The Definition of Disaster

When disaster strikes, EMS is there—before, during and after



The role of EMS in responding to disasters is much more than just answering the call when a major incident occurs. In fact, EMS’ role in maintaining stability—and building resiliency in a community—starts long before winds begin to build or a bomb goes off. That work begins months or years earlier through training local residents how to help themselves and help each other when tragedy strikes. In the best of those situations, EMS professionals teach residents to be the true first responders and how to take care of themselves—and others—until help arrives.

During EMS Week 2018, it’s important to remember the critical role EMS plays on a local and national level when a disaster hits. Throughout some of the toughest, most horrific scenarios humans face, EMS responders are there to help those who need them most—the community, its citizens and fellow EMS providers.

Cheryl Crow remembers getting the call.

A paramedic with Acadian Ambulance in Lafayette, Louisiana, she’d been a member of a regional Disaster Medical Assistance Team (DMAT) since 2011, but had never been activated—until this year.

Crow was part of a DMAT deployed to Puerto Rico for a 30-day mission to provide emergency medical care to the region ravaged by Hurricane Maria.

“There’s a lot of things that go through your head,” Crow says. “I have to get all of my things together. We were told we were going into real austere situations. You have to be able to be sufficient on your own in terms of food and water for a least 72 hours.”

Crow, however, had work to do. Before she could leave she had to coordinate coverage with the team at Acadian to cover shifts and make sure her work on the technical help desk continued smoothly. She needed to get someone to feed her animals while she was out of the country.

“I let people know, pretty much, I’m going to be off the grid for 30 days,” Crow says. “Don’t expect to hear from me. Don’t worry.”

Michael Potts, a paramedic and support services manager with MedStar Mobile Healthcare in Fort Worth, Texas, was also one of those who answered the call for volunteers to help out in the wake of Hurricane Harvey. A married father of young twins, Potts didn’t sign up when the first request went out because the team had enough members.

“Once it got to a category 4 storm, they needed a lot more help,” says Potts. “I’ve got the training. I’ve got the skillset. It’s neighbors helping neighbors.”

Crow and Potts were not alone in stepping up to respond in 2017 when a series of hurricanes hit the mainland United States, Puerto Rico and the U.S. Virgin Islands. Fact is, they were just two of many EMS, fire and police personnel deployed into other states, towns, territories and islands desperately in need of emergency help for rescues, EMS and humanitarian aid following a string of severe storms that ripped apart regions of the country.

Acadian alone had 592 medics and support team members deployed into the Louisiana and Texas regions hit by Hurricane Harvey. The agency also sent five ambulances and crews to Florida to help after Hurricane Irma hit the state.


When a major disaster occurs, local and regional responders are in first, followed by help from responders just outside the area and then across the country. The Federal Emergency Management Agency estimated that over a span of 25 days starting with landfall of Hurricane Harvey, FEMA and its partners deployed “tens of thousands of personnel across 270,000 square miles in three different FEMA regions.”

That should come as no surprise. Four hurricanes made landfall, affecting more than 25.8 million people. And as the hurricane season ended, the California wildfire season hit.

“You’ve had years of activity where it’s been pretty busy,” says Craig Fugate, the former FEMA administrator who now works as a consultant in the areas of emergency response and crisis. “The thing that makes [2017] kind of unusual is you’ve had Harvey, and Irma, and then Marie. Three different states, all significant impacts.”

The response to major events happens through a variety of forms, ranging from regional or state EMS task forces, DMAT teams, FEMA’s Urban Search & Rescue task forces and FEMA’s Federal Disaster Response Team, operated by American Medical Response.

The Federal Disaster Response Team was created following the hurricane season of 2005. In 2007, FEMA named American Medical Response as the primary provider of ambulances, air ambulances and other emergency equipment and personnel to supplement the federal and military disaster response.

Those teams are what Dr. David Persse, Medical Director for the Houston Fire Department, calls the “cavalry,” which comes in shortly after the storm hits.


“We had a large contingent of EMS crews from Virginia respond to Hurricane Harvey in Florida,” says Tom McEntee, CEO of AMR’s east region. “They went to work and it was like they’d been in Florida their entire careers. It was pretty amazing. And they did it because this was impacting their AMR family.“

Also among the crews deployed from around the country were more than 70 members of the Los Angeles Fire Department, who were deployed as part of FEMA’s US&R CA-TF1 to assist with Hurricane Harvey in August. After several days of working on rescue and recovery, the team was then redeployed to Alabama to prepare for the response to Hurricane Irma. Also in August, 80 members of New Jersey’s TF-1 responded to Katy, Texas to help out after Harvey; and in early September, they were sent to Florida to assist in the preparation for Hurricane Irma.

FEMA has 28 such teams around the country trained for rescue and all were activated during the brunt of hurricane season in 2017.

“The definition of a disaster is an event that didn’t stick to the plan,” says Dr. Persse, who has worked on multiple major disasters in his career.

Hurricane Harvey was the first category 4 storm to hit the United States since 2005 and dumped more than 50 inches of rain. The record-setting rains flooded waterways that normally don’t overflow, and stranded people in neighborhoods and on roadways.

“There are times when you are faced with problems and your first reaction is overwhelmed,” says Dr. Persse. “Then you have to get your act together and work the problem.”

Working on that problem comes along with a whole host of challenges. There’s the response by local residents, the initial coordinated response by local providers, and then there’s the integration of the outside agencies and others sent in to help communities continue the rescue, recovery and rebuilding phases.


