EIIP Virtual Forum Presentation — June 27, 2007

U.S. Public Health Service Commissioned Corps
Readiness and Response Program

CAPT Oneal (Neal) Walker, Ph. D.
Division Director for Recruitment, Office of Commissioned Corps Operations (OCCO)
Office of the Surgeon General, Department of Health & Human Services

CDR Dan Beck
Deputy Director, Office of Force Readiness and Deployment (OFRD)
Office of the Surgeon General, Department of Health & Human Services

Amy Sebring
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]

Amy Sebring: Good morning/afternoon everyone. Thank you for joining us today. On behalf of Avagene and myself, welcome to the EIIP Virtual Forum! Our topic today is the "U.S. Public Health Service Commissioned Corps Readiness and Response Program."

Now it is my pleasure to introduce CAPT Neal Walker Division Director for Recruitment in the Office of Commissioned Corps Operations (OCCO), Office of the Surgeon General. A licensed (clinical) psychologist, CAPT Walker has served in various clinical and administrative leadership roles for more than 18 years. CAPT Walker holds several degrees including an M.S. (1986) from University of Southern California, and a Ph.D. (1993) from California School of Professional Psychology. Trained as a ready responder, he has participated in two major deployments in Florida and Mississippi serving in a senior role as a mental health consultant and provider.

We are also pleased to welcome CDR Dan Beck, Deputy Director, Office of Force Readiness and Deployment (OFRD). He has deployed to over 25 events serving in roles ranging from Medical Strike Team Leader to Operations Center Director during 9/11 to Director of the HHS Hurricane Relief Program during Hurricanes Katrina/Rita/Wilma. He has been directly involved in the management of over 150 deployments and missions. CDR Beck will assist with responding to your questions during the Q&A part of today's program. More biographical details, as well as links to materials related to today's topic are available from our Background Page.

Welcome to you both gentlemen, and thank you for taking the time to be with us today. I now turn the floor over to CAPT Walker to start us off please.


Neal Walker: Thank you Amy for providing me with an opportunity to participate in this forum. As an officer in the United States Public Health Service Commissioned Corps (Corps), I have always enjoyed serving others especially those in medically underserved communities.

My official position as the Director of Recruitment in the Office of Commissioned Corps Operations puts me in daily contact with healthcare professionals who have an interest in serving as Corps officers or are in charge of health and health-related professional training programs across the nation. One of the principal challenges my Division faces daily has to do with "marketing" the Corps and implementing policy and programs aimed at expanding our roles as healthcare providers.

Perhaps, some of you may have already visited our web site at www.usphs.gov. If you have not, then I'd like to invite you to do so, after our meeting today. The web site provides detailed information about eligibility requirements to become a Corps officer. I hope that after you learn more about the Corps, you may consider serving in the Corps as a possible career option for yourself and share the web site with other health professionals who qualify to serve.

For more than 200 years, the U.S. Public Health Service Commissioned Corps has been our Nation's frontline against the spread of disease from sailors returning from foreign ports, to immigrants entering the country, to communities affected by natural and manmade disasters. The U.S. Public Health Service Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the Nation's public health promotion and disease prevention programs and advancing public health science. As one of our Nation’s seven uniformed services, the Commissioned Corps fills essential public health leadership and service roles within the Nation's Federal Government agencies and programs.

Before I make some general remarks about the Corps' Readiness and Response Program, I should let you know that I am no stranger to readiness and deployment. As a Corps officer, I have been deployed to two specific hurricane sites to serve in the capacity of a senior mental health provider.

My first deployment was in August 2004, in Fort Pierce, Florida. The devastation and impact were so severe that my assigned mental health team could not stay in the immediate area due to unavailability of hotels, rooms and other types of boarding facilities (e.g., school auditoriums). Realizing we were on a special mission, the mental health team commuted on a daily basis, 100 miles from the nearest habitable location, Orlando, to Fort Pierce. If you are thinking we were in "Funland, USA," -- we saw very little daylight in Orlando due to the early start and long return evening drives back to Orlando.

If Fort Pierce was a challenge, then Gulfport, Mississippi, was a nightmare for that community. As a mental health professional with more than 20 years experience dealing with extremely difficult emotional situations, nothing, to date, compared with what I saw and experienced in the Gulfport area. I was assigned to a team of the best and brightest the Corps has to offer. We surely thought we were "ready" in September 2005 to face the enormous task ahead of us. Once in place, however, we realized that this was not going to be "business as usual." Our days were long, exhausting and demanding. We were stretched to our limits given the tremendous need for mental health intervention.

