This study demonstrates that there is no major revising of training programs for DMATs, especially for national DMATs. However, the training protocols for Taipei EIDSCT fulfill most of the requirements. According to the requirements we suppose, it still needs more improvements in promoting the education/training for DMATs in Taiwan. The continuous education/training programs such as NBC (nuclear, biological and chemical) training may provide resolution for this problem.
Management of a bioterrorism or a biological event will begin with early detection and intervention at the local level. Any large-scale event will require rapid local and national response. National initiatives targeting bioterrorism have increasingly become a complex web of executive and legislative actions, frequently initiated in reaction to specific events, and often unrelated to this threat. It is essential to develop predefined or clear and rapidly discernible criteria for deployment of local and national emergency resources.⁵
If bioterrorism occurs, medical response is provided primarily through deployment of DMATs followed by health and medical consequence management operations provided by Department of Health and Human Services and other partners. in the United States. DMATs are locally operated and supported voluntary teams of 100 people with varying medical skills. If local hospital capacity is exceeded, several approaches may be used, including activating the patient evacuation and definitive care elements of the NDMS, mobilizing local auxiliary care resources, or deploying treatment resources to the affected areas. And medical response, patient evacuation, and definite medical care are three components of NDMS. In other words, DMAT is responsible for primary medical care component of NDMS, whereas NDMS are the partners of Department of Defense, Department of Health and Human Services and Veterans Affairs that are important agencies for emergency support functions. It is not clear, to our knowledge, that if the DMATs are also responsible for medical care when an epidemic or endemic emerging infectious disease occurs. However, because of the many similar aspects between bioterrorism and emerging biological events, we believe the deployment of DMATs when indicated may be a reasonable approach. As mentioned above, Taipei City government has implemented the EIDSCT to respond to emerging infectious disease such as SARS. Although the teams are not attributed to the infrastructure of DMAT, they are really a specific form of DMAT. The current policy for such a team is to address the training in biological event responses. In the point of view, there should be continuous updating in education programs with the advances in this field. For example, besides syndrome surveillance,^7-9 high clinical suspicion index such as severe disease manifestations in previously healthy people, higher than normal number of patients with fever and respiratory/gastrointestinal complaints, multiple people with similar complaints from a common clues, an epidemic disease appearing during an unusual time of year, unusual number of rapidly fatal cases, greater number of ill or dead animals, rapidly rising and falling epidemic curve, and greater numbers of patients with pneumonia / sepsis / cagulopathy / fever and rash / diplopia with progressive weakness. Although the triage system for mass causality (such as START system) can apply to the biological events, it still needs modification by the nature of the event. An expanded version of SIR analytic framework, referred to as SIERV, provides the basis for a triage tool to identify potential steps and avoid missteps in the course of management of a potential bio-agent: (1) Susceptible individuals; (2) Exposed individuals; (3) Infectious individuals; (4) Removed individuals; and (5) Vaccinated successfully. These are merely examples to show the importance of updating the training program for DMAT members, either general or special. Because most of the DMATs are short of professionals who are responsible for the updating of training programs, the advancement in the field is not manifested. In addition, there is still no professional department or authority that possesses a task force team implementing the golden rules or guidelines for preparedness. It also results in the lack of uniformity in education/training for disaster preparedness.
EIDSCT is a new trial for biological event response. We do believe that it may be a special DMAT. According to the planning, many new training protocols and modules may be included. Besides new categories included in the protocol, e-learning is also the goal to facilitate learning for all of the members. Whether the goal can be accomplished and the updating is continued deserve further follow-up.
The major limitation of this study is that we cannot review explicitly the details of the contents of different training programs. We also cannot approach the real circumstances during training or learning at each DMAT. In other words, the same topic may not mean the same training or the same achievements. In addition, the evaluation of students' performance is different for each DMAT. It is difficult for us to determine if the fulfillment of the categories included is equivalent to the accomplishment of the real learning objectives.
In summary, the original national DMATs should keep updating in their education whereas the local DMATs should continue to complete their training programs in Taiwan.