Deployment of the Philadelphia Medical Reserve Corps for the 2015 Papal Visit and the 2016 Democratic National Convention

Abstract

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org.

The Philadelphia Medical Reserve Corps (MRC), founded in 2005 as a small group of volunteers to support the city's mass prophylaxis plan, has evolved over 11 years into a cadre of approximately 2,400 medical and nonmedical volunteers trained to help Philadelphia respond to public health emergencies. In 2013, as neighboring states dealt with the aftermath of Hurricane Sandy, the Philadelphia Department of Public Health (PDPH) embarked on a planning effort to determine how we would share MRC volunteers across county lines in Pennsylvania if a hurricane or other large weather emergency were to devastate Philadelphia. This planning coincided with the Philadelphia MRC's increasing involvement in special events around the city, including the provision of first aid care at races and large concerts alongside the Philadelphia Fire Department-Emergency Medical Services (PFD-EMS). This partnership came about after the Boston Marathon bombing; Boston MRC volunteers who had been stationed at medical tents along the race route responded to the explosions alongside Boston's first responders, proving the importance of strong partnerships between MRC units and first responder agencies.

Building partnerships with local and state MRC coordinators, as well as with PFD-EMS, set the stage for the Philadelphia MRC to be involved in 2 events on the national stage: the 2015 papal visit to Philadelphia for the World Meeting of Families and the 2016 Democratic National Convention (DNC). These high-profile events provided a new and expanded opportunity for the Philadelphia MRC unit to integrate the many skills and talents of its volunteers into the larger city responses to these events. To prepare Philadelphia for these historic events, the healthcare system planned for surge by opening first aid stations to provide care to the large number of visitors.

Planning for National Special Security Events

The 2015 papal visit and the 2016 DNC were designated National Special Security Events (NSSEs) by the Secretary of the Department of Homeland Security. When an event is designated as an NSSE, the US Secret Service assumes its mandated role as the lead agency for the design and implementation of the operational security plan. The Philadelphia Department of Public Health participated in the planning for these events through a health and medical committee co-chaired by PFD-EMS, the Philadelphia Office of Emergency Management (OEM), and the Secret Service. Public health planning included providing medical services in temporary locations for event attendees.

Medical Reserve Corps Activities

The Philadelphia MRC provided first aid and medical care at 9 medical field sites during the papal visit and 4 sites during the DNC. During the papal visit, the Philadelphia MRC activated its Intrastate MRC Volunteer Deployment Plan, developed post–Hurricane Sandy, to bring additional MRC volunteers into the city from the other MRC units across Pennsylvania for a 4-day deployment. The MRC was able to provide clinicians, including physicians of multiple specialties, nurse practitioners, registered nurses, paramedics, EMTs, behavioral health specialists, and a wide variety of skilled nonmedical volunteers, to staff the medical field sites during both events. A total of 169 MRC volunteers from 9 MRC units worked 4,452 hours to support PFD-EMS activities at medical stations and first aid tents with no adverse events. PDPH estimates a net savings of $113,332 for the city by using this volunteer resource, accounting for transportation, feeding, housing, and additional ancillary support costs. During the DNC, which had a much smaller medical field site footprint, 50 Philadelphia MRC volunteers worked 425.5 hours over the 5-day event; the MRC contribution was valued at $21,882, with no cost to the city.

Volunteer Deployment and Show Rates

During the papal visit in 2015, MRC units across the Southeastern Pennsylvania (SEPA) region deployed to Philadelphia to staff medical stations and first aid tents. Nine units sent 169 volunteers, a deployment rate of 2.8% of the total number of registered volunteers in these units. While in many ways this MRC deployment was a great success, this deployment rate should be concerning to volunteer organizations, as it demonstrates a significant difference between the actual number of volunteers that deployed for this statewide deployment and the high rates of willingness and ability to deploy for disasters reported in a 2014 Pennsylvania-wide survey of volunteers; most of the respondents were MRC volunteers. Out of 1,061 survey respondents, 79.3% were willing to deploy to support general and medical operations at a large special event potentially at risk for a terrorist attack. Additionally, only 64% of the 263 volunteers who registered to respond for the 2015 papal visit ultimately showed up for their deployment.

