2007 Model Practice Application (Public)

Dallas County Medical Reserve Corps

Dallas County Health and Human Services

The Dallas County Medical Reserve Corps program targets medical and non-medical volunteers to include mental health professionals and clergy. To date, the programs has recruited 1133 (19%) of the 6000 volunteers that will be needed to prophylax 2.3 million people residing in Dallas County. The goal of the practice is to develop a comprehensive response to bio-terrorism as well as any other public health emergency and has the following objectives:

• Develop a response capability for bio-terrorism, pandemic flu and displaced special populations as the result of a natural disaster.
  
  
• Develop epidemiological and medical surge capacity.
  
  
• Develop a psycho-social response capability for supporting localefforts for the provision of mental health services.

The following outcomes have been achieved:

• An MRC which has 1,133 volunteers, approximately 600 have been trained in: Medical Surge, SNS/POD mass prophylaxis, POD Leadership, MRC/Com Ham Radio, Epidemiological Surge for a pandemic, Personal and Family Preparedness, and Non-medical support roles such as crowd control, security, administration, and logistics.
  
  
• To increase sustainability for the infrastructure of the MRC, volunteers lead and conduct unit meetings consisting of: eight (8) Disaster Units (Medical, General Support, Mental Health, Communications, Social Work, PIO (Public Information Officers), Translation, and Faith Based Organizations) and five (5) Work Units (Recruitment, Training, Drills/Exercises, Procedures, and Volunteer Staging/Management) which plan and meet regularly.
  
  
• In addition, during Katrina/ Rita Hurricane response, over 350 volunteers participated in this mass casualty event recording over 2,200 volunteer hours and $560,000 worth of in-kind.

The public health issue that the practice addresses is the response to bio-terrorism and other public health emergencies. The process used to determine the public health issue's relevance to the community was the 10 Essential Services of Public Health. The practice addresses the issue by assisting the local community during a public health emergency by providing a rapid, coordinated and specific response using locally recruited medical, mental health and health support volunteers appropriately trained in the latest emergency response methods.

During a public health event, the need for volunteers outside of the field was noted. During the measles epidemic of 1988 - 1992, Dallas County Health Department set up immunization clinics for 4 consecutive Saturdays in 1990. The first Saturday 1,000 residents filed through, the numbers increased until on the fourth Saturday over 5,000 residents were immunized and some were turned away. Additional medical manpower was needed to prophylax the patients. During the 2005 flu season, Dallas County Health & Human Services ran out of flu vaccine. A cadre of MRC volunteers manned a call center to successfully locate additional vaccine. This practice would reach a greater population in Dallas County in a shorter period of time by providing the first 12 - 72 hours medical surge capacity in the event of a mass casualty to prophylaxis the residents of Dallas County.

Dallas County Health and Human Services is the grantee for the CDC Cooperative Agreement. The Medical Reserve Corps is now partially supported by this grant. Dallas County Health and Human Services offers in-kind support to include (but is not limited to): strategic direction from the Dallas County Health Authority, project management, direction and supervision from the Emergency Volunteer Program Coordinator, administrative support, office space utilities, telephone, cell phone copier & paper and PC workstation. The role of stakeholders/partners in the planning and implementation of the practice is to support Dallas County Health & Human Services in assisting with providing a rapid, coordinated and specific response using locally recruited medical, mental health, and health support volunteers who have been appropriately trained in the latest emergency response methods. Dallas County Health and Human Services is a member of VOAD (Volunteer Organizations Active in Disaster) County and Regional, DCCCC (Dallas County Citizen Corps Council) County and Regional, Disaster Mental Health Coalition, North Central Texas Council of Governments Citizen Corps Working Group. The relationship is one of consistent monthly meetings in which resources, responsibilites and roles are shared, training programs are developed and emergency planning is collaborated. These relationships identify roles of first responders, identify gaps in services and coordinate planning and preparedness efforts in advance of a disaster. In addition, DCHHS fosters cooperation between the Medical Reserve Corps and local professional organizations like Dallas County Medical Society and Chiropractic Emergency Response Volunteers.

Funding sources included: CDC Cooperative Agreement, City Readiness Initiative funds, and NACCHO grant.

Dallas County received a $50,000 grant for the Medical Reserve Corps for start-up each year from 2004 - August 31, 2006 covering:

• Personnel: $35,690
  
  
• Fringe Benefits: $12,647
  
  
• Travel: $150
  
  
• Supplies: $1,530

Currently the MRC is supported under the CDC Cooperative Agreement.

