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Assessment of the Medical Reserve Corps Program

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Results (continued)

3.2 External Coordination

3.2.1 What External Partnerships Did the MRC Establish?

Federal MRC Program

It [my unit] needs to be bigger, but not to the point where I don't have an opportunity to create a relationship with the individual volunteer at some point and they know that this is a viable and sustainable program. We are not looking for a list.

During the first 2 years of the MRC demonstration project, the program office focused heavily on establishing and providing support to MRC units. MRC interactions with external partners during this time were largely informal and intermittent in nature and primarily centered on raising the awareness of the MRC Program among local, State, and federal partnering agencies. Staff did so by attending and presenting at partner organization meetings such as the Homeland Security Council, the National Association of City and County Health Officials (NACCHO), and the Office of Public Health Emergency Preparedness (OPHEP). The MRC also developed a relationship with the Red Cross and the Points of Light Foundation. The program was publicized through various professional organization newsletters and the Metropolitan Medical Response System (MMRS) Web site soon after its establishment.

The MRC also reached out to other professional organizations such as the American Public Health Association (APHA), the Council of State and Territorial Epidemiologists (CSTE), the American Medical Association (AMA), and the Association of State and Territorial Health Officials (ASTHO). However, informants speculated that those relationships were less well developed partly because the mission, interests, and goals of the organizations were not as closely aligned with those of the MRC as the other organizations mentioned. Also, there was a lack of MRC staff time to build and sustain these alliances, although interest in developing those ties remains.

The national deployment of MRC in 2005 during Hurricane Katrina helped increase the MRC's visibility among external partners, demonstrated its viability, and helped strengthen existing partnerships (OPHEP, American Red Cross) and build new alliances (Centers for Disease Control and Prevention Coordinating Office for Terrorism and Preparedness and Emergency Response [CDC-COPTER], National Disaster Medical System [NDMS], Veteran's Administration [VA]).

With the addition of regional coordinators in 2004, MRC Program staff was able to devote more time to developing strategic partnerships and leveraging existing resources and focusing some of the relationship building within the region. Some relationships were still informal in nature, but extended beyond basic information exchange, and others became more formalized. For example, the MRC worked with the Points of Light Foundation to develop a 2-hour volunteer management training, which was given during the 2005 national MRC meeting. The MRC's relationship with ESAR-VHP became more structured in 2004 with the establishment of an MRC workgroup and regular meetings to discuss guidelines for integrating MRC units into local and State emergency support function (ESF) 8 plans. In addition, in 2005, the VA also began to work with the MRC to explore the utility of the MRC providing backfill support for VA personnel deployed in national ESF 8 responses. Also in 2005, a small cooperative agreement was awarded to NACCHO to develop core competencies for MRC units.

MRC Units

The six MRC units represented in the case study established partnerships with a wide range of organizations over the course of the demonstration period. Nearly all had established a relationship with the local chapter of the American Red Cross, the emergency management agency in their area, and the State or local public health agency. About half had established relationships with hospitals; a few worked with local schools, professional health societies, mental health and social service agencies, and other MRC units in their region. Interestingly, although the MRC is a founding partner program of the Citizen Corps, only two MRC units reported strong ties to that entity.

The MRC partnerships were largely informal and communication was typically on a monthly or every-other-month basis. Nearly all the MRC units had at least one or two partners who assisted in some critically strategic or pivotal way, such as helping to train and orient the MRC volunteers or providing them access to an important stakeholder group (e.g., physicians).

3.2.2 What Were the Challenges to External Coordination and How Did the MRC Address Them?

Federal MRC Program

It takes time to develop relationships and nurture strategic partnerships. Staff in the MRC Program Office were stretched very thin and did not have resources to devote solely to outreach activities. While the addition of a program officer for outreach and 10 regional coordinators in 2004 significantly relieved the burden on the national office staff, most of the relationships with external partners were still largely informal in nature and contact with these partners could be sporadic.