The potential for low deployment was a concern when planning for the MRC involvement at the DNC. PDPH used only local volunteers from the Philadelphia MRC unit this time; through careful assignments of seasoned volunteers and a system of confirmation calls and training, the Philadelphia MRC was able to fill 52 of 59 requested shifts, with a show rate of 90.9%. While this was a smaller response overall and still not a perfect score, it showed a marked improvement. The continued inclusion of the MRC in citywide response operations shows volunteers they are valued. Staffing volunteers at public events will continue to increase the visibility of the MRC and boost recruitment and retention.

Best Practices

Philadelphia is unique in that it had the opportunity to execute 2 National Special Security Events within a 10-month timeframe, which allowed PDPH to learn from the first event and apply lessons learned to the second. The best practices during the DNC were taken directly from areas for improvement after the papal visit. Best practices include: (1) working seamlessly alongside EMS to provide first aid and patient care over extended operational periods; (2) the development of a medical field operations management plan that allowed for site visits, volunteer support, and communication at all hours of the response; and (3) setting clear expectations for volunteers prior to deployment.

These events expanded the MRC's medical field operations capabilities to include serving multiple first aid tents throughout the city at one time. MRC volunteers supplemented EMS's capabilities, adding physicians, nurses, and patient tracking assistance. PDPH could not dedicate staff to each site full time, so a schedule was drafted to allow for site visits as well as central office coverage so volunteers could reach us by phone, radio, or email. Volunteers were sent weekly updates in advance of the upcoming response, and pre-event training was administered via webinar, while just-in-time training was given each day at the volunteer rally point.

Lessons Learned

Some lessons learned were continuations of issues we had during the papal visit. Lessons learned include: (1) establishment of a clear chain of command across multiple responding agencies for both logistical and medical decision-making issues is critical; (2) regular site visits by volunteer coordinators for on-site training, questions, restocking supplies, and volunteer morale is essential; and (3) confirmation calls to volunteers is critical for ensuring a high volunteer show rate.

Between the papal visit and the DNC, the MRC integrated itself into EMS's field response structure; the MRC became part of the chain of command and part of the team during the second event. Creating this type of strong working partnership takes time. After 2 NSSEs and numerous local special events, the integration and partnership are strong. Regular site visits were done to ensure that the sites were operating and volunteers felt that their contribution, especially during times of very low patient volume, was valued. Volunteer show rate was examined from previous events, and confirmation calls were implemented to ensure high attendance. While there is still work to be done, the MRC-EMS partnership has been solidified through side-by-side work during these unique special events.

Conclusions and Future Planning

Lessons learned from these relatively small deployments can be extrapolated to mass prophylaxis planning for the entire city of 1.5 million. MRC coordinators should measure volunteer expectations, not overpromise, and augment staffing pools with as many other resources as possible. The Philadelphia MRC will work with EMS to develop a policies and procedures manual that documents our partnership, including codifying protocols about volunteer safety, patient tracking, training, and attendance that have been evolving since 2013. While we don't expect any National Special Security Events or special events of this scale to come to Philadelphia in the near future, these lessons learned will inform all future MRC deployments.

Because the MRC is at a critical juncture, when the need for volunteer services is expanding and funding cuts continue, providing volunteer coordinators with the necessary skills to promote volunteerism during emergencies is an efficient way to foster sustainability. Five MRC units in Southeastern Pennsylvania won a grant to provide training on volunteer willingness and efficacy that will take place in fall 2016. It is our hope that we will continue to build volunteer response capacity so that we are in a state of readiness to respond effectively during an unanticipated disaster.