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A partnership between Cobb and Douglas Public MRC and the GA Bureau of Investigation for creating continuity during a mass fatality

State: GA Type: Model Practice Year: 2019

Cobb and Douglas Public Health (CDPH) provides exemplary public health services to the residents of Cobb and Douglas counties in Metropolitan Atlanta, Georgia. CDPH works to assist its residents to live healthier, longer and more rewarding lives by promoting and protecting the health and safety of approximately 899,636 residents who are racially diverse(White (56%), Black (31%) and Hispanic (12%)), per the Georgia Department of Public Health (GDPH) standardized health data repository, OASIS. The remaining demographic consists of various other cultures. Our population is steadily increasing. Per the Atlanta Regional Commission, Cobb county, one of the five largest counties in the Metropolitan Atlanta Statistical Area, alone has increased its population by 8,000 residents since last year. We house the Atlanta Braves Stadium and host many other special events. More information about CDPH can be found on our website,www.cobbanddouglaspublichealth.com. Mass Causality incidents (MCI) and Mass Fatality incidents (MFI) are on the rise in the United States. As an emerging public health issue, CDPH has convened partners to discuss important issues related to MCI/MFI response, such as, coordinating resources, communication messaging, and surge capacity, particularly among morgues and Medical Examiners (MEs), in order to sustain critical operations. CDPH, and its partners, have developed plans which address the unfortunate reality of events which are not a question of if”, but when”. As an important distinction, MCI focuses on managing the surviving victims of an incident whereas a MFI focuses on the identification and examination of deceased victims. Although a MFI may or may not be the result of a MCI, they often occur simultaneously. The purpose of distinguishing between a MCI and MFI is to consider the various kinds of resources needed to manage each event; living victims are attended to by medical personnel such as EMS, while deceased victims are attended to by medical examiners and/or coroners (ME/Cs). Personnel management can be especially challenging since ME/Cs do not have staffing agencies for temporary or per diem support trained to assist in morgue operations. Furthermore, a state-level response which could necessitate activation of the Disaster Mortuary Operational Response Team (DMORT) to assist in large scale disasters can be very expensive, especially for a large metropolitan area. Depending on the type of event, methods to coordinate and disseminate accurate and timely information, which is essential among public health and its emergency partners, can also be quite challenging. Goal: To increase community resiliency during MFI through response coordination and management of the dead in the most difficult aspect of disaster response and recovery. Objective: To expand personnel capacity to assist in surge situations in partnership with the GBI ME office by recruiting medical Cobb & Douglas Medical Reserve Corps (CDMRC) volunteers to assist in morgue operations in a MFI as Medical Scribes (Emergency Support Function (ESF) 8, Public Health and Medical Services). Objective: To develop a MFI Medical Scribe curriculum for surge capacity in partnership with the GBI ME office. Objective: To provide specialty-training using the MFI Medical Scribe curriculum to twenty medical CDMRC volunteers each year. CDPH EPR is responsible for fulfilling capabilities from two federal programs, Public Health Emergency Preparedness (PHEP) and the Healthcare Preparedness Program (HPP). The practice focuses on surge capacity, Mass Fatality and Volunteer Management capabilities. CDMRC is a network of medical and non-medical volunteers who are committed to improving the health, safety and resilience of our communities. CDMRC will identify, screen, train and organize volunteers in order to utilize and support routine public health activities that augment preparedness and response efforts. CDMRC volunteers are on a multi-tiered training program: Tier 1 Core is the basic training: Personal and Family preparedness, ICS 100, 700, Blood Borne Pathogens. Tier 2 Intermediate is more involved training: ICS 200, 800, Psychological First Aid, Cultural Competency, PODs, and Epidemiology. Tier 3 Advanced is the intensive training: Radiological D-con, Leadership and Decision Making. Majority of CDMRC volunteers are on a Tier 2 level or higher. The Specialty Medical Scribe curriculum involves lessons learned from MCI/MFI like 9/11, on-going morgue operations training and any other additional trainings as deemed necessary by the Chief Medical Examiner (ME). Medical Scribe volunteers will know every form, policy and procedure of the ME office as if they were employed there. The success of this program depends on the relationship built between the GBI ME office, the subject matter expert (SME), and CDPH EPR. This project has developed a true collaboration with GBI Chief ME with our hope to replicate the program throughout all nineteen MRCs in the state.
Rising MCI/MFI across the United States in recent years have led to important discussions on public health's role to address capacity issues among Medical Examiners (MEs) to aid in response and recovery efforts. Since there are no standard tools or practices for MCI/MFI, CDPH EPR examined events that occurred across the United States to prepare for an event, should it occur, within the Metropolitan Atlanta Statistical Area. CDPH EPR, and its partners, considered difficult questions, such as, how would response efforts different if the event involved a shooting, versus a bomb, and/or Weapons of Mass Destruction? How many injured? How many died? How were other agencies, also strapped with limited resources, working to build capacity for response? After examining Cobb and Douglas resource capacity, a need was identified to support the capacity of MEs. Recognizing the long-standing number of highly trained MRC volunteers, CDPH EPR worked with the GBI ME office to develop the nation's first-ever, Medical Scribe curriculum used for MFI support. This project/program highlights how CDPH EPR leveraged existing resources (its MRC volunteers) to enhance coordinated response capabilities through deployment of a Medical Scribe curriculum. CDPH EPR, with response partners, developed the state's first Medical Scribe curriculum for use among CDMRC volunteers to support ME mass fatality surge capacity in morgue operations.
Enter the LHD and Community Collaboration related to your practice Goal: To increase community resiliency during MFI through response coordination and management of the dead in the most difficult aspect of disaster response and recovery. Objective: To expand personnel capacity to assist in surge situations in partnership with the GBI ME office by recruiting medical Cobb & Douglas Medical Reserve Corps (CDMRC) volunteers to assist in morgue operations in a MFI as Medical Scribes (Emergency Support Function (ESF) 8, Public Health and Medical Services). Objective: To develop a MFI Medical Scribe curriculum for surge capacity in partnership with the GBI ME office. Objective: To provide specialty-training using the MFI Medical Scribe curriculum to twenty medical CDMRC volunteers each year. This practice was developed in response to concerns voiced by The Metro Atlanta Mass Fatality workgroup regarding continuity of morgue operations and resiliency in a MFI. While this practice focuses on Cobb and Douglas counties, the entire metropolitan statistical area consists of 12 counties which is home to an ever-going population with many social and political events. Host of Superbowl LIII in February of 2019 at the Mercedes-Benz Stadium, and home to the world's busiest airport since 1998, the need for strong emergency preparedness response remains critical. CDPH EPR works actively with emergency response partners to protect a diverse community, which includes approximately 104 million travelers from across 150 domestic and more than 75 international destinations each year through Hartsfield Jackson Atlanta International Airport. Cobb County, located approximately 25 miles from Hartsfield-Jackson Atlanta International Airport and the Georgia capitol, also houses the Atlanta Braves Stadium, SunTrust Park, which has seating for 41,000. SunTrust Park is anchored by Battery Atlanta where one can dine, play, shop or stay, in addition to the 2 malls, additional shopping plazas, apartments, hotels and restaurants. The SunTrust is only 12 miles from downtown Atlanta, where the Superbowl will play out at the Mercedes-Benz Stadium. Cobb County also houses the Atlanta United, MLS Soccer champions, training grounds. Per the Minnesota Superbowl Host Committee, last year more than 1 million people attended festivities in Minnesota before Superbowl LII for over 10 days. Because of Cobb County's close proximity to the