As noted earlier, external coordination at the State level has been hampered by States' reluctance to use MRC units because (1) the States have no control over how the MRC units are established and (2) the State may not be aware of units within the State. In response, the MRC has encouraged States to appoint MRC State coordinators to increase coordination at and between the State and local levels, as well as with the MRC Program Office.

How do these volunteers know what they would be doing? Are they screened? And what happens when volunteers move? Are their names taken off the roster? How is the roster kept up to date? How do they know the roster numbers are accurate? These are big questions.

According to about half of the informants, one of the most significant obstacles to external coordination at the State and national levels was the lack of standardization across units with respect to training, credentialing, and supplying volunteers. Each MRC unit was different, so no assumptions could be made regarding baseline volunteer knowledge, skills, or the supplies that would be available to volunteers. Moreover, there was no standard protocol for managing MRC volunteers. As a few of the informants explained, this lack of structure made the MRC units essentially an unknown and therefore potentially unreliable entity, and organizations were understandably reluctant to work with them. The MRC made efforts to address some of these concerns by entering into a cooperative agreement in 2005 with NACCHO for core competency development. MRC also worked with the Points of Light Foundation to provide a 2-hour volunteer management training session during the 2005 national MRC conference.

I think the disaster community is a bit skeptical of the presidential programs and programs that come out of issues and are established with few resources. I think they are waiting to see if they are real or will go away with the changing of the administration. There is a bit of the attitude among the disaster community that they did this before without the MRC. And they are willing to work with MRC and observe, but they will not buy into the MRC until it has established itself as valid and long-term and part of the system. There is a lot of "wait and see" attitude.

By and large, being a newly created initiative was perhaps the most significant challenge to external coordination at the federal level during the demonstration period. As a new program, the MRC had to prove that it was a credible, reliable player and, equally important, that it had the potential to survive changing political tides. While formal and informal relationships established during the demonstration period had helped build its visibility, a few external partners with whom we spoke expressed reservations about the MRC as a viable and sustainable stakeholder in the disaster response community if certain weaknesses are not addressed (e.g., lack of core skills and knowledge, training, and credentialing).

MRC Units

The MRC units experienced a variety of challenges in establishing the necessary partnerships to make their units successful. Mainly these collaboration challenges fell into four areas: (1) conflicts over jurisdictional authority, (2) concerns about liability protections, (3) concerns about the utility/ preparedness of the volunteers, and (4) questions about the credibility of the MRC-sponsoring organization. We discuss each of these of challenges in more depth in this section and identify facilitating factors that helped the MRC units address them.

In one case, the issue of jurisdictional authority emerged as a significant stumbling block. One MRC unit found itself operating parallel to but not in coordination with the State MRC office at the State health department because of "turf" issues driven by the fact that the MRC unit is housed outside of public health. Because volunteers may sign up for both the county MRC unit and the State MRC unit, the need to coordinate deployments would be critical during a State or national deployment. But thus far, the State health department has refused to exchange information with the county MRC unit regarding mutual volunteers. While this jurisdictional conflict is limited to this one unit, this experience may have wider implications for efforts to harmonize the management and oversight of multiple MRC units at the State level.

Most of the people that were being recruited for the MRC at the time were retired personnel.... These people were not welcomed with open arms into a hospital ... when you go into disaster mode, you don't ask for untrained, unskilled [people] to come into your hospital and try to start seeing patients.

For half of the units, establishing critical partnerŽships was hampered by the perception that volunteers are unreliable, untrained, or a "hassle" to deal with during the course of an emergency or disaster. Similarly, at an organizational level, the sponsoring institutions of two of the MRC units had to contend with perceptions among key stakeholders that they lacked the breadth of experience and knowledge to support an emergency or disaster.

The second you say the word "volunteer," no one is looking at the MD [medical doctor] or the RN [registered nurse] after their name.... You have to work a little harder at getting people to understand this is a person who is an emergency room nurse or a physician who works every day as a neurosurgeon.

