EIIP Virtual Forum Presentation — April 26, 2006

Medical Reserve Corps
Volunteer Medical and Public Health Professionals

Marna Hoard, M.P.A., M.P.H.
Lieutenant, U.S. Public Health Service
Program Officer, Medical Reserve Corps Program
Office of the U.S. Surgeon General

Avagene Moore
EIIP Moderator

The following version of the transcript has been edited for easier reading and comprehension. A raw, unedited transcript is available from our archives. See our home page at http://www.emforum.org

[Welcome / Introduction]

Avagene Moore: Welcome to the EIIP Virtual Forum! We are pleased you could join us today!

Today's topic is "Medical Reserve Corps (MRC) - Volunteer Medical and Public Health Professionals."

It is my pleasure to introduce our guest speaker, Lieutenant Marna Hoard, who is with the U.S. Public Health Service and serves as the Program Officer for Outreach with the Medical Reserve Corps Program. Marna is responsible for overseeing the coordination of MRC outreach activities that includes developing activities to increase awareness about the program, encouraging establishment of new MRC units, and participating in partnership and coordination activities with Federal government agencies, non-governmental organizations, and professional associations.

If you have not read the background page, http://www.emforum.org/vforum/060426.htm , please do so after our session today to learn more about our speaker's respective expertise and experience and check out the MRC Web page http://www.medicalreservecorps.gov.

Welcome to the EIIP Virtual Forum, Marna. I now turn the floor to you for your formal remarks.


Marna Hoard: Thank you, Avagene. Good afternoon everyone. It is a real pleasure to be here and to talk with all of you about the Medical Reserve Corps (MRC) program.

Almost immediately following the attacks on the World Trade Center and the Pentagon, thousands of volunteers – including many medical and public health professionals - began showing up at the various attack sites to help in anyway they could. But there was no mechanism in place to screen these medical volunteers, nor were they already a part of the response plan. Most were turned away or were told to help in ways that didn’t use their professional skills. The Medical Reserve Corps was created in direct response to this issue.

The MRC began to take form following President Bush’s 2002 State of the Union address. It is a partner with Citizen Corps and USA Freedom Corps. The MRC concept is fairly simple: building on the American spirit of volunteerism, communities can set-up MRC units to identify, credential, prepare, train and organize volunteers before an emergency.

Local MRC units are also encouraged to adopt the public health priorities outlined by the U.S. Surgeon General Richard H. Carmona. His goals are to increase prevention efforts, eliminate health disparities, and improve public health preparedness. MRC units are doing this throughout the year by holding diabetes detection clinics, blood pressure screenings, health fairs, flu vaccinations, preparedness workshops and so much more.

Local MRC units organize and utilize local volunteers in support of existing programs and resources to improve the health and safety of communities (and the nation). In doing so, local MRC units are encouraged to partner with all key community partners. Based on the community's needs, the MRC leaders should recruit, train, and activate volunteers in response to a variety of public health activities, including emergencies - to make their communities more resilient. The mantra of the program is 'local, local, local!’.

MRC volunteers include medical and public health professionals such as physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists. Many community members - interpreters, chaplains, office workers, legal advisors and others - can fill key support positions.

With 420 MRC units in 49 states, the District of Columbia, U.S. Virgin Islands and Guam and more than 75,000 volunteers, the MRC program is expanding rapidly and local units are having a profound impact on the health and safety of their communities. MRC volunteers can play an important role in their communities. For example, they can:

  • Serve as MRC leaders
  • Provide medical care
  • Administer vaccines and dispense medications
  • Provide health education as part of a local public health initiative
  • Provide counseling for victims, families, and responders
  • Promote preparedness
  • Provide administrative, logistical and communications support

During the 2005 hurricane response and recovery efforts approximately 6000 MRC volunteer were activated in their local communities and an additional 700 volunteers agreed to be sent outside their local community through response efforts with the American Red Cross and the Department of Health and Human Services (HHS).Volunteers responding either at home or in the areas affected by the hurricanes supported a wide-variety of response activities:

