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The U.S. Health and Human Services Department began to realize in the early 1990s that U.S. medical facilities were ill-equipped to cope with the effects of weapons of mass destruction (WMD) attacks, those employing chemical, biological, or nuclear weapons.
Thus in 1995, the department began developing the first prototype Metropolitan Medical Strike Team (MMST) in partnership with the Metropolitan Washington Council of Governments and their 18 local member jurisdictions in and around Washington, D.C. Following the success of the initial concept, a team was developed in Atlanta for the 1996 Olympic Games, and, in 1997, 25 teams began to be established as part of the Domestic Preparedness Program.
The teams had two missions. First, supplement the local hazardous materials and medical response to weapons of mass destruction by offering specialized equipment and knowledge, and on-going training. The primary mission of the group is not to respond, but to train others, who in turn should train additional personnel. The MMSTs comprised 129 people, consisting of fire service, emergency medical services personnel, hazardous materials technicians, physicians, nurses, and law enforcement officials. Responding personnel are issued with protective equipment to ensure their safety as they complete their tasks. The team is divided into three groups of 43 persons each, which rotate assignments. One task force is always on duty while another is on standby and the third is considered off duty. While establishment costs are on the order of $500,000, the Public Health Service did supply the equipment, but the personnel are found from existing local health services and emergency agencies.
 In 1999, the Department of Health and Human Services modified the program to become the Metropolitan Medical Response System (MMRS). This was done in an effort to show the importance of the system, and also reflected the ongoing efforts to bring together not only the fire, emergency medical services, and hazardous materials communities, but also the public, private and mental health communities. It is vital for not just the first responders, but also the hospitals to be prepared to handle contaminated patients, so that medical staff are not decimated as they treat the sick. The name change also reflected increased attention toward not just dealing with release of chemical agents, but also a covert biological weapons attack (the first two MMSTs were, to an extent, merely enhanced hazardous materials teams). In 2000 and 2001, 50 more cities were added to the first 47, to make a total of 97 cities involved in the program (see map).
Today the Metropolitan Medical Response System maintains a detailed response plan, with specialized response and medical equipment, plus pharmaceuticals, together with enhanced transport and treatment capabilities. Detection equipment includes mini chemical agent monitors, atmosphere monitoring instruments, radiation detection monitors, computers with specialized software, and weather monitoring devices. Decontamination equipment includes mass decontamination systems, and sprinkler, lighting, and heating systems for the deployable decontamination tents. Also held are chemical agent antidotes and enough pharmaceuticals for the treatment of 1,000 patients.
For the future, increased integration of multiple, sometimes overlapping, homeland security efforts is a key factor. Recently, the Health and Human Services Department reviewed the biological warfare preparedness of the 50 states and found in many cases that the MMRS was not being adequately integrated into either state plans or public health and hospital preparedness. Of the 50 states, only 16 still had progress to make, eight with integration into state plans, seven with health and hospital preparedness, and one, New York, with arrangements to draw upon the National Pharmaceutical Stockpile. It seems that in its development and its integration efforts, the MMRS has done reasonably well to prepare the cities it covers for the future threat of biological terrorism.
Sources
News reports, Department of Health & Human Services briefing slides
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