The MRC units were able to overcome these perceptions by establishing a track record through exercises and drills or actual emergency deployments. In one case, the unit was able to secure the support of a well-respected and connected physician champion who was able to help establish the unit's credibility with the local hospital administrators. In other cases, the units established goodwill and credibility by offering something of value (aside from volunteers) to their stakeholders, such as training materials, equipment, or cross-training exercises.

The issue of organizational credibility speaks to the larger question of the impact of the organizational home in developing critical external partnerships. For example, we expected MRC units with no formal ties to the emergency management agencies to have more difficulty establishing their credibility with those agencies. Instead, we found that among the four MRC units housed in organizations with no authority for emergency management, three had successfully established relationships with those entities. Likewise, we found that three of the five MRC units in nonpublic health agencies had encountered little difficulty in gaining the support and participation of their local or State public health agencies.

The council is an assembly of key stakeholders from each of the programs and an elected official from the local area. The whole purpose of that is to identify areas where the various programs can complement one another....

Thus, we found that MRC units can operate successfully in a range of organizational homes. The historical alliances between the various private and public stakeholder institutions that support the MRC unit are much too varied and unique to the locality to recommend one "best" or "ideal" organizational home across the board. While there may be one "best" organization to house an MRC unit within a particular community, each will have its own unique set of collaboration challenges. Each organization has a set of natural allies and others that take additional work to establish. The presence of a strong Citizen Corps Council may be one important facilitating factor. In two of the MRC units, working through the auspices of the Citizen Corps helped them rapidly form relationships with organizations that might have taken years to establish on their own.

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3.3 Public Health Engagement

3.3.1 How Have MRC Units Contributed to the Resolution of Other Public Health Needs in the Community?

In addition to providing a cadre of health volunteers to provide assistance to local agencies in the event of an emergency or disaster, one of the goals of the MRC demonstration project was to "determine whether the MRC approach provides cadres of health professionals who contribute to the resolution of public health problems and needs throughout the year." From the case studies we found that the understanding of the types of activities that are considered to be community health activities as opposed to emergency deployment activities varied widely. Although it was not clearly true for the case studies units, the housing institution of the MRC unit may influence whether an activity is defined as emergency deployment or community health. For example, some respondents considered MRC unit participation in influenza immunization clinics and on influenza hotlines as emergency response, while others considered the same types of activities to be public health initiatives. Others considered helping nursing home residents relocate after a fire to be community health instead of emergency deployment. The struggle to define the difference between these terms is common from the national to local level. For the purposes of this report, community health activities were defined as deployments that were planned in advance, even if the notification and response time for volunteers was somewhat short. In practice, staffing an immunization clinic could be either a community health activity or an emergency deployment.

Most of the MRC units in the case studies reported at least some non-emergency public health activities during the demonstration period. The level of participation of the MRC units in community health activities was reported as being mission dependent. If the leaders of the MRCs understood the MRC mission to be solely for emergency response, the MRC unit tended not to have participated in community health activities. For those MRC units that understood the MRC mission to include non-emergency service throughout the year, a wide variety of community health activities were reported. Some of the reported activities were:

  • Immunization clinics, especially influenza vaccination clinics and hotlines;
  • Health fairs.
  • community training on emergency preparedness.
  • Health screenings.
  • Staffing for first aid tables at large conferences and sporting events.
  • Mentoring of nursing students.
  • Train-the-trainer activities for emergency preparedness.
  • Smallpox vaccination training.
  • Postexposure prophylaxis in response to a disease outbreak.
  • Education and outreach to undocumented persons.

In addition to the perceived mission of the MRCs, liability coverage for volunteers was a barrier to participation in community health activities for some units. A minority of units reported that their liability coverage was only for emergency responses, not day-to-day public health activities. One MRC addressed the liability issue by partnering with other agencies for liability coverage of volunteers for public health activities. Detailed information on those procedures was not provided. Half of the MRCs either used partnering with other agencies as a way to identify community health needs or saw the advantage in doing so. A few units did not know of community public health needs because they did not partner with public health agencies.