  • Establishing medical needs shelters
  • Providing medical support in evacuee shelters and clinics
  • Filling in locally for others who were deployed to the disaster-affected regions
  • Immunizing first responders prior to their deployment to the disaster affected regions
  • Staffing response hotlines
  • Teaching emergency preparedness to community members

The hurricane response of 2005 showed that many MRC volunteers were willing to deploy outside their local jurisdictions. And their hard work and efforts showed many that this growing resource may be too important to ignore - particularly in response to incidents of national significance. Recently, the White House Report on Lessons-learned from the Hurricane Katrina Response stated that "HHS should organize, train, equip, and roster medical and public health professionals in preconfigured and deployable teams..." and that these teams should include members of the MRC.

In response to this growing interest (both from volunteers and outside response agencies), the MRC program office is working to identify the best mechanisms to allow volunteers to activate outside their local jurisdictions:

  • State-to-state mutual aid agreements and the Emergency Management Assistance Compact (EMAC)
  • American Red Cross
  • HHS 'Federalization' process...serving as an auxiliary to the Public Health Service

Activation and other topics, including volunteer management, training, and legal protections were featured at the MRC National Leadership and Training Conference held last week in Dallas, TX. This conference joined national government and nongovernmental organizations, emergency response and public health experts, and other community volunteers for 4 days of knowledge sharing. This conference was an ideal opportunity for local MRC communities to share best practices and strategies. For units and other interested individuals who were unable to attend the conference, the presentations will be available on the MRC website (www.medicalreservecorps.gov) very soon.

Now all this talk about what the MRC is and what a great asset it can be for your community may lead some of you to ask "how do I become a volunteer" or "how do I get an MRC started in my community"? The MRC website is an invaluable resource.

One role of the MRC program office is to provide technical assistance to communities who are (or may be interested in) establishing an MRC in their community. In order to facilitate this process, the program office provides guidance in the form of its Technical Assistance Series. This text contains a wealth of information for those communities just getting started. The TA series includes the following guides:

  • Getting Started: A Guide to Local Leaders
  • Organizing an MRC Unit: Operational Components and the Coordinator’s Role
  • Coordinating with your Local Response Partners
  • Developing Volunteer Relationships and Capabilities
  • Establishing and Maintaining your MRC Unit's Organization

For those interested in volunteering, the website also contains contact information for all registered MRC units. Volunteers contact local units to find out about the volunteer opportunities and how they can become an MRC member.

Unit contact information is also available to other MRC leaders and partner organizations so they can share information with each other on best practices or find out how they can partner with their local MRC. In addition to the local unit contact information, the website has contact information for the 10 MRC Regional Coordinators and the MRC State Coordinators (for those states who have appointed one). Both of these resources provide a wealth of information that is specific to the region and/or state where the MRC unit will be located.

The website also has a host of other information that helps volunteers and communities join or establish an MRC, as well as share information with other MRC units and volunteers. For any additional questions on how you can join, establish, or partner with an MRC unit, please do not hesitate to call or email me.

But for now I feel that I have more than used up my allotted time. So I am going to turn this back over to Avagene. I will be available for questions. Thank you again for having me here.

My contact information is email - [email protected], phone - 301-443-0920.

Avagene Moore: Thank you, Marna. We will now turn to questions from our audience.

[Audience Questions & Answers]

Audrey Sweazey: what advice do you have for communities trying to start an MRC?

Marna Hoard: Good question Audrey. The key to the MRC is local partnerships -- building a program with the health needs of the community in mind, and working with your partners to determine those needs. Good advice is to first determine if there is an MRC already in your community. If not then work with your local hospital, health department, emergency management and other local response agencies to build an MRC that is right for your community. If there is a large population of elderly, you may want to emphasize programs that meet the needs of that population. If you are in a region of the country that is hit by a lot of natural disasters you may want to build a program on the EMS models.

But the best advice I can give you is to contact already established MRC units. They hold a wealth of knowledge on how to get started and what challenges to expect, they also have great info on best practices. Also remember to go online to the MRC website and download the Technical Assistance series. It spells out step-by-step how to get started.

