Use of State-Based Health and Medical Personnel in Emergency Response - Position Statement

Public health emergencies caused by natural disasters, terrorist attacks, or disease outbreaks require a health and medical response that depends primarily on the mobilization of qualified, well-trained personnel. If a public health emergency overwhelms the capacity of a local, state or territory to respond, health and medical personnel from other jurisdictions may be able to assist through pre-established mutual aid agreements or other mutual assistance arrangements. While critical to an effective response, the use of these personnel from other government agencies and the private sector presents unique challenges, particularly related to legal protections, credentialing, and command and control.

The National Health Security Strategy (NHSS), which was released in December 2009, is the first comprehensive approach to providing a common strategy to help the nation prevent, protect against, respond to and recover from emergencies. It is designed to achieve two goals: build community resiliency and strengthen and sustain health and emergency response systems. One of the objectives addressed in the NHSS is to develop and maintain the workforce needed to achieve national health security and one of the goals is to foster informed, empowered individuals and communities. Communities can use partnerships and community networks to enhance social connectedness in the response and recovery phases. Robust social networks can be used for preparedness planning and subsequently leveraged during incident response and recovery.

These established networks of assets, including potential volunteer personnel, are an integral part of preparedness activities. Under established federal guidance, state, local health and medical agencies have developed programs to identify, register and credential volunteer health and medical professionals. Two programs established for this purpose are the state-based Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and local community-based medical reserve corps (MRC) units.

Programs that tie into pre-established mutual assistance arrangements may allow these personnel to be utilized across state borders. The Emergency Management Assistance Compact (EMAC) is an available mechanism to request and receive interstate assets, including governmental public health and medical professionals, during governor declared emergencies. Signed by 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, EMAC enables rapid state-to-state assistance and clarifies issues such as liability, reimbursement and workers compensation. EMAC assists with requesting health and medical assets; however, EMAC has been used in some instances to transfer nonstate governmental employees across state borders. Additional specialized mutual assistance agreements may be needed for states to request and receive assistance from international countries such as Mexico or Canada or those having large tribal populations. The ability to do this depends on legal requirements and procedures that vary among states.

To improve the response to future public health emergencies and to maximize the provision of public health services to affected populations, all levels of government must follow emergency response protocols that have been established and tested through exercises and actual events, including:

• Encouraging all jurisdictions to follow emergency response protocols outlined in the National Incident Management System (NIMS) and the National Response Framework (NRF).
• Increasing awareness, education and proficiency among governmental staff regarding existing and established emergency response and mutual assistance protocols related to use and deployment of registered volunteer health and medical professionals.

I. Providing a consistent message from all jurisdictions, based on existing protocols.

This message can be facilitated by

• Directing health and medical volunteers interested in responding to do so through their agency’s established procedures.
• Developing and maintaining media outlets such as websites and telephone hotlines to inform and direct volunteer health and medical professionals to existing registration systems (i.e. ESAR-VHP and MRC).
• Informing volunteers that deployments and assignments are based on requests for assistance and may come later in the response or recovery phase.
• Encouraging the utilization of preregistered, verified and credentialed volunteer health and medical professionals (i.e. ESAR-VHP and MRC).
• Encouraging deployment only through state-sponsored mechanisms or accredited institutions and discouraging spontaneous self-deployment.
• Encouraging communication with the state-level ESAR-VHP/MRC or volunteer coordinator, for awareness only, should a health and medical-focused volunteer be deployed by a community or faith-based organization.

II. A key component of effective emergency preparedness and response is the implementation of ESAR-VHP system to register and maintain records for volunteers.

The electronic system should

• Validate and track the professional credentials of many types of public health and medical professional volunteers, as well as store volunteer identification and contact information.
• Allow and encourage local, state and territorial health agencies to track their own personnel and other assets, regardless of the mechanism of deployment, so the capacity to respond to intrastate emergencies is not compromised.

III. State-to-state deployment of volunteers can be facilitated by use of established mutual assistance protocols that take into account issues related to legal protections, credentialing, and command and control.

These protocols will be most effective if:

• States and territories remain the primary agents responsible for registering, credentialing and deploying volunteers across state lines.
• Any new federal, local, or private mechanisms established to identify, register and deploy volunteers complement, rather than conflict or compete with, existing effective state-to-state assistance systems.
• State governmental personnel and other health and medical assets deployed across state lines during declared emergencies are sent through the proven, established EMAC system.
• States have the right to develop legal options, either through executive order or legislation, which allow for the deployment of volunteers through each state’s EMAC protocols.
• All volunteers are directed to the appropriate registration system and deployed according to existing state protocols regardless of whether they can be deployed through EMAC.
• States make initial requests for volunteer assistance through EMAC and refer requests that cannot be met through EMAC or other pre-existing state-level arrangements to the appropriate federal channel.

IV. The federal use (if deemed necessary) of health and medical volunteers should be done only with approval and in coordination with states in order to assure adequate preparedness and response capacity in all local jurisdictions at all times by:

• Encouraging potential volunteers to contact their local, state or territorial public health agency about registration and deployment options.
• Ensuring confirmation and coordination with local, state and territorial agencies when volunteer health and medical professionals from their jurisdictions are to be federalized and deployed so the capacity to respond to intrastate and regional emergencies is not compromised.

Approval History:

ASTHO position statements relate to specific issues that are time sensitive, narrowly defined or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and the ASTHO Board of Directors. Position statements are not voted on by the full ASTHO membership.

Preparedness Committee Review and Approval on Aug. 12, 2011

Board of Directors Review and Approval on xxxx, 2011

Policy Expires September 2014

For further information about this Position Statement, please contact ASTHO Preparedness Policy staff at preparedness@astho.org.