They are dedicated to people, especially the nurses I have been in contact with in my work in the clinic. They've been very dedicated, and very eager to help. That's why they're volunteers.

Among all respondents who mentioned partnership, volunteer participation in community health activities was generally reported as good, although there were lower expectations for participation in community health activities than for participation in emergency response. Some respondents suggested that because volunteers had been recruited for emergency response, they were unlikely to have an interest in community health activities. Several other respondents pointed to scheduling as a barrier to volunteer participation in community health activities for the many working professionals in the MRC units. However, MRC units found ways to overcome barriers to volunteer participation in community health activities. In one unit in which there were a wide variety of community health activities, the unit coordinator commented that approximately 10% to 15% of unit volunteers participated in any single community health activity, but that different volunteers participated in different types of activities depending on the volunteers' personal interests. Volunteers likely to participate in community health activities included retired persons and those able to attend events during the day, as well as nurses and volunteers with public health experience who had "witnessed the aftermath" of events like disease outbreaks.

I think it is in part that we recruited as a disaster organization, and we haven't taken it to the next step. So would 290 of [the volunteers] rally if we had a [terrorist attack in this area] again? Probably. Would 290 of them rally to do a blood pressure screening at the mall? Probably not, but I could probably man it.

About half of MRC units were seen as doing well in fulfilling the community health needs of the MRC mission. Although respondents thought the units could do more in this area in the future, the demonstration period was successful in that the units began to learn how they could serve their communities. A few MRCs envisioned increasing community health activities as a way of increasing awareness of the MRC units in their communities. Half of MRC units consider community health activities a valuable way to keep volunteer skills fresh and a means to train volunteers for emergencies, as well as to keep volunteers engaged and increase the sustainability of the MRC units. Only one unit saw a need to possibly scale back certain public health activities, out of concern that the unit may have "oversaturated" a particular community population. About half of the units believe they would benefit from increasing their partnership with public health agencies in the future, although only half of those reported concrete plans to do so.

Some barriers remain for increasing community health activities. Although the MRC unit housed in a health department was one of the units to report the most public health activities, the understanding of the mission of the MRC Program by its leaders is probably more important than the housing institution. One way to overcome the barrier of the mission perception would be to identify community health activities that the MRC volunteers, as health professionals, are uniquely able to address. Similarly, several MRC units do have a plan to increase their community health activities in the future, because they believe that the MRC mission has changed from an emergency response-focused mission to one that includes ongoing public health activities. While this suggests that initially some MRC stakeholders did not fully understand the mission of the MRC, it indicates that over time this important goal of the MRC has been given adequate attention and made clear to many stakeholders.

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3.4 Emergency Deployment

3.4.1 Were MRC Unit Deployments Effective in Building Surge Capacity? What Factors Facilitated and Hindered Effective Deployment?

Federal MRC Program

The original design of the MRC Program was to serve as a medical surge resource in local disasters and emergencies. Moreover, as a demonstration project, there was no defined role for the MRC within the NRP nor were there any preexisting agreements amount the MRC and its federal and private partners to deploy MRC volunteers in the wake of a disaster of national significance. Response to Hurricane Katrina—a "watershed event for the MRC" in the words of one informant—demonstrated the MRC's utility and viability as a medical surge resource for a national call-up effort.

At the federal level, the integration of the MRC into the Katrina response activities was smooth considering the lack of preexisting protocols and the fact that the program had been in place less than 3 years. MRC Program staff coordinated their activities with their federal partners from the Operations Center at HHS and with the Red Cross at their Disaster Operations Center during the hurricane strike and in the ensuing weeks. In total, more than 600 volunteers in 105 units were deployed to the affected regions to help staff Red Cross and medical/special needs shelters, participated on medical strike teams, and provided care in a variety of settings.

