Creating a University Disaster Medical Response Team

by Ruben D. Almaguer

As one of the top 10 disaster-prone states in the nation, Florida continues to strengthen its ability to prepare for and respond to any disaster requiring specialized emergency surgical or critical care medicine. With shrinking budgets and increased demand, building effective and rapid disaster medical response capabilities requires more than just collaboration among governments, healthcare providers, hospitals, and the private sector.

Ruben Almaguer headshotBuilding effective and rapid disaster medical response capabilities requires getting creative and exploring new organizations and resources such as universities. Most major universities are already integral parts of their communities, yet they still have untapped existing medical capability and resources that could enhance local and state response capabilities.

In 2015, Florida International University (FIU), located in Miami, reached into its own backyard and began a dialogue with the Florida Advanced Surgical Transport (FAST) Team to determine how the existing FAST Team could leverage the resources of FIU’s Herbert Wertheim College of Medicine and Department of Emergency Management. Early in the process, both parties recognized that collaboration between FIU and the FAST Team could address many of the challenges and needs that the state of Florida and the FAST Team were struggling to handle. Currently, the FIU-FAST Team is in place and working through administrative and logistical challenges, adding new team members, purchasing and storing additional equipment, and securing a larger and more centralized warehouse facility in Miami-Dade County. 

FIU-FAST Team members group photo, after conducting an austere environment exercise in the Everglades National Park, Miami, Florida (Source: Thomas Congdon, 10 December 2016).

FIU-FAST Team members group photo, after conducting an austere environment exercise in the Everglades National Park, Miami, Florida (Source: Thomas Congdon, 10 December 2016).

Status of Florida’s Medical Response Teams

Through the Florida Department of Health (DOH), the state maintains seven regional State Medical Response Teams (SMRTs) and one FAST Team. As the lead agency for public health and medical, DOH can activate SMRTs during a gubernatorial declared state of emergency when the ability to manage medical surge exceeds local resources and state assistance is required. The SMRTs and FAST Team are comprised of volunteer medical and public health professionals and support personnel.

Although both receive funding through the DOH, the FAST Team is distinctly different from a SMRT as it is the only civilian critical care and surgical medical team certified and capable of transporting vehicles, equipment, supplies, and patients on military aircraft. On short notice, the FAST Team can immediately transport by ground or on military aircraft – such as a C5, C17, or C130 – via the 315th Airlift Wing, at the request of and supported by Homestead Air Reserve Base in Florida to the area of need.

FIU-FAST Team members inside their critical care tent, simulating patient packaging of a critical patient for helicopter transport in Miami, Florida (Source: FIU Media Relations, 29 April 2016).

FIU-FAST Team members inside their critical care tent, simulating patient packaging of a critical patient for helicopter transport in Miami, Florida (Source: FIU Media Relations, 29 April 2016).

Decision to Create a University-Based Disaster Medical Response Team

Over the years, Florida SMRTs and the FAST Team have faced the same perennial challenges as many federal, state, and local disaster response teams. Common questions include:

  • How do you recruit, retain, and train volunteer medical professionals and support staff?
  • How do you procure, maintain, and store nonmedical support equipment, a medical cache, and pharmaceuticals with limited funding?
  • What is the latest research on emerging diseases or new public health threats?
  • What are new technologies that can be used to teach and train medical professional?

The simple answer to all of these is, “Look in your own backyard.”

Many major colleges and universities have a variety of medical professionals on staff. In addition to the obvious medical schools, there are opportunities and resources within other programs such as nursing or public health. Obviously, the primary focus of the academic faculty is to educate students, among their other administrative duties. However, it has been FIU’s experience that, when asked and supported by their supervisors and deans, staff are more than willing to volunteer to be members of the FIU-FAST Team.

A large part of FIU’s success in recruiting medical staff is owed to the leadership of Dr. John A. Rock, founding dean of the Herbert Wertheim College of Medicine and senior vice president of medical affairs. He immediately recognized the benefits of creating a university disaster medical response team and worked closely with the University’s Department of Emergency Management to make it happen. Dr. Robert Levine, FIU college chair, professor of emergency medicine, and FIU-FAST team member, was tasked to identify and recruit existing FIU physicians in needed specialties (pediatrics, emergency medicine, anesthesiology, trauma surgery, and orthopedics) to voluntarily serve on the FIU-FAST Team. Ten additional FIU physicians quickly volunteered to be part of the team.

Neonatologist Jaime Fernandez and Emergency Physician Robert Levine assess a Down Syndrome infant in Puerto Barrios, Guatemala (Source: Ruben D. Almaguer, 7 February 2017).

