supposed to prevent from happening. They were created because it was obvious that in any large scale emergency (hell, moderate-scale) county and maybe even state officials will also be among the victims and will need some assistance right now. So NDMS comes in with their doctors and nurses and medical supplies and 72 hours of autonomy and help out. It's actually, and I don't say this about the government all that often, a pretty good plan. If only it had worked.

[UPDATE - (because I keep reading and it keeps getting more outrageous) Managers failed to fill orders for essential drugs for four days during the immediate aftermath of Katrina because they insisted on faxed supply forms. Fucking bureaucracy.]