A significant challenge for the utilization of volunteers in this unplanned national deployment of the MRC was the lack of uniform credentialing of volunteers. OPHEP had to verify credentials for volunteers who did not have verified credentials. Those who already had verified credentials from their unit did not need to go through any additional verification process and were immediately deployable. A few of the informants thought the integration of MRC units with ESAR-VHP would largely assist in the effort to have standardized credential process and would make any future out-of-State deployments of MRC units a smoother process.

MRC Units

Four of the six MRC units reported emergency deployments. All four units responded to Hurricanes Katrina and Rita in some way. Only two of the units in our case study had been involved in supporting a local emergency or disaster that was not related to Hurricanes Katrina and Rita during the demonstration period. One was involved in staffing local shelter operations for victims of flooding, and the other staffed a mental health clinic that was set up to handle an overflow of homeless patients at a local emergency room. The feedback provided by the partners and volunteers involved in these activities indicated that the deployment had been well executed and MRC involvement was viewed as a positive contribution to the situation.

That [having an MRC volunteer] really saved us because our State division of emergency management failed to provide us a physician to work 8 to 5 Monday through Friday while we had our service center open.... We supplemented that with MRC personnel and they were able to provide services at the center that otherwise evacuees would not have been able to obtain.

Hurricane Katrina, which occurred at the end of the demonstration period, demonstrated the MRC units' capacity to respond out of State and, even more importantly, locally. Four of the six MRC units supported the Katrina and Rita disasters by deploying volunteers through the MRC unit to the affected areas (i.e., a national deployment). Two of those four MRC units also assisted with staffing local shelters in their communities that were set up to house evacuees. One unit also provided medical care at a clinic established for fire crews returning from the Gulf region.

Most of the informants reported that the activation process had been very smooth. Communication was handled primarily by E-mail, and followed up with landline and cell phone communication. The latter proved an absolute necessity in the field, which suggests that for volunteers who may not be comfortable with technology like mobile telephones and E-mail (e.g., some retired volunteers), communication could pose a problem. Obviously, disasters and emergencies do not follow a nine-to-five schedule, but one MRC unit had failed to set up an after-hours communication protocol, so when the Federal Emergency Management Agency (FEMA) issued a request for volunteers during the evening, no one was available to respond until the next day.

Volunteers deployed to the Gulf region reported that communications from federal officials at HHS and FEMA were clear and simple, and the unit coordinators encountered no major problems contacting or recruiting volunteers to take up the assignments.

My understanding during the debriefing afterwards is that [MRC volunteers] had appropriate information on where they were going and what they would be doing prior to being deployed, other volunteer groups who didn't have a clue what they would be doing once they were there.

A number of factors facilitated the effectiveness of the deployment, most notably an up-to-date, manageable database of volunteer contact information that could issue mass E-mails quickly and easily, and frequent communication between the unit coordinator and volunteers deployed in the field. The small size of some of the units made one-on-one communication easier, but it was clear that even in the much larger units, unit coordinators' efforts to personally reach out to their volunteers in the field was recognized and appreciated. Furthermore, these frequent communications enabled unit coordinators to stay abreast of events as they happened so that problems could be addressed early on. For example, one unit coordinator was able to identify and return home shortly after deployment a volunteer who was so traumatized by the events that he never reported for duty.

I was in communication with [the MRC unit coordinator] by cell phone and that never failed us. It was very easy.

One key finding of the Katrina experience was the importance of flexibility. It is necessary to have documented processes and procedures for activation, but they do not always cover the exigencies of a situation. Working closely with the MRC Program Office, the four units established a means to deploy their volunteers where they were needed. One unit, however, was, in various respects, so mired in its bureaucracies and processes that it was never able to effectively deploy volunteers. The State's mutual aid agreements, according to one informant, "broke down," leaving the MRC unit with no assurances that their volunteers would be given a specific mission in a specific location-a critical piece of information they would need in order to deploy volunteers.

