National Disaster Medical System

The National Disaster Medical System (NDMS) is a federal medical-response system that includes Disaster Medical Assistance Teams. In the book, it appears not as a guarantee of seamless rescue but as an organization whose command arrangements, access to patients, and logistical capacity shaped emergency care after Hurricane Katrina and remained consequential in later disasters. Its institutional history and the repeated problems of coordination and supply reveal how federal response depends on more than the presence of medical personnel: teams must also be able to reach patients and obtain the equipment they need.

Structure and Federal Oversight

The NDMS included Disaster Medical Assistance Teams, or DMATs, and formed part of the federal medical response. Following the September 11, 2001, attacks, the system was moved out of the Department of Health and Human Services and placed under the Federal Emergency Management Agency and the Department of Homeland Security as part of a broader governmental redesign. After Katrina, it was returned to the Department of Health and Human Services, which coordinates federal health-care resources in emergencies through Emergency Support Function 8 under the National Response Framework. The transfer and return reflected a consequential question of institutional placement: which part of the federal government would coordinate medical resources when disaster response required them.

Katrina: Command and Access at the Airport

After Katrina, federal medical teams operated amid a wider rescue effort marked by poor communication and uncoordinated action. The federal review described confusion over the command structure of the medical teams and characterized the medical operation at Louis Armstrong New Orleans International Airport as chaotic. The airport had become a makeshift hospital, but clinicians who were not members of the federal teams, including John Thiele, were turned away. Thus the presence of doctors did not ensure that they could contribute: organizational boundaries could separate available expertise from patients in need.

The review also described a triage practice that placed the sickest patients apart from others so that they could die separately. This account makes the airport response a stark example of how classification and the organization of space could determine not only who received care, but where people waited and how their prospects were understood. These failures were part of a larger New Orleans emergency involving delayed evacuation, insufficient transportation, fragmented rescue efforts, and overwhelmed medical facilities; the book does not present the NDMS as the sole cause of those failures.

Haiti and the Persistence of Supply Problems

In 2010, after the earthquake in Haiti, a U.S. disaster medical team established a field hospital in tents on a college campus in Port-au-Prince. The team’s work showed how a medical response could be constrained by basic identification and supply needs. Because staff had difficulty recording unfamiliar names, patients were assigned numbers; a thirty-eight-year-old woman, Nathalie LeBrun, was recorded as Jane Doe 326. The team found oxygen for her, but the tank ran out overnight. Staff later obtained another tank, while a portable oxygen concentrator proved unreliable, overheating and shutting down; it also depended on electricity at a time when generator fuel was scarce.

The book connects these difficulties to supply-chain and procurement problems that had also appeared after Katrina. After the Haiti earthquake, some supply caches arrived with heaters rather than air-conditioners, while bottled oxygen, fuel, and equipment for operations ran short. The example shows that sending a medical team and supplies to a disaster zone did not by itself ensure that the arriving equipment matched conditions or that essential resources could be replenished. The account identifies the Haitian response as logistically more challenging than the earlier U.S. disaster, while noting that supply failures continued to encumber lifesaving work.

Adaptation and Continuing Significance

The book records subsequent changes to NDMS supply, resupply, and logistics processes, including placing supplies in warehouses around the country for use by any team and anticipating specialized needs, such as beds for very obese patients. These adjustments addressed the practical problem of having the right equipment available where and when teams needed it. They also indicate that preparedness involved revising systems of distribution, not merely adding resources.

The account describes further changes in the use of response teams: DMATs used smaller strike teams to respond more flexibly to Superstorm Sandy in 2012, while Health and Human Services behavioral health teams supported first responders and affected communities after mass shootings and bombings in 2012 and 2013. Across Katrina, Haiti, and later emergencies, the NDMS’s significance lies in this tension between a federal capacity to mobilize medical help and the organizational, logistical, and physical conditions that determine whether help reaches people. Its history is presented as an ongoing effort to learn from failures without assuming that institutional redesign can eliminate the difficulties of disaster care.