Neonatologist Jaime Fernandez and Emergency Physician Robert Levine assess a Down Syndrome infant in Puerto Barrios, Guatemala (Source: Ruben D. Almaguer, 7 February 2017).

Maintaining a disaster medical response team in a deployable-ready status requires funding to purchase and store a significant amount of equipment and supplies. Limited funding also makes it difficult, if not impossible, to hire staff to perform the many administrative functions required to support a team such as maintaining personnel records, licenses, and certifications, property accountability, procurement contracts, vehicle maintenance, training records, etc. Limited funding also limits the ability to conduct trainings and exercises, a critical part of a team’s development and its readiness level. Training provides new members and existing members the chance to work together and understand each other’s medical strengths and weaknesses, which strengthens the team’s capabilities and effectiveness as a whole. The opportunity to practice with critical medical equipment, with each other, in an austere environment is invaluable.

FIU immediately tackled these fiscal challenges. Again, through the leadership of Dean John A. Rock, the Herbert Wertheim College of Medicine entered into a funding partnership with a multitude of private companies to assist in financially supporting the FIU-FAST Team. Supporters included Baptist Hospital, Florida Blue, Leon Medical Center, Nicklaus Children’s Hospital, and The Batchelor Foundation for now. These partnerships quickly provided financial commitments to support needed operating expenses, including upgrading and purchasing equipment and medical supplies, acquiring a communications system, establishing a portable base of operations, and improving ground transportation.

This ability to recruit and utilize physicians and other medical professionals from within the university and from area hospitals has already paid dividends. Following Hurricane Matthew, the Florida Department of Health requested two members of the team to deploy to Daytona Beach to support Halifax Health Medical Center. In February 2017, the FIU-FAST Team deployed with the U.S. Southern Command and the U.S. Navy as part of a medical humanitarian mission known as Continuing Promise 2017. The FIU-FAST Team sent six physicians, one nurse, and one paramedic on a 12-day medical mission to Puerto Barrios, Guatemala. FIU-FAST served alongside a team of 169 Army, Navy, Air Force, and Marine Corps service members providing veterinary and medical services to local communities in Guatemala. Throughout the 12 days, the FIU-FAST Team saw over 1,500 patients and assisted in distributing much-needed medical supplies provided by the U.S. military to local hospitals.

The Next Step

There are clear, discernable advantages for local, state, and even federal medical disaster teams to collaborate with major colleges and universities. Like FIU, many of these institutions possess the credibility, organizational structure, and fiscal resources that can serve as a force multiplier in creating or collaborating with disaster medical teams. The experiences, good will, and community engagement that a team can bring to a university are equally vast.

The creation of the FIU-FAST Team illustrates the benefits of working with both government and private sector partners to find innovative solutions to long-standing problems. One final unintended consequence and benefit has been that the FIU-FAST Team has already inspired many medical and nursing students. Upon completing their education at FIU, they have been challenged to find similar disaster medical response teams around the country and the world to volunteer and give back to their communities during disasters, when their profession is most in need. With all the growing pains and a learning curve, and challenges still to be faced, the FIU-FAST Team has so far demonstrated that this university-based model is worth considering in other states.

For more information about FIU-FAST, visit

Ruben D. Almaguer currently serves as the assistant vice president of disaster management and emergency operations and serves as the executive director for the Academy for International Disaster Preparedness. He also oversees the Florida Advance Surgical Transport Team, in coordination with the Herbert Wertheim College of Medicine. Formerly, he served in Monroe County Fire Rescue Department, Florida, as the chief of emergency medical services. He served as the interim director and deputy director for the Florida Division of Emergency Management. Prior to this, he worked for Miami-Dade Fire Rescue Department as a division chief and led many Florida Task Force One (FL-FT1) Office of U.S. Foreign Disaster Assistance (OFDA) and Federal Emergency Management Agency (FEMA) Urban Search & Rescue Teams to over 27 natural and manmade disasters, including: earthquakes in Venezuela, Colombia, Taiwan, and Turkey; hurricanes and floods throughout Central America, Africa, and the Caribbean, including hurricane Katrina; as well as responses to the Oklahoma City Bombing and the terrorist attacks of 9/11 at the Pentagon in Washington, DC. He received masters in homeland security and defense from the Naval Postgraduate School and in public administration from Florida International University. He also graduated from Harvard University’s John F. Kennedy School of Government’s Senior Executives in State and Local Government and is a Certified Emergency Manager (CEM®).