We were the second MRC activated and by the end it was working pretty well. It had never been done before. I mean we were up with the national office helping write policy in the middle of the night.

Aside from the few protocols and procedures that did not work as expected, there were other barriers to emergency deployment. Chief among them was the lack of liability coverage for volunteers. Four of the MRC units addressed the issue of liability either through a change in legislation or other arrangements, such as volunteers attending hospitals in order to establish themselves as a deployable resource. Many of those liability protections are in effect during a declared state of emergency, but may not cover volunteers for day-to-day public health deployments such as flu clinics.

I remember sitting in a meeting talking about the scenario for activating the MRC and one of the high ranking officers just turned to me and said, "you know the feeling is that we have enough professionals here to do the first responding. They are not going to call the MRC unless they get to the point where they don't know what else to do."

MRC units may be formally recognized in local emergency plans but, even more importantly, they have to be functionally integrated into the emergency response system. This was illustrated best by the experience of a unit in the Gulf region, when hundreds of evacuees were arriving into their community. Despite a clear need, the unit was never activated by the county emergency officials per the local preparedness plan. Ironically, as local MRC volunteers anxious to deploy waited for a call-up, scores of MRC volunteers were arriving from outside the State. When it became clear that a call to activate was never going to come, volunteers began to self-deploy through other organizations. As one respondent said, "It was kind of frustrating. We kept getting calls for people. Our protocol was that they [the county emergency management agency] were supposed to activate. That was the clear understanding. That was the way our volunteers were trained." The membership of that unit in the Gulf region was largely retired health professional volunteers. Key stakeholders (the county emergency management officials and the hospitals) had grave concerns about the volunteers' abilities, training, and preparedness. This concern was the reason the unit was never activated. During the debriefing of the event, the MRC leadership and the county emergency officials agreed that the lack of deployment had been a missed opportunity. Leadership further agreed that improvements to the training and preparation of the MRC volunteers were needed to avoid such a breakdown in the deployment process in the future. Another unit recognized this issue early on and thus required all its volunteers to undergo emergency room training at the local hospital so they could familiarize themselves with the staff and the procedures at that facility.

Communication with local partners during emergency deployments at the local level was by and large unproblematic and straightforward. However, the lack of good local-to-State communication was raised as a barrier to emergency deployment in three of the MRC units. In one case, volunteers were not afforded the State's liability protections because the unit coordinator was not aware that she should notify the State's emergency office of their deployment. In another case, the unit coordinator had been unable to establish an effective working relationship with the State MRC coordinator. The unit coordinator felt this relationship was important because during a local emergency she might need to coordinate her resources with those that the State would deploy to her community. A few informants also described situations in which State public health officials were unaware of the existence of an MRC unit or seemed to ignore the MRC units because State officials had no direct authority over them.

When you are working in a Red Cross shelter... you are not allowed to do anything but first aid. A doctor is also not going to leave a place where he can do what he is trained to do in an emergency and go administer first aid.

Matching the skill sets of the volunteers to the needs of the emergency was a challenge as well. In most emergencies, the American Red Cross played a critical role, and the MRC units were asked to provide support in their shelter operations. However, the MRC volunteers were not permitted to render any medical attention beyond first aid when supporting Red Cross shelters, and there was a perception among some of the informants that some highly trained medical volunteers would not believe this was a good use of their skills during an emergency1.

A potential impediment to effective emergency deployment that was not actually realized but revealed in our discussions is the source of the recruitment pool. A few of the units recruited heavily from local hospitals which would effectively undermine surge capacity since these are the very personnel who would be required to be working during the event or disaster that involved their facility. Units have dealt with the issue of volunteers having multiple commitments to emergency response ("double-counting") in different ways. Multiple MRC units ask volunteers to supply information on other emergency response commitments on their applications. One MRC reported that volunteers with clear first response commitments are not included in the MRC database as true volunteers because they would not be available for an emergency, although they are not barred from participating. Some unit coordinators recognize the potential problems with double counting, but are not sure how to handle them. Several volunteers reported that they also volunteer with other emergency response groups. In all cases, though, the volunteers either said that the MRC was their priority, or that it would depend on the type of emergency and whichever group they perceived needed them more. Only one volunteer had a clear primary responsibility to another emergency response group, and that was military-associated.

