In early 2018, the Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response (ASPR) announced plans to develop a Regional Disaster Health Response System (RDHRS).1 This new regional approach comes in response to an ever-evolving threat environment that requires creative solutions to pandemic diseases, active shooter emergencies, natural disasters, and other public health and security threats. As we shift gears towards a new approach, we must identify and utilize valuable, existing resources, like the Medical Reserve Corps (MRC), to strengthen local and state partnerships and fill niche roles in bridging the last mile.
For starters, the ASPR MRC Program is a national network of volunteers, organized locally, to improve the health and safety of their communities. The MRC was created after the September 11, 2001, terrorist attacks when thousands of spontaneous volunteers, many health care professionals, offered their services in support of response and recovery efforts. The following year, in 2002, President Bush's State of the Union Address called on all Americans to volunteer in support of their country. From that call to action, the MRC Demonstration Project was created. The original project began with 42 community-based units of medical, public health, and other volunteers, with the enduring mission—to engage local communities to strengthen public health, reduce vulnerability, build resilience, and improve preparedness, response, and recovery capabilities. Since 2002, the MRC has grown immensely. Volunteers serve from diverse professional backgrounds and are not limited to medical and public health professionals. As of June 2018, the MRC network comprised 910 MRC units with 190 920 total volunteers.2 Today, the National Association of County and City Health Officials (NACCHO) works in partnership with ASPR's MRC Program Office to promote, support, and build capacity within the MRC network.
A Regional Approach to Response
Building the RDHRS is one of Dr. Kadlec's top 4 strategic priorities, the others being: providing strong leadership; sustaining robust and reliable public health security capabilities; and advancing an Innovative Medical Countermeasures Enterprise. Dr. Kadlec, has elaborated that this new framework would be based on a tiered, regional system that “emphasizes the use of local health care coalitions and trauma centers that integrate their medical response capabilities with federal facilities and local emergency medical services. [The] system would expand specialty care expertise in trauma and CBRN [Chemical, Biological, Radiological, and Nuclear] casualty management and coordinate medical response through mutual aid.”1 The RDHRS is expected to integrate preparedness measures into everyday standards of care while expanding key public and private sector health care partnerships such as trauma centers and public health laboratories.
When considering the MRC, one constant remains: all disasters begin and end at the local level. The new, regional approach inspires a renewed focus on developing local and state partnerships and resource sharing through health care coalitions, keeping in mind interstate and intrastate needs. As Dr. Kadlec once said, “Coalitions are the foundation of our disaster response system.”
MRC units are uniquely poised to fill this role because of their local knowledge and personal commitment to their communities. Many MRC units regularly work with health care coalitions. For example, the Snohomish County MRC Unit #174 in Washington developed a Health Care Coalition Response Team to specifically train a group of MRC volunteers to provide situational awareness, information sharing, and resource brokering to health care organizations in their region. Organizations included public health departments, hospitals, clinics, tribal nations, emergency management agencies, hospice providers, long-term care providers, and the American Red Cross. Volunteers additionally are trained to activate to the Snohomish Health District or Disaster Medical Coordination Center, which controls hospital patient flow during disasters. Unit leader, Therese Quinn, shared the following with NACCHO: “Through our work on this project we became more connected with hospitals and clinics throughout the region (a five-county area). This has helped us to be able to provide more trainings in the area and to find more opportunities to offer surge support resources.”
Engagement with health care coalitions may take on different manifestations for other units across the country. Through relationships cultivated in the Ventura Health Care Coalition, the Ventura County MRC in California worked with hospitals, the Emergency Medical Services Agency, and other public health organizations in its operational areas to demonstrate MRC volunteer skills and its ability to seamlessly integrate into the hospitals' surge capacity during a large-scale event. The Ventura County MRC conducted hospital assessments to identify a training curriculum, trained 95 MRC volunteers alongside 80 public health nurses to prepare communities and hospitals for disaster-induced medical surges, and produced a “bedside credentialing toolkit.”
As a member of its local health care coalition, the Southwest Florida MRC conducted hospital decontamination exercises and participated in medical surge simulations aimed at testing hospitals' emergency plans while the Alameda County MRC in California partnered with local community members including local health care coalition members to support Alameda County in disseminating timely educational messages and inquiries related to Zika.
Supporting “The Last Mile”
“The Last Mile” is a supply chain management and logistics term that refers to the final process of delivering a product into the hands of the customer or end-user. For emergency preparedness, the last mile is about filling a final, local needs gap. It is the last logistical step that gives resources or services directly to individuals impacted by disasters. Whether this involves dispensing medical countermeasures at point of distribution (POD) sites, administering vaccines, or providing psychological first aid, these services must cater to local communities in a way that accounts for their distinct cultural, transportation, and access and functional needs, among other requirements.5 The understanding to do this often lies with local, informed residents, like MRC volunteers. MRC unit leaders and volunteers are critical to recovery because during every large-scale federal disaster response, there comes a time when the federal and state personnel must leave. After the dust settles, when donations begin to dwindle and the media lose interest, impacted communities are left to finish recovering, rebuilding, and reclaiming a new sense of normalcy.
So many current MRC capabilities are quintessential to reaching the last mile. In 2017, NACCHO conducted a national survey of MRC units. Results from 769 MRC unit leaders were used to develop the 2017 MRC Network Profile, which found that 68% of MRC units are housed within local health departments and 89% of units are integrated into their housing organization's emergency plan.3 Between 2015 and 2016, MRC units contributed 384 565 cumulative volunteer hours toward their communities. The top 3 reported that emergency preparedness activities are personal preparedness information campaigns, national preparedness month activities, and mass vaccination/mass dispensing events. The top 3 reported that public health activities are community outreach events, health education, and seasonal flu vaccination clinics.3
MRC Success Stories are further evidence of the MRC's value. Through trainings, outreach, and mission-ready response teams, these local units provide exceptional, irreplaceable services:
- Hospital Operations Support: The Rhode Island MRC Unit #148 trains volunteers through field hospital missions at mass-gathering events across the state. The MRC regularly offers hospital services with treatment and release capabilities to ultimately improve community and state resilience. In 2017, the MRC developed a Hospital Operations Training Program for clinical volunteers to cultivate leadership skills to function in command roles. This training ensures that RIMRC has sufficient and properly trained volunteer leaders to oversee quality patient care and greater volunteer satisfaction. Furthermore, the MRC was originally sponsored by the Rhode Island Disaster Medical Assistance Team (RIDMAT), an organization with which the MRC continues to operate in coordination with today as the RIDMAT/MRC.
- Shelter Operations Support 4: The Western Nevada MRC Unit #488 developed the Northern Nevada Functional Assessment Service Team (FAST) in 2017, which works alongside shelter personnel to assess and meet essential functional needs so that shelter clients maintain their health, safety, and independence during disasters. While the FAST Program was originally developed and implemented by the California Department of Social Services (http://www.cdss.ca.gov/inforesources/Mass-Care-and-Shelter/FAST), Western Nevada MRC hopes to make FAST teams a function of local MRC units, creating yet another key role for MRC volunteers during shelter operations. The MRC also developed an access and functional needs support team training participant guide, available in the NACCHO Toolbox.
As disasters become stronger and more frequent, there are many new issues that communities will have to overcome to properly prepare, respond, and recover. These projects exemplify how the MRC plays a vital role in those processes and is poised to adapt its capabilities for 21st-century challenges.