Although I functioned in my specialty for the most part, dentists, nurses, physicians, pharmacists, environmental health and safety officers, mental health specialist, and others banded themselves together to provide any required services needed by the victims of the hurricane. In due course, approximately 2,600 Corps officers were deployed to the Gulf Coast to assist victims of hurricanes Katrina, Rita, and Wilma in 2006.

Okay, let me attend to the focus of our chat today, which is the Corps' Readiness and Response Program. It is important to let you know that the Secretary of the Department of Health and Human Services is a principal driving force behind our Corps Transformation and the Corps Readiness and Response program.

As stated in the Commissioned Corps Personnel Manual Circular, PHS No. 377; on July 3, 2003, the Secretary of the Department of Health and Human Services recognized the Corps' unique status to provide what was then defined as "swift and effective" responses to urgent health needs. Consequently, he directed that all active-duty officers in the Commissioned Corps meet force readiness standards by 2005. Approximately four years later, this recognition continues to highlight the Commissioned Corps' ability to meet the urgent and extraordinary public health needs of the American people.

Officers in various health and health-related disciplines stand ready to respond while continuing to perform in their traditional mission areas that are focused on protecting, promoting, and advancing the health and safety of the Nation. For those of you who would like to explore more comprehensively the readiness requirements for the Corps, please visit the following web site at http://ccrf.hhs.gov/ccrf/.

The overall mission of the Commissioned Corps Readiness and Response Program is to "provide quality medical and health care, compassion and comfort to the American public, or the global community, in the event of a natural or manmade public health care crisis." In order to execute this mission the Corps has developed a four-tier system of deployable officers.

I should let you know that there are several components to the Corps' Readiness Program and that what I am discussing with you today is at best the present version of things as they are presented in our current information available to the public. Essentially, the four-tier system for rapid deployment of our officers will follow the template laid out below:

Tier One
The "Tip of the Spear" of Tier One will be the Health and Medical Response (HAMR) teams. These multi-disciplinary teams composed of 105 officers each will be online in FY08. The HAMRs will consist of the Nation’s first full-time, dedicated Public Health and Medical Response force and will be available for immediate deployment within 4 hours of notification 365 days a year. When not deployed, these teams will engage in response training as well as conducting training for other Commissioned Corps officers, as well as State and local assets including the Medical Reserve Corps. These teams will also complete clinical and public health rotations at underserved and hardship sites.

Tier One also includes five Rapid Deployment Force (RDFs) teams and 10 Incident Response Coordination Teams (IRCTs). Individuals assigned to Tier One are expected to report to a point of departure within 12 hours of notification. The RDFs, composed of 105 officers each, are centered in 4 locations. PHS-1 RDF and PHS-2 RDF utilize officers near Washington, DC. PHS-3 RDF includes officers near Atlanta and officers near Raleigh/Durham. PHS-4 RDF includes officers near Dallas and officers near Oklahoma City. PHS-5 RDF includes officers near Phoenix and officers near Albuquerque.

Tier Two
Tier Two involves five Applied Public Health Teams (APHTs), and five Mental Health Teams (MHTs). Individuals assigned to Tier Two are expected to report to a point of departure within 36 hours of notification. The APHTs are composed of 47 officers with skills that reflect the functions found in public health departments. Each APHT is capable of replacing or augmenting a decimated county health department. The MHTs are composed of 26 officers each, and are capable of providing mental health/behavioral health services after a disaster or as a consequence of an urgent public health need.

Tier Three
Those officers not placed on Tier One or Tier Two response teams will be placed in Tier Three, which includes every other active duty officer in the Commissioned Corps. Individuals assigned to Tier Three are expected to report to a point of departure within 72 hours of notification. Tier Three personnel can expect to be deployed on a regular basis, either to augment Tier 1 or Tier 2 teams, or to provide specific requested technical skills and subject matter expertise when required.

Tier Four
Tier Four will comprise officers in the Inactive Reserve Corps (IRC) as well as the Medical Reserve Corps.

In general, as described above, the Corps' stands ready to respond quickly to the Nation's emergencies. Indeed, the Corps has morphed in many positive and challenging ways during its history. While we as Corps officers are assigned to specific agencies, we recognize the need to maintain our clinical skills as we continue to respond to the health needs of the nation and the global community.

Let me stop here and turn the session back over to our Moderator. I'll be happy to address any related questions you might have for me. Thank you.

Amy Sebring: Thank you very much Neal. Now, to proceed to your questions or comments.

[Audience Questions & Answers]

Kevin Huckshorn: Capt. Walker, are there age limitations or restrictions to joining the Corp?

Neal Walker: Kevin, yes. At present an applicant must be less than 44 years of age at the time of commissioning.

Ric Skinner: Timely and bi-directional information flow is critical to support what yours teams are tasked to do. To what extent has interoperability of emergency management systems been a problem for your work?