3.4.2 Were MRCs Integrated into Emergency Preparedness Plans?

Given the MRCs' contributions to the Katrina response, it is now clear that the MRC can play an ESF-8 functions of the NRP. However, what that role should be with respect to the NRP is still under discussion. A number of the informants recommended that MRC be specifically listed as an entity within the ESF 8 of the NRP to give it greater visibility and credibility at the national level.

To improve the situation, I suggest they do the rewrite of the National Response Plan to list them as an entity with the ESF-8. This would go a long way toward raising awareness to State and local levels, the other federal partners as well. This would give them a lot of credibility.

Federal and national informants emphasized the importance of State and local integration as well. Absent a formal designation of roles and responsibilities within local and State emergency plans, it was unlikely, they believed, that MRC units could be effectively deployed in the event of a disaster in the community. Some respondents explained that being named as a deployable resource in a local or State preparedness plan would confer a level of credibility that emergency management and public health officials would consider a prerequisite to deployment. By the end of the demonstration period all six MRC units had been recognized as a medical resource with their local emergency plan and one had been named in its State's emergency plan.

I think we still have a communication issue from the federal and national level to the State level to the local level. I think communications could be improved in that respect regarding what is that people think it is they need all the way from the beginning of that request down to the end stage.

Formal, government-sanctioned recognition is not sufficient. Functional integration, as noted earlier, is equally if not more important. In that respect, four of the six units were working with their local emergency management in a close and coordinated fashion that would ensure they would be utilized and recognized as a valuable asset. However, for all but one MRC unit, which had "buy-in from the start" of key officials, functional integration was earned, not given. MRC units had to prove themselves by sponsoring and participating in trainings, attending meetings consistently, demonstrating reliability and competence, and validating the credentials of their volunteers.

I think a State, and this is not a criticism, a State needs to try to figure better coordination with the MRC and voluntary agencies like the Red Cross, so that they can be integrated in a more easy fashion.

3.4.3 How Has MRC Involvement Enhanced the Skills and Competencies of Volunteers to Support Emergency Deployment?

I think we are better prepared to deal with a disaster than we were prior to the MRC... I think it has been very successful to date and I'd like to see it have the opportunity to grow to the next level of continuing to improve our preparedness, our training and resources, and inventory of resources that would be available to us if we really need them.

Half of the MRC units conduct trainings and presentations on a monthly or every-other-month basis on a range of topics including the procedures for activation in their area, which is usually presented as part of an orientation. In addition, all MRC units have trainings and resources online that they encourage their volunteers to use. Only one MRC unit required its volunteers during the demonstration period to pass or attend a training or orientation on core topics such as the Incident Command Structure.

A perceived major shortcoming of the MRC experience for volunteers was the lack of emergency deployment training where they would have the opportunity to practice their procedures. Two of the MRC units had never conducted an emergency deployment drill, and three only did so once or twice in the 3 year demonstration period. Two of the units conducted routine (approximately monthly) response drills to assess how many and how quickly volunteers would respond.

Volunteers generally described the trainings as interesting and helpful. They also thought the trainings would have been improved by increasing interactions among volunteers, as there was not any structured opportunity to meet or get to know the other volunteers. A few would have preferred more trainings, because they did not think the training had properly prepared them for all possible types of disasters (e.g., toxic spills, radiation exposures, bombing).


1. MRC volunteers were clearly informed before being deployed with the American Red Cross that the Red Cross only allowed a basic level of care in their because of shelters their corporate liability coverage. Notification was done through LISTSERV® messages, Web site information (http://www.medicalreservecorps.gov/Hurricane/DeploymentInfo), and briefing calls.


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