Friday, August 14, 2009
Will Carlisle be ready in an emergency?
It is beginning to look more and more as if this fall or winter, the town’s Medical Reserve Corps (MRC) may be called to run its first operation in the Carlisle School, an emergency dispensing site (EDS) to vaccinate town residents against the H1N1 virus.
Carlisle’s MRC, formed by the Board of Health in 2007, is part of a national network of local groups intended to organize medical professionals and lay volunteers in teams that would be available to help following disasters or during large-scale public health emergencies. The town’s MRC unit, led by Board of Health (BOH) member Bill Risso, BOH Agent Linda Fantasia and an executive committee, is one of 34 such teams in towns west of Boston’s close-in suburbs, organized into Region 4A.
MRCs have been formed to prepare for three types of operations: an emergency dispensing site (EDS), a shelter, or hospital-level care for ill residents. For instance, an EDS might be used to administer vaccine in a pandemic. The plan is to have the capability to treat all Carlisle residents within 48 hours of receipt of the medication. (For the latest Centers for Disease Control (CDC) advisory on priority groups to be vaccinated first, see www.cdc.gov/media/pressrel/2009/r090729b.htm).
Should a storm or other natural disaster leave residents without power and therefore without heat or water for an extended period, the MRC may have to set up and run a temporary shelter at the Carlisle School. There is also a remote possibility that, should local hospitals reach “surge capacity” during a pandemic or other disaster, the MRC team might have to provide medical care within town, possibly at the school, to residents who need hospitalization but do not need a respirator.
Up to 200 more volunteers needed
BOH agent, Linda Fantasia, says the MRC needs many more volunteers than have thus far signed up to help. She emphasizes that although medically trained volunteers are critical to providing the required treatments, many lay people will be needed to run an operation that aims to treat 251 people per hour - to direct traffic, to provide food, help residents with paperwork, set up tables, manage the facility, information technology, fetch supplies, etc.
The town’s EDS plan, revised by BOH intern, Marykate Martelon, in 2007, will require 37 volunteers for each of two 12-hour shifts. However, planners know that in a “real” alert many medical personnel may have to be elsewhere and lay people similarly unavailable, so they would like to have many more on the roster of potential volunteers. Thus with between 35 and 40 current MRC members, Fantasia hopes to recruit up to 150 more willing to help. Signing up volunteers must happen well in advance of any alert, since time will be required to register and train volunteers before they can be allowed to serve.
Getting the word out
If phone service in Carlisle goes out, BOH officials and the MRC executive committee are concerned about how to communicate not only with volunteers but with all town residents quickly in a crisis. Calling out volunteers from Fitchburg and Worcester MRC turned out to be virtually impossible following last winter’s ice storm. Since local MRCs were unable to contact their own volunteers, those who staffed shelters came almost entirely from Region 4A, because they could be reached by email.
One tool the MRC hopes will help is to establish “neighborhood networks” throughout the town. These could enable direct communication between groups of residents and emergency officials. These networks, involving no more than 30 homes each, would be critical should a power loss or other disaster disable landline and cell phones, by providing a single contact person who could then communicate with neighbors.
Neighborhood networks could also be “next-door” support systems when it might be difficult for townspeople to contact emergency workers directly, or for workers to reach individual homes, and could allow for sharing of needed emergency supplies if a disaster isolates an area of town. The BOH envisions more than 50 of these networks spread throughout in town, but thus far only one has been formed (in the area near Bellows Hill Road).
Thus the MRC also seeks about 50 local organizers of neighborhood networks in addition to recruiting volunteers to staff an EDS or shelter. Neighborhood network organizers will be encouraged, initially, to bring those who live nearby together, to discuss how they can cooperate and share resources in an emergency. In an emergency, they can also act as a neighborhood contact for town officials, especially if telephone systems are disabled. The MRC will provide volunteer organizers with guidance, a speaker for any gathering and sample forms to collect contact information for each neighbor. (see “Neighborhood networks and emergency planning – then and now,” May 23, 08)
Unfortunately the Carlisle School’s telephone notification system cannot be used to communicate with all households in town, so Fantasia has also asked for funding for the initial cost of a web-based telephone notification system. This system has recently been set up for the town of Norfolk at a cost of $6,000 to $7,000 for the initial year.
Though only one neighborhood network exists, another potential tool to link neighborhoods with a central communications post may be provided by ham radio operators. Alan Cameron and Dave Willard have begun to organize a group from among the 50+ licensed operators in Carlisle to be available to support the MRC during an emergency. Finally, the MRC has even contemplated using police cruisers going door-to-door throughout town to notify residents what to do or where to go.