Dan Beck: There is no question that interoperability and communications are always key issues. Currently we are supported through a number of command layers during a Federal response. We do use the WebEOC product within our Secretary’s Operations Center (SOC) to manage information flow. As follow up, the field deployed teams (HAMR, RDF, etc) report to the Incident Response Coordination Team (IRCT) in the field, who communicates back to the Emergency Management Group (EMG) at the SOC, all coordinated through WebEOC. This can then be routed throughout our interested parties during an event.

Richard Besserman: How does the Corp intend to integrate with dissimilar Medical Reserve Corps (MRC) organizations, each with its own mission and limitations, especially their lack of financial support for planning and deployment. Many MRC organizations are affiliated with County Public Health agencies and others are independent. Funding has been cut to almost zero. As a coordinator of MDs I find that surprising.

Dan Beck: As follow up, the field deployed teams (HAMR, RDF, etc) report to the Incident Response Coordination Team (IRCT) in the field, who communicates back to the Emergency Management Group (EMG) at the SOC, all coordinated through WebEOC. This can then be routed throughout our interested parties during an event.

Neal Walker: Funding is a major challenge everywhere.

Wes McDermott: Are there other career opportunities within the USPHS emergency response program besides as a commissioned officer (e.g. federal civil service positions)?

Neal Walker: Yes, there are other opportunities. My focus though is more on Corps assets. But there are systems in place to participate at the federal level with other agencies.

Avagene Moore: Neal, I am pleased to learn about the resources available through the Commissioned Corps. I was not aware of this prior to seeking you out as a speaker and am sure others share in this lack of awareness. How are you marketing or publicizing this 6,000+ trained resource that is so badly needed in events such as Katrina?

Neal Walker: First, Avagene, our new web site has been developed, and is still evolving as we reach out to professional organizations, health programs, pipeline programs (even high school), and so on. Because we are a professional Corps with specific educational and licensure requirements, we have a greater challenge to fill positions. (We want to grow to 6,600 by next year.) But we are on target to recruit America's best and brightest.

John Chiaramonte: Under what circumstances would PHS backfill military medical operations, and how would PHS balance that request with other (i.e. ESF-8) requests?

Dan Beck: USPHS officers have backfilled military medical operations on a number of occasions and provided primary staffing on a number. USPHS dentists have been deployed to Camps Lejeune and Pendleton addressing dental readiness needs of the US Marines. Additionally, we are currently actively deployed aboard the USNS Comfort supporting the President's Latin American Initiative. And we are serving aboard the USS Peleliu in the Pacific.

It is my responsibility within the Office of Force Readiness and Deployment to ensure that any of our missions allow us to remain ready to respond to other events, including ESF-8 activations (e.g. hurricanes).

Amy Sebring: Can you address how PHS demands are balanced? Perhaps through the deployment decision process Dan?

Dan Beck: The first step in the process is our rotational rostering process. All assets within the Corps across all tiers are on a five month rotational cycle; therefore we have a balance of assets at any given time across our teams, tiers, skills and duty stations. Additionally, all activations of Corps officers are vetted by my Office, and then the Surgeon General, and then the Assistant Secretary to ensure that both response and day-to-day needs are met. This ensures our ability to respond to multiple events and to avoid being tasked indiscriminately.

David Olinger: Capt. Walker, is the Corps for licensed professionals only? Who is eligible?

Neal Walker: Yes, except in those instances when a particular profession does not require a license (e.g., Computer professional, IT, etc.) Otherwise, each Corps officer in a clinical profession must maintain a license in his or her professional category. The web site provides much more on this.

Ric Skinner: From your earlier response on interoperability it sounds like USPHS should be one of the role players in interoperability demonstrations such as CWID that we just completed. We used OPEN and IIMS to send emergency management relevant messages, including spatial data, between and among civil and military domains. Has USPHS been approached to participate in CWID or similar interoperability initiatives?

Dan Beck: That particular activity would specifically be coordinated by the Office of Preparedness and Emergency Operations. They coordinate the Department’s emergency operations logistic support.

Marcia Williams: The mental health services you provide - are they solely for the victims? Do you have any after disaster services for responders?

Neal Walker: Yes, we do Marcia. Our officers are encouraged to have out briefings to deal with their own mental health challenges. I participated in an out briefing and had Corps opportunities to address my own situation. I met with a small group of professionals who participated in "downloading." Plus the OFRD folk wanted us to provide feedback about our own experiences by filling out a questionnaire. These all were helpful.

Dan Beck: Additionally, each team has a MH provider specifically to address team MH issues and we have MH and behavioral health resources made available to our responders upon their return. With respect to other local and state responders, that is one of the missions that can be performed by our Tier 2 Mental Health Teams. The MH resources that are made available to our teams are also available to other responders

Neal Walker: The Red Cross had many mental health volunteers who provided aftercare to all personnel. In addition, the Corps sent teams afterwards to provide aftercare.

