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1/17/2003

Medical Reserve Corps Offers Local Opportunity for Pharmacists

Donna Young

Before the terrorist attacks on New York City and the Pentagon, some communities and organizations had already been developing emergency preparedness plans and holding mock-disaster drills.

The tragic events of September 11, 2001, have spurred the nation to take action in developing better-organized and more comprehensive emergency plans.

However, a national recession and a lagging economy have sunk most state and county budgets, and funding for new programs is hard to find.

So states and local communities are seeking to yoke the strength of volunteer activism to aid in homeland security and health care awareness campaigns.

The Medical Reserve Corps (MRC) was created last year to supplement local communities’ existing emergency preparedness plans and public health education and awareness programs.

The federally funded program was designed to provide organizational structure and training for licensed health care professionals—practicing, retired, or otherwise employed—who want to volunteer in their local communities.

MRC is coordinated by the Office of the Surgeon General and is part of the Bush administration’s Citizen Corps—introduced last year to complement other national service programs, including the Peace Corps, created by President John F. Kennedy in 1961, and AmeriCorps, established by President Bill Clinton in 1993.

USA Freedom Corps is the Bush administration’s umbrella organization for Citizen Corps, Peace Corps, and AmeriCorps.

Funding

Under the 2002 Supplemental Appropriations Act for Further Recovery From and Response To Terrorist Attacks on the United States, Congress appropriated $25 million last fall to the Federal Emergency Management Agency (FEMA) for Citizen Corps.

FEMA announced in December 2002 that $21 million of the funds would go to states to expand Community Emergency Response Teams (CERTs)—volunteers who are trained in basic response skills and assist emergency personnel in times of disasters—and for the creation and support of Citizen Corps councils—local community leaders who will be responsible for assessing possible threats, identifying local resources, and driving public participation in developing community action plans.

The Los Angeles, California, fire department developed the CERT model, and FEMA began promoting it nationwide in 1994.

FEMA has challenged the nation to have 400,000 CERT-trained volunteers by 2005.

Each state was allocated a base amount of 0.75 percent of the $21 million. Territories were allocated a base amount of 0.25 percent. The remainder of the funds was allocated to states and territories based on population.

California, Texas, and New York, the states with the largest populations, received the most funding with about $1 million each. American Samoa, with a population of 57,291, received the smallest grant of just under $55,000.

States are required to divide 75 percent of each grant among local governments.

In November, the Surgeon General awarded 42 organizations in 27 states demonstration project grants of up to $50,000 apiece to establish an MRC unit in their local community. Health and Human Services (HHS) Secretary Tommy G. Thompson had announced the availability of $2 million for the grants in July 2002.

To receive funding, a demonstration project did not have to have a Citizen Corps Council in the community, said a policy adviser to the Surgeon General. But the MRC unit might act as an impetus for a community to organize a council, she said.

Local communities decide how to use funding for Citizen Corps Councils and MRC units, the adviser said, but must provide performance reports and evaluations to the federal government about how funds are used.

MRC project applicants were required to provide letters of support from local emergency response agencies, law enforcement, and community leaders showing that community agencies and organizations would welcome and uphold an MRC unit.

The Bush administration has proposed that Congress authorize $10 million in 2003 to fund new MRC demonstration grants and for the continued support of the 42 MRC units under way.

Last year, 177 organizations applied for the MRC grants.

Without the $10 million, it is unclear how the MRC program will continue, according to the Surgeon General’s office.

National Citizen Corps Council

The White House also created a National Citizen Corps Council in December to advise the Bush administration about ways to promote safety practices and engage volunteers in homeland security and community preparedness.

The 43-member council consists of health care, firefighter, emergency management, and law enforcement associations; relief organizations, including the American Red Cross and the Salvation Army; intergovernmental groups, such as the National Governors Association and the National League of Cities; and various federal agencies.

The American Society of Health-System Pharmacists is the only pharmacy organization that was invited to be a charter member of the council.

