San Diego County Medical Reserve Corps (MRC)

On Monday, October 22, 2007, approximately 876 San Diego County Medical Reserve Corps (MRC) volunteers were activated using the County Alert Services System. Volunteer enrollment at that time included 139 physicians, 527 nurses, 119 pharmacists or pharmacy technicians, 6 physician assistants, 4 respiratory therapists, and other medical and non-medical volunteers. Volunteers were asked to respond with their potential availability for 72 hours in case they were needed. At that time, we did not know what the scope of the fire would be or how many requests for medical assistance we would receive at the County Emergency Medical Services Medical Operations Center (MOC).

More than 300 MRC volunteers offered their assistance throughout the first week. Many volunteers even called as they were being evacuated to let us know their status and intent to be available once they got settled.

Tom Gehring, San Diego County Medical Society (SDCMS) executive director and CEO, provided assistance by identifying and precredentialing physicians who could be used by the MRC as needed, which provided a pool of approximately 30 additional physicians.

Another active partner of the local MRC is the San Diego Pharmacy Emergency Response Team (RxERT). John Johnson, Craig Steinberg, and Michael Sohmer are all local pharmacists who have been active members of the MRC from the early days of the unit back in 2002. As Dr. Bruce Haynes, EMS medical director, notes in his reflections on this disaster (see page ?), they played an important role in providing pharmaceutical support at many of the shelters. Their leadership was exemplary, as was the dedication of all the pharmacists, technicians, and students.

In total, the MRC deployed 70 volunteers to shelter locations across the region and contributed over 700 hours of care at more than 15 locations. The number of volunteers willing to help exceeded the need for medical assistance. Fortunately this was not a mass casualty incident and the requests for medical assistance were low, despite some media reports. We were fortunate indeed that the low deployment of, and low need for, responding volunteers was the most frequent complaint we heard during the week.

Many lessons were learned. The following are several of the main areas that we are directing our attention to as we continue to develop our MRC and plan for future activations.

• Integration With Medical Management at Spontaneous Shelters: The unprecedented scope of this evacuation led to the establishment of numerous spontaneous and unaffiliated shelters throughout the county. At one point there were over 40 shelters operating. These shelters performed a heroic role in this disaster. Many of them established their own medical teams using volunteers. Towards the end of the first week, MRC began receiving requests for medical assistance as the initial spontaneous volunteers became tired. Many did not know about the MRC and were happy to accept the additional support.
• Management of Spontaneous Medical Volunteers: We have no idea how many of the estimated 50,000 licensed healthcare professionals in San Diego County volunteered or attempted to volunteer at shelters. MRC will participate in local efforts to address the issues associated with spontaneous volunteers.
• Pre-identified MRC Response Teams: There is a need to develop MRC teams with additional training (National Incident Management System, mass casualty triage techniques, etc.) to assess and establish medical management of the sites until stabilized and back-up support is deployed.
• Medical Supplies: It had been previously assumed that MRC volunteers would fall in line with existing medical resources onsite and that they would have access to the supplies of the other responders. We found that this was not the case and that MRC volunteers do need basic medical supplies to triage and aid patients.
• Administratively, we are looking at improving procedures for managing the responses from volunteers and communicating the status of the medical needs in a timely manner. The Emergency Medical Alert Network (EMAN) was a great tool for participating members. Approximately 16 alerts were sent during the disaster, which provided key medical updates and included information on MRC activities. A group of volunteers will be identified to provide staff support for MRC activities during an activation.

What can you do? We need more physicians. We need more respiratory therapists and physician assistants. We received more than 40 new applications in the two weeks after the fires, and we will be working with SDCMS to increase these numbers. When you take into account that many of the volunteers may be affected themselves, we need a large pool of volunteers to support any sustained response and extended shifts.

Participation in MRC is voluntary, and deployment is based on your availability. MRC is sponsored locally by the County Health and Human Services Agency. MRC volunteers are registered with the California Disaster Service Program, which provides volunteers with workers’ compensation if they are injured performing disaster service work and, in addition, provides statutory immunity from liability. Retroactive registration into the program is not possible, so we encourage you to sign up now. To volunteer with the San Diego MRC, contact me, Melissa Dredge, at (619) 285-6429 or at mrcvolcoord@sdcounty.ca.gov. On a personal note, I am very proud to be associated with the amazing professionals who have demonstrated their commitment to serving San Diego as a member of the MRC. Thank you.