For outside agencies, deploying EMS, fire and police to the front lines of someone else’s disaster takes planning. In addition to sending teams out of town, managers must also make sure their home response areas are covered as well.

“The work doesn’t stop, if anything, it picks up,” says Potts. “When you start talking about sending mass amounts of people out of town, you have to ask, is this right for our community? Is our community going to take a hit for it?”

Indeed, Potts says MedStar made a decision before the deployment to only have the team out of town for seven days before it was switched out with a new team.

In the aftermath of Harvey, Dr. Persse says FEMA sent 206 ambulances into the Houston area, plus 25 rotarywing air ambulances and 29 fixed-wing ambulances.

Another 93 ambulances came from around the state. Those units supplemented the Houston Fire Department’s 50 BLS ambulances, 35 paramedic ambulances and 11 paramedic squads.

And for those going to other regions, EMS responders may need to deal with language barriers, or climate issues they usually don’t face at home.

“EMS employees deployed to disasters tend to figure out how to work together,” says Jerry Romero, president of Acadian. “They don’t worry about turf battles, they don’t need to understand local politics. They’re all there to help.”


However, there is another factor that is often overlooked in such responses—the impact on the disaster on the EMS workforce and their families. Residents expect EMS, fire and police to be there whenever they call, no matter the weather conditions, 24/7, 365 days a year. But, when an incident occurs in their own region, first responders are tasked with helping others, while also worrying about the safety of their own families, their homes, their cars and everything they own.

“If you know it’s coming, with some of these weather events, then your people have some time to get their families secure before they come into work,” Dr. Persse says.

Planning for the care of staffers—and their families—is often overlooked by EMS agencies, says Fugate. In many cases, after a storm, EMS goes back to normal operations. But when the homes of EMS providers are damaged in the storm, returning to normal can be a challenge at best. In the U.S. Virgin Islands, for instance, most homes were damaged, leaving EMS providers facing a conundrum—help themselves or help others?

“I think that’s one of our blind spots,” Fugate says. “We forget as we plan that we may be as much impacted as the people we’re trying to help. What happens when you’ve got large evacuations that take place, but you have to have your critical response ready? What’s your protocol on that? This is something that doesn’t get on anybody’s list. It’s hard for you to say ‘I need you to come in here’ and the person’s saying, ‘I’m in the evacuation zone.’”

The impact of Hurricane’s Irma and Harvey was felt deeply by employees at AMR, according to McEntee.

“Along with the stress associated with trying to move thousands of patients and get them to safety, at the same time EMS personnel are trying to make arrangements to take care of their own families—and

in several cases we had employees whose homes were pretty badly damaged,” McEntee says.


Michael Bascom, a Task Force Leader with the New Jersey EMS Task Force, knows that stress first-hand.

When Superstorm Sandy hit New Jersey in 2012, Bascom was away from home for 14 days coordinating the EMS response in his community and around the New Jersey shore region devastated by the storm.

While he was responding to the emergency, his home was flooded.

He took that experience and lessons learned at home with him to the U.S. Virgin Islands, where he led a deployment of 59 EMS, New Jersey State Troopers and Disaster Mental Health personnel in a mission to help residents of St. Thomas and St. John, which were

badly damaged by back-to-back category 5 hurricanes. One goal of the mission was to allow local providers much-needed rest and a chance to check on their own homes.

“I knew the impact [Superstorm Sandy] had on my family,” Bascom says. “We were insistent when we got there that they take a break and get home.”

“They got beat up pretty good,” says NJ EMS Task Force planner Neel Mehta, who went on two

deployments to the U.S. Virgin Islands. “They needed time off to do whatever they had to get done in their personal lives.”

Therein lies an inherent trait in most first responders—a willingness to respond to major events and then work longer-than-normal hours without regular breaks.

“Many of our EMS providers worked for days before they could even find out if their home was flooded,” Romero says. “Some talked to neighbors, but they stayed for days at work before they could get access to their homes.”

Romero says about 100 employees were directly affected by Hurricane Harvey in the Greater Houston, Beaumont and Port Arthur regions because their families were in the storm zone. Soon after, Acadian set up financial help for them as well as hands-on help to assist with the cleanup and rebuilding of their homes.


Acadian Ambulance lead recruiter Brian Cowart, a paramedic, was one of those who volunteered to help his co-workers start that emotionally draining process. He’s been through it before, having had his home damaged in 2016 when the Amite River flooded his neighborhood.

“For all the people who helped myself and my family, it was real important for me to give back as best I could,” Cowart says.

Cowart knows well the importance of taking care of responders in the aftermath of a disaster. It’s also something Fugate says is critical, though often overlooked, especially in the preparation phase.

“You’ve got to take care of your team,” Fugate says. “What are the things they need to have so they can stay at work serving the community? How can you ask that person to give 100% to the community if they’re worried about their family’s safety?”


Crow didn’t have to worry about her home when she was deployed to Puerto Rico. Instead, she was thinking about the people she expected to help when she was in Puerto Rico. She packed extra soap, shampoo and other personal items with the intention of leaving them behind to help those on the ground trying to rebuild.

“People were so grateful for whatever you would give them—shampoo, deodorant, snacks. They were trying to give us things when they needed them at home,” Crow says.

If the call comes again to respond to a disaster, she’ll be there.

“It makes me want to do it again because you realize how much we actually have and it makes you grateful for what you do have,” Crow says. “When you’re in any kind of emergency response business, we’re in it to help our fellow man.”