Wes McDermott: Do you have any information regarding the "Pathfinder" team typing that was recently published by the NIMS Integration Center (i.e. is "Pathfinder" a USPHS resource)?

Dan Beck: The Pathfinder Task Forces are resource typed as local assets to assist with, among other taskings, POD site location and management. I am not aware of who the champion for that was, but I believe the comment period is still open.

Avagene Moore: Neal, Sec. Leavitt also mentioned enhancing the Corps' relationships with state and local jurisdictions, as well as becoming better known generally. What efforts are being made in those areas?

Neal Walker: At present, the Corps is seeking innovative ways to place our officers in various state and local healthcare facilities. Just today, that came up in a discussion I was part of. The Corps has always had assets in community health centers and rural/migrant areas. What we are currently seeking to do under this new initiative is to make it much easier to assign our officers to state and local facilities. We do have a limited number of individuals "detailed" to a few places, but the plan is to make this a routine assignment.

Dan Beck: Officers within the Centers for Disease Control and Prevention have long served within State Health Departments, particularly assisting with epidemiological surveillance activities. Also, there are initial efforts underway at embedding Corps officers within the educational community, essentially establishing PHS Centers of Excellence.

Amy Sebring: Dan, training improvements were noted as being needed, post-Katrina. How has the Corps emergency response training been improved?

Dan Beck: In terms of training we are currently conducting the first fully integrated field training for our Tier 1 and Tier 2 teams this summer. These teams will be training over 5 weeks at Camp Bullis in San Antonio, TX beginning in July. This will provide training to the RDFs, APHTs and MHTs in two specific National Planning Scenario based exercises.

Additionally, we have managed to assemble a TRAINING Field Medical Station (FMS) specifically to enable our teams to train with one of the primary physical assets of the Department. We have requested a very robust training budget for next year and beyond, and with the addition of the training capability of the HAMRs, we believe that we have planned an exceptional training program moving forward.

John Chiaramonte: How does PHS communicate during a response? Is it just cell phones / satellite phones or radios? Do you rely on commercial service providers?

Dan Beck: Essentially the answer is yes. Our communications logistics are provided by the IRCT I mentioned earlier. We will use whatever the infrastructure will support. Initially we will rely on commercial service providers unless they are unavailable. Then we have the capability to establish our own cell sites and of course, sat phones, etc. provide additional backup. It is worth mentioning that FEMA logistics is responsible for the Federal communications in the field during a disaster, so they provide another level of backup if our own systems are overwhelmed.

Amy Sebring: Dan or Neal, I also saw somewhere that there might be a need for legislation regarding the capability to deploy officers from an employer standpoint? Is that still an issue, and if so, has there been any progress?

Dan Beck: A legislation package was prepared that would address the idea of establishing a Ready (or Select) Reserve. The Corps currently only has an Inactive Reserve Corps in addition to our active duty officers. The fact that our officers are assigned on a day-to-day basis to agencies of the HHS and other Federal agencies (USCG, BOP, USMS, NPS etc) does mean that officers must be released from their normal assignments to perform emergency response operations. But this will be addressed by the HAMRs, which are full-time response assets reporting directly to the Surgeon General.

Richard Besserman: Now that NDMS is back with HHS, do you see a closer training relationship developing with the NDMS/DMAT teams that train periodically?

Dan Beck: Absolutely. We will be having members of the NDMS staff attending our field training at Bullis, and we have collaborated already with our Learning Management System. As you may know, the NDMS was located within HHS only four years ago and the relationship between the NDMS response teams and the Corps was developing very well at that time. I think it provides an amazing opportunity to cross-train. "We train as we fight" as the saying goes, and there is no better time to work together, learn together, than BEFORE the event.


Amy Sebring: Let's wrap it up for today. Thank you very much CAPT Walker and CDR Beck for an excellent job! We hope you enjoyed the experience.

Neal Walker: Thank you giving us the opportunity to participate. I can be contacted at [email protected] And please visit our web site at www.usphs.gov.

Dan Beck: My pleasure; CDR Dan Beck ([email protected]), and I would encourage everyone to visit www.usphs.gov

Amy Sebring: Please stand by just a moment while we make a couple of quick announcements.

We are pleased to welcome a new partner today, Bridge Solutions, Inc., http://www.bridgesolutions.ca; POC Tim Edwards, President. If your organization is interested in becoming an EIIP Partner, please see the link to ‘Partnership for You’ from our home page.

Thanks to everyone for participating today. We stand adjourned but before you go, please help me show our appreciation to Neal and Dan for a fine job!