Pharmacists’ role

Pharmacists are an essential component of any local MRC unit, said the Surgeon General's policy adviser. By volunteering, she said, pharmacists can assist a local community’s emergency response during a public health crisis by helping to vaccinate residents against smallpox, providing medication information and counseling, or supplying knowledge about antidotes used to counter a toxic substance that has been released.

Pharmacists can strengthen and sustain a community’s health care initiatives, she added, by helping to educate the public and engaging other health professionals in MRC training programs.

Demonstration projects

Since most of the demonstration projects received the funding in December 2002, MRC units are at various stages of development, the Surgeon General’s policy adviser said. MRC units will vary from community to community, depending on an area’s public health needs, leadership involvement, vulnerabilities, and population, she added.

Bayonne, N.J., a densely populated city located on a peninsula across the Hudson River from New York City, has a large potential for several hundred casualties if terrorists struck any of the many oil refineries, chemical plants, or factories in the area, said Lisa Catlin, Bayonne Medical Center director of grants administration.

Catlin’s medical center, one of the 42 MRC grant recipients, is developing a project to actively recruit medical health professionals, social workers, and clergy to be trained for any large-scale emergency.

The project will also use volunteers to help with health and wellness education, cancer and glaucoma screenings, and other health initiatives, she said.

Bayonne’s Citizen Corps Council will be actively involved in overseeing the community’s MRC project, Catlin said.

"They will be helping to make sure we involve the right people and that they are correctly trained," she said.

New Jersey’s Hudson County Metropolitan Medical Response System, a federally funded program that helps communities coordinate resources and prepare for a possible attack of weapons of mass destruction, will also be involved in the project.

Bayonne is a "tight knit" community, Catlin said, and her city’s police and fire departments, city council, and emergency response systems are working together to help the project be a success.

Yale New Haven Health System in New Haven, Conn., is using its grant to coincide with a state initiative to develop a statewide reserve of medical volunteers, said Christopher Cannon, director of the health system’s office of emergency preparedness.

Yale New Haven was one of two hospitals selected by the state to help coordinate and address emergency-response planning, including the stockpiling of medications and supplies and the development of clinical protocols.

"No one institution in an area can bear the brunt of an emergency crisis on its own," he said. "You have to look to other institutions and medical volunteers."

Yale New Haven’s MRC project includes identifying area colleges and universities with medical, nursing, public health, and pharmacy schools that could provide educators and students who would be trained to aid medical response teams in the event of a disaster.

New Haven’s MRC unit is also seeking help from area organizations, such as the Kiwanis and Rotary clubs and other service groups, to help with public awareness campaigns and communications.

Training and hiring emergency medical technicians is the focus for an MRC project in Farmington, Maine, said Olan A. Johnston, paramedic supervisor for Franklin Memorial Hospital, the organization that is coordinating the project.

Opportunities to Volunteer

Disaster Medical Assistance Team, a group of professional and paraprofessional medical personnel that provides emergency medical care during a disaster or other event anywhere in the nation or oversees. Information is available at http://oep-ndms.dhhs.gov

Medical Reserve Corps, locally-based health volunteers who can assist their own community during a large-scale emergency, such as an influenza epidemic, a chemical spill, or an act of terrorism. Information is available at http://www.medicalreservecorps.gov/index.htm

National Pharmacist Response Team, volunteer pharmacists and pharmacy technicians who respond to regional disasters and medical emergencies. Applications are available at http://www.oep-ndms.dhhs.gov/NDMS/Downloads/downloads.html

The hospital serves 30,000 rural residents in a 2,200-square-mile mountainous area that includes Sugarloaf USA, a popular ski and recreational resort area. The hospital’s ambulance service often transports patients into Canada.

"A disaster of any kind, whether it is caused by bad weather or a terrorist, can strain and stretch a community’s health system," he said.

