MMRS Program Grows
By Jim Chandler
(Originally published in the Tidewater EMS Council's Response newsletter, January 2004)
Two years ago the Tidewater EMS Council entered into an agreement with the Hampton Roads Planning District Commission to perform services leading to implementation of the Hampton Roads Metropolitan Medical Response System (HRMMRS). Much has happened since then, and much more will happen in the months ahead. This article reviews where we have come, and where we are headed.
The HRMMRS was created in response to federal funding to the most populous cities in the United States to help them better coordinate medical response to large disasters, with a focus on terrorist incidents. The Hampton Roads Planning District Commission accepted the available funding on behalf and at the request of four jurisdictions (Virginia Beach, Norfolk, Newport News and Chesapeake) that were to be recipients of the federal funding. Working together, the funds were able to benefit sixteen jurisdictions comprising the planning district. The initial funds provided support to create an MMRS plan and to purchase an initial cache of medications and supplies to help support the region. These activities were completed.
During development of the HRMMRS plan, concern arose that the region needed to ensure the plan could be implemented and equipment and supplies, particularly expiring medications, could be replaced as time passed. Again, working through the planning district commission, all sixteen jurisdictions agreed to an MMRS sustainment program, funded by a per capita contribution. The planning district then contracted with the Tidewater EMS Council to lead the sustainment program in close cooperation with the Peninsulas EMS Council (both councils are included within the planning district).
In early 2002 the Tidewater EMS Council hired an MMRS program manager, developed an MMRS Oversight Committee, and developed a subcommittee structure to address training, strike team operations, mental health, public health, hospitals, equipment, volunteer development, budget and planning. The council’s EMS field coordinator was also tasked with a portion of duties to support MMRS. Equipment, hospital decontamination systems and medication purchases, using the federal MMRS funds, were undertaken. The various committees spun up and began to review the plan and develop their own specific actions and preparations. Over 250 individuals representing some 90 different agencies and jurisdictions serve on these committees. The MMRS job was big, and, following September 11, it was about to get bigger.
The 9-11-01 terrorist strikes prompted the federal government to direct greater financial support to hospital, public health and responder preparedness. Money began to flow in late 2002 and into 2003. As the region was implementing the HRMMRS plan, CDC grants to public health, HRSA grants to hospitals, and various emergency management grants to first responders tended to accelerate and enhance those goals identified during the MMRS planning.
The CDC support led to creation of regional and state-level emergency preparedness and response (EP&R) personnel within the health department, as well as additional local health district preparedness and epidemiology staffing. The regional EP&R staff is based at the Norfolk Department of Public Health. A main thrust of this CDC effort is developing plans for receipt and distribution of the national supply of pharmaceuticals and supplies, known as the national strategic stockpile. Other initiatives include improved biosurveillance and enhanced laboratory capabilities and improved abilities to provide mass vacinations.
The federal HRSA grants support statewide hospital preparedness, planning, the creation of five hospital preparedness regions plus training, equipment, improved communications and other needs identified by individual hospitals. One HRSA priority is the creation of “surge capacity” which is development of beds, equipment, supplies and personnel to care for masses of victims. Another priority is the capability to isolate greater numbers of victims with infectious diseases.
The HRMMRS hospital committee was expanded to include additional hospitals from the Eastern Shore and Northern Neck, and it became one of the five hospital preparedness regions under the Virginia Hospital and Healthcare Association which was contracted by the Virginia Department of Health to administer the HRSA funding. During the first year of HRSA funding, the region employed two part-time hospital planners/trainers. In November 2003, for the second year of HRSA funding, a full-time hospital preparedness coordinator was employed to support all hospitals in the region, with the two part-time trainers continuing to support training efforts. The full-time coordinator is based at the Peninsula EMS Council and the part-time trainers are based at Sentara Norfolk General Hospital and Riverside Regional Medical Center.