Connie Aguilar-McCowan: I'm the Emergency Planner for the Salt Lake Valley Health Department (SLVHD), which happens to be the largest County Public Health Agency in Utah. We are in the process of setting up an MRC but have concerns with all of our first responders and stakeholders who already use (medical) volunteers in their emergency plans. Example: Primary Children's Hospital has a group of volunteers that are dedicated to them when the RSV [respiratory syncytial virus] season hits to help the hospital with their overwhelming crunch. If we have a disaster during that season, our MRC/medical resources "may" be sparse. Any ideas on how to fix that?

Marna Hoard: This is where local community partnerships come in. We encourage all our MRC units to become a part of their local response plan. This allows for the community planners to have a good understanding of what assets they have and how much of that asset they have. But this is a question that comes up over and over again, double counting of volunteers. This is where we must rely on the volunteer to be as honest about his/her responsibilities with their job and/or other volunteer agencies.

When I worked at the Red Cross Headquarters during Hurricane Katrina and Rita response we had thousands of individuals who were willing to go. Our job specifically was to deploy MRC volunteers, but we still had people who were willing to go with anyone anyway they could, so part of the process to activate an MRC is to get the MRC unit leader sign-off on whether the volunteer is really an MRC volunteer and able to go. When we encountered individuals who were not with the MRC we encouraged them to join their local MRC. We tried not to send anyone who was not an MRC volunteer, but a few got through the cracks. In talking with MRC unit leaders, we encouraged them to develop relationships with all their local response groups, especially other volunteer groups. That way each of the groups would know what names were on which rosters.

Of course all of this should be done prior to a major catastrophe, but the best laid plans…. I do think however that the 2005 hurricane response did provide a good learning experience for everyone, and units leaders, now more than ever, are working to build those bridges between the other response groups. But again, I would like to defer to the MRC units leaders in answering the question how these relationships can and have been developed. They are your best source of information.

Robert Inlow: How are we related to DMAT? (Disaster Medical Assistance Team)

Marna Hoard: Robert, this is a good question and one we get all the time. An MRC unit is a local asset while DMAT is a federal asset. DMATs provide definitive care; they have the equipment, personnel, and supplies to set-up a 250 bed hospital and maintain it for about 2 weeks. MRC units cannot do that, actually they were never meant to do that. They are a local asset that is there to augment and support the existing resources in the community. MRC units mostly provide support personnel; pre-credentialed, licensed medical and public health providers who assist their local communities’ public health activities, including emergency response. But I do want to say that there are several MRC units across the country who have developed working relationships with DMATs. These relationships are support in nature.

MRC units do not activate or deploy with DMATs, but where it is appropriate MRC volunteers assist and partner with DMATs to meet the needs of their communities. One more thing I would like to say...DMATs are teams of personnel who train together throughout the year and then deploy together as a team. MRC units don't function that way. Yes, their personnel are trained, but remember they are volunteers and most have other full-time jobs that do not allow them to deploy at any time - particularly not outside their local community (as a DMAT would).

Charlie Hanson: In Montana, we have had two programs that were started when there were federal grant monies available. My understanding is that the grant monies are gone and one of the programs has died already and the other is on life support. Realizing the dangers of getting overly dependent on the federal dole, how can local jurisdictions develop and maintain this vital program without the federal funding carrot?

Marna Hoard: Thank you Charlie for that question. Sustainability is always a concern. My best response to local units is to get known in their community. If they become an invaluable resource for their community, then monies should follow. The states are beginning to recognize the importance of the MRC program. They also have monies to prepare but remember anything that comes from a higher level, may come with standards. So my advice is get your MRC out there -- on the news, in the schools, in public policy -- make the MRC KNOWN. There are also some units that have gone to non-profit status to fund the program. If you want we can talk more off-line about that.

Amy Sebring: Would you agree that it would be critical to find a "champion" among the local medical or public health community to carry the spear for starting a new unit where none exists? (Not only for generating initial interest, but also for maintaining interest?)