In-Kind Costs:

• In-Kind contribution from Dallas County Health and Human Services increase 21% in '05.
• Physician Consultant: University of Texas Southwestern Medical center - $3,780
• Strategic Direction: Dallas County Medical Health Authority - $2,200
• Project management, supervision and strategic direction: [ Senior Planner] - $5,264
• Project management, direction and supervision: [Emergency Volunteer Program Coordinator] - $11,000
• Administrative duties: [Clerk] - $25,289
• Dallas County Health and Human Services in-kind support icludes (but is not limited to): office space, utilities, telephone, cell phone, copier & paper and PC workstation - $95,600
• Total: $143,133
• In-Kind contributions from MRC volunteers working Katrina/Rita '05: $560,000

Specific tasks taken but not limited to:

MRC staff:

• Created MRC brochures, Orientation Handbook, Procedures Manual, recruitment presentation to include PowerPoint.
  
  
• Facilitated recruitment presentations.
  
  
• Facilitated Orientation and POD trainings including three (3) full-scale exercises consisting of prophylaxis training.
  
  
• Unveiled the eight (8) Disaster Units and five (5) Work Units to support the infrastructure of the MRC.
  
  
• The Training Unit which is under the Work Unit has trained: a cadre of RNs in POD directives of Dispensing/Screening and Triage to include special populations; and a cadre of mental health professionals to provide critical incident stress management, isolation and quarantine services in the past trainings of '05 & '06 including but not limited to special populations.

MRC Training Program: The 2007 training schedule is robust providing 52 training opportunities on a rotational basis in the following areas:

• Orientation
  
  
• Personnal & Family Preparedness
  
  
• Leadership
  
  
• Ham Radio Operations and Licensing
  
  
• POD Directors
  
  
• Epidemiological Surge Capacity
  
  
• Inventory
  
  
• Triage & Safety
  
  
• Screening & Dispensing
  
  
• Administration & WebEOC
  
  
• Public Helath & Shelters
  
  
• Mini-Institute
  
  
• Tabletop Exercise

The time frame for these tasks is in progress and on-going.

Dallas County Medical Reserve Corps has more than sufficient stakeholder commitment to perpetuate the practice. This commitment is ensured by the attendance of the Emergency Volunteer Program Coordinator or the MRC Coordinator to all above mentioned meetings. The MRC eight (8) Disaster Units and five (5) Work Units are supporting the infrastructure of the MRC. The MRC integrates with the Dallas County Medical Society and Chiropractic Emergency Response Volunteers (CERV) to provide medical surge capacity in addition to the registered MRC medical registered volunteers. The MRC Mental Health Unit consists of 5 teams with each team on a monthly on-call rotational basis. The MRC Translation Unit has four (4) teams of translators fluent in Spanish, French, German, Vietnamese, etc. The MRC/Com Unit has a cadre of 38 trained and certified Ham radio operators who have successfully tested their communication systems, constructed additional communication boxes and provided monthly technical and standardized training. The MRC Social Work Unit has four (4) teams specializing in substance abuse, medical and dental services, group homes and dialysis, nursing homes and adult protective services and foster care. The MRC Training Unit supports the mission by training volunteers who provide POD training: 1. screening/dispensing, 2. triage, 3. general support, 4. translation, 5.mental health and Personal & Family Preparedness. DCHHS has ensured its commitment to supporting the MRC and its initiatives to include the provision of the necessary response equipment. For example, DCHHS has purchased 40 HAM kits to ensure an effective MRC Communications response. In addition, DCHHS has procured 4 satellite communications systems, 3 of which are transportable, capable of ensuring telephone, fax, and internet communications. MRC Communications team members have been trained and continue to receive training on all of these systems.

Goal: Developing a comprehensive response to bio-terrorism as well as any other public health emergency.

Objective: To develop a comprehensive medical & mental health response capacity to an act bio-terrorism or other public health emergencies.

Performance Measure: The formation of 25 highly trained POD Leadership teams who can provide volunteers for two shifts per POD.

Outcome: The MRC has 1,133 volunteers in the database with approximately 600 trained.

Lessons learned were that:

• The MRC must recruit additional medical professionals who can be credentialed, trained and prepared for future disasters.
  
  
• The MRC training program's focus on highly technical POD issues and integration with other stakeholders was highly received.
  
  
• MRC Volunteer trainers need to be brought on-line more efficiently to address the need for more frequent training.