The MRC project in Lane County, Oregon, is designed to work in conjunction with the local Disaster Medical Assistance Team (DMAT), a specialized team of volunteer health professionals that can be mobilized by the federal government within 72 hours to respond to an emergency in the United States or overseas.

HHS’s Office of Emergency Response coordinates DMATs through the National Disaster Medical System.

Licensing and liability

Pharmacists deployed as part of a DMAT or National Pharmacist Response Team—volunteer pharmacists and pharmacy technicians who are deployed regionally to respond to an emergency—have federal protection from liability. They also have job protection under federal law, and their professional licenses are recognized nationally.

Pharmacists volunteering for an MRC unit, however, must be licensed by the state in which they volunteer.

MRC units should obtain appropriate legal advice, the Surgeon General’s adviser said, to ensure full compliance with all local laws and regulations.

A prepared response

During the anthrax attacks of fall 2001, local fire fighters in Great Barrington, Mass., had responded to area emergency calls about potential anthrax contamination without wearing protective hazardous materials suits, said Doreen M. Hutchinson, vice president of operations and chief nurse executive for Fairview Hospital, a 22-bed facility in the town.

"After we looked at that situation, we decided that we needed to be more organized and better prepared in our community," she said.

Hutchinson said the MRC grant was a perfect opportunity for her hospital, which serves 14 towns in Massachusetts, New York, and Connecticut, to get involved in emergency preparedness.

Great Barrington’s local police department is providing office space for the project’s command center, Hutchinson said, and part of the grant is being used to employ a project coordinator.

Because of its proximity to the Berkshires, a popular resorting area, Great Barrington’s 7,500 population can swell during the summer tourist season by about 30,000 more residents.

Many elderly reside in the area during the summer months, which poses additional health concerns for the community’s small hospital.

The MRC project has helped Great Barrington evaluate its vulnerabilities, Hutchinson said.

For instance, the isolated area’s communication systems can easily be knocked out during a snow blizzard or ice storm. There are no cellular towers in the area, which can also create communication problems when cell phones are used during an emergency.

"We’ve had to look to our churches, schools, and other organizations to identify what resources we have in our community," Hutchinson said. "Our public transportation is very limited and all taxis in the area close down by 7 in the evening. With the large retired population we have, we discovered that our schools’ buses would be helpful if we needed to be able to mobilize people."

Special populations

San Francisco's elderly population poses another challenge for emergency responders.

More than 238,000 residents in the Bay Area are Asian, many of whom are elderly, live in poverty, and speak no English, said Cecilia Lai, chief operating officer for Self-Help for the Elderly, a multiservice organization that provides assistance to more than 25,000 seniors in the San Francisco area.

"Many of our seniors live in single-room hotels that are not well equipped," she said. "They are confined and have little contact with the outside world."

Lai’s MRC unit is recruiting health care professionals who speak Chinese, Vietnamese, or another Asian language to assist if a crisis occurs in the area or to help with health care programs for seniors.

Pharmacists with language skills can contribute a great deal, she said, by providing seniors with medication counseling and health education and interpreting for other health professionals.

A community’s homeless population can also affect an area’s overall public health, said Ron Cookston, director of Gateway to Care, a service organization that helps the uninsured and underinsured in Houston access health care.

The group is also an MRC grant recipient.

Houston has more than 10,000 homeless people, he said.

"Have cities thought about what they are going to do about the homeless if or when we need to vaccinate for small pox?" Cookston asked. "We are going to have to go out and find them."

Pharmacists will be needed in every community when the smallpox vaccination process for the public begins, he said.

Houston learned a valuable emergency preparedness lesson in logistics when Tropical Storm Allison flooded the area in 2001, Cookston noted.

"Many of our hospitals were also flooded," he said. "Allison showed us that hospitals cannot be command centers and sometimes end up being the places where emergencies happen. We had to evacuate patients from the hospitals. We thought we were prepared for emergencies, but Allison showed us that we weren’t."