Marna Hoard: Yes!!! Another Citizen Corps program (Volunteer in Police Service) has Shaquille O'Neal as one of their spokespersons. Tell me that doesn't generate interest! But you don't even have to go to that high level. At our conference, one of the speakers (Richard Hyde) spoke of risk communication. In his presentation he stated that, according to research, people trust local community members to get truthful, useful information. If this is the case, then yes, find someone in your community who is well-known and trusted and bring them into your MRC (maybe as a board member or someone involved in the process) and get them talking in your community. You will be amazed at how much good this does.

Cindy McManaman: Marna, excellent overview of MRC. I am MRC Coordinator from MRC of Southern Colorado, an established MRC unit. We receive lots of questions from people looking to start units. The website Technical Assistance is an excellent resource, even for us established units. MRC units across the country differ greatly in meeting what their particular community needs are.

Marna Hoard: Thank you Cindy. As the Outreach Officer I find more than not I refer those interested in the program to the local unit leaders because you know the lay of the land, as it were, and you have done it. The expertise you and the other MRC unit leaders have is a great and valuable asset to the MRC program. Thanks for all your hard work.

Amy Sebring: Do MRC volunteers get NIMS training, or some kind of "Emergency Management 101" orientation?

Marna Hoard: It depends on the local unit. As this is a local program, the units themselves determine what types of training are needed, but if the units are involved in the local response plan or are housed within a local government agency, which most are, then there is some level of requirement for NIMS and ICS training. Also we encourage these types of training, as they allow the MRC the knowledge of how to work within the ICS system if they are activated to respond. In addition, although the program office cannot regulate training, we are in the process of developing Core Competencies for the units to use, if they deem them helpful.

Avagene Moore: Many volunteer programs have difficulty maintaining interest and momentum once they are organized and trained. How do the MRC units handle this to keep up interest and needed numbers?

Marna Hoard: Good question. MRC units work throughout the year on various types of public health activities. Because they do not respond only to emergencies, volunteers may activate to provide public health education, man an immunization clinic, or help develop health policy within their communities. Keeping them involved is important and believe me there is enough to do in the public health arena, if the MRC is truly working with all their local partners than they will be busy all the year-round.

Johna Easley: As a local public health agency, my emergency preparedness volunteer database is required to be MRC credentialed. Can you tell me how this partnership (between local MRC units and other agencies) works, whose volunteers are whose, how to avoid double counting, etc?

Marna Hoard: Avoiding double counting is hard. The best thing I can tell you is if you do not already have an MRC, encourage one to be established in your local health department. They can share the database at that point. As for outside agencies, again this comes back to the development of the relationship. Volunteers will volunteer where they think they can be activated. The job of the MRC unit leader is to maximize the volunteers’ understanding of the Incident Command System thus minimizing the volunteer overlap. Also it cannot be overstated that building the local partnerships is the best avenue of avoiding double counting.

Amy Sebring: Obviously, the "special needs" issues were highlighted in Katrina and Rita. Is the MRC Program Office coordinating with DHS and the Interagency Council to identify potential opportunities in this area? Was this topic addressed at your conference?

Marna Hoard: Actually Amy it was. We had a speaker, Kelly Reinhardt, who spoke on this exact topic. And yes, we have been working with DHS through the White House Homeland Security Council, as well as HHS, to discuss possible roles for MRC volunteers in response to special needs populations. But I also want to add that MRC units are addressing special needs everyday in their health activities. Several units have had their brochures translated into other languages, many units provide services to the underserved and special needs populations in their communities, particularly to children, the elderly, and native populations.


Avagene Moore: Thank you, Marna! We greatly appreciate your effort and time on our behalf and wish you and the MRC continued success. Please stand by a moment while we make some quick announcements.

If you are not currently on our mailing list, and would like to get program announcements and notices of transcript availability, please see the Subscribe link on our home page. Again, the transcript of today's session will be posted later today and you will be able to access it from our home page. An announcement will also be sent to our Mail Lists when the transcript is available.

Thanks to everyone for participating today. We especially appreciate everyone in our audience!

Before you go, please help me show our appreciation to Marna for a fine job. The EIIP Virtual Forum is adjourned!