The MRC also intends for volunteers to practice their roles running an EDS soon, probably at a flu clinic for elderly residents. Two volunteers from Carlisle helped in nearby towns during the ice storm (see “Volunteers reflect on emergency shelter experiences” on page 10). Both valued their prior participation in training exercises in Billerica and Concord. Fantasia admires the MRC effort in Burlington, where “they’ve practiced their roles in an emergency [every year for] four years, during senior flu shot clinics.”
Two initial drills based on the town’s EDS plan were held in November of 2007 - one for newly recruited MRC volunteers, one for town officials (see “BOH holds MRC training,” Dec 7, 2007). However, these were “walk-throughs” with no chance to set up or practice a mock operation. A few MRC volunteers also participated with Margolies in an emergency response training drill held by Concord’s Community Emergency Response Team last fall, and the Carlisle MRC hosted a Red Cross training, in shelter operations, in May.
One nagging concern for town officials has been the lack of a generator to provide enough power for heat, light and water to enable MRC operations at the school even if the rest of the town has no electric service. That worry seems nearly resolved, with final delivery, installation and hookup of a small used generator expected within the next few weeks. This will enable heat, light and water in the Wilkins building, or water at the Corey building.
Dependence on outside agencies
Despite these efforts and plans of town officials, success in providing treatment or shelter during an emergency could be dependent on how well outsiders fulfill their promises. That is, the town could be vulnerable if the Centers for Disease Control, regional or state agencies fail to come through as promised.
Thus far, there has not been much financial support for the town’s preparations. What little has been received has come from Homeland Security funding to cover 34 towns in Massachusetts Region 4A ($114,000 this year). The BOH generator at the school was purchased and installed using about $6,000 from a Homeland Security grant, and the town has also been able to obtain some of the supplies that will be needed from this source.
Inconvenient MRC training
Carlisle is at the northern edge of Region 4A, which straddles Route 495 on the west, Route 128 on the east, and reaches south to Wrentham, Sharon and the Rhode Island border. Nearly all the free training sessions conducted by the Region 4A MRC have been held well to the south. Thus few Carlisle volunteers have received any specific MRC training. Holding more convenient sessions for busy medical workers seems unlikely, since the MRC insists that Carlisle must guarantee at least 15 attendees before they will conduct a session here.
Red Cross coordination
The American Red Cross will not allow any volunteers their organization has not trained, to work in shelters they run. So even though the Red Cross does not provide medical treatment in shelters, MRC workers cannot work with them.
This has not yet been a problem locally, but it was an issue during the December 2008 ice storm. At that time, in order to take advantage of available MRC volunteers like Carlisle’s Margolies and Ho, the cities of Fitchburg and Worcester chose to run the ice storm shelters themselves rather than letting the more experienced Red Cross manage them. According to Fantasia, the Red Cross and the regional MRC are now developing a memorandum of understanding which will enable MRC volunteers to serve in Red Cross shelters.
Last minute “push packs”
Carlisle MRC has obtained and stored some of the supplies that would be needed for any emergency operation, but in the event an EDS is required, the necessary medication and supplies to administer it, including protocols (how-to instructions), will be delivered “just-in-time” from the strategic national stockpile managed by the CDC. In theory these “push packs” are deliverable within 12 hours of the decision to administer vaccine or treatment. Fantasia is confident the town will get what it needs.
Who writes the order?
At the town level, the chairs of the Boards of Selectmen and Health can decide jointly to open and manage an emergency operation. But there is some ambiguity concerning what entity will authorize the treatments or vaccinations that would be dispensed. According to Fantasia, this issue - “who’s writing the order?” - has not yet been resolved at the regional or state level.
The operational problems encountered during the ice storm served as a wakeup call for MRC planners, says Fantasia. Systems to notify volunteers, to track citizens in and out of an EDS or shelter, to keep records of medical monitoring and treatment, and to keep a log of events are still being developed by Region 4A.
Hopefully, these logistical issues will be resolved by the time the MRC has to do something. Meanwhile, there are still steps that can be taken locally to ensure the MRC will be ready, principally finding many more volunteers. MRC organizers hope that townspeople will sign up soon, to allow time to be credentialed and trained before the MRC must act, by calling the BOH at 1-978-369-0283. ∆
© 2009 The