In November the Department of Homeland Security awarded Virginia $37.8 million in anti-terrorism grants for state and local first responders to pay for planning, training, equipment and exercises to enhance prevention, response and recovery capabilities, plus additional funds for law enforcement terrorism prevention and Citizen Corp Councils. Several communities within the region have received additional grants averaging $49,000 to support Citizen Corps activities.
In September the Department of Homeland Security extended the funding for MMRS jurisdictions for an additional two years, calling for development an inventory capability report, a sustainment plan, an operational verification report and a final report. This two-year extension also allows MMRS systems to add equipment, medications, training and exercises within the funding provided. In October, the Hampton Roads Planning District Commission again entered into a federal contract enabling the availability of these additional funds to benefit the entire region.
Meanwhile, the basic implementation of the HRMMRS plan has faced the difficulty of overwhelming tasks and limited personnel support. The MMRS program manager is stretched in many directions as each committee, grant and activity needs focused direction, support or integration with the other. The MMRS program emphasizes integration of, and the avoidance of duplication between, the various other federal programs.
In recent committee meetings, the need for an MMRS training coordinator and an MMRS equipment logistics coordinator has been identified. In addition, the need for personnel to support the two-year extended federal contract was identified. The Tidewater EMS Council and the Peninsulas EMS Council are now discussing additional contracts with the Hampton Roads Planning District Commission to support these needs.
A high priority is creation, training and operationalization of the Metropolitan Medical Strike Team (MMST). A target implementation of July 1, 2004 has been set. The strike team is a responding asset which can provide expert advice and support for large-scale medical disasters to an incident commander. In order to create the strike team, two legal agreements need approval by each jurisdiction and agency which would provide team personnel. In early 2003, the first round of the agreements (response and mutual aid) was distributed for signature, but they required revisions to satisfy all participating agencies. City and county attorneys went to work, and revised versions were finalized and distributed to localities in November. Once agreements are signed, MMST membership will be finalized so training, personal equipment and communications can be provided or verified. As the MMST capabilities are brought on-line, education about its resources and capabilities will be provided to the responder community.
To support the strike team, two trailers and tractors will be purchased and equipped with a range of medical support gear. Already purchased are two communications trailers with towers, base stations and portable radios to enable vigorous strike team communication and interface with any locality. All MMRS rolling stock will be located in both Norfolk and York County. Additional communications and specimen identification equipment are slated for purchase to assist public health, hazmat and hospitals.
Another priority is full distribution of the WMD medication kits to localities and hazmat teams. An initial limited distribution occurred during 2003, and smaller pre-positioning of some kits has occurred during certain local events, but additional medication purchases and full distribution are anticipated in early 2004. The additional purchases will also provide for back-up medications which will be stored in the hospitals, available for field or hospital use.
An Internet-based volunteer management software program has been developed by staff at the Hampton Roads Planning District Commission. This program will be freely available to public health departments and the jurisdictions’ emergency management to help support medical and non-medical volunteers which can be anticipated to become available during any large-scale disaster. The database program will primarily be used to sign up volunteers ahead of time so they can be more effectively utilized. Two computerized photo ID systems were purchased to support volunteer as well as professional responder identification during disasters. The volunteer management program will be linked to the identification systems for rapid generation of IDs when necessary. The ID systems are currently housed at the Tidewater and Peninsulas EMS Council offices.
The HRMMRS is integrating many available local and regional exercises. For example, the first test of the MMST was during the Navy’s Southern Spring drill in early 2003. The MMST also responded to the Chesapeake LEPC drill in the fall of 2003, and most top-level hospital and public health officials participated in a tabletop biological drill in late summer of 2003 which was cosponsored by the MMRS hospital committee and the Virginia Department of Health. A large federal exercise called Determined Promise 04 will be held in the fall of 2004 in this region. The MMRS program manager plays an active roll in exercise planning, and strike team leadership worked to develop a responding model to help define future MMST operations. Any agency or locality planning large scale exercises is urged to integrate the MMST.
With 16 jurisdictions, the Hampton Roads MMRS is the second largest in the United States. While the size and complexity of our system remains a challenge, we can rest assured steady progress continues and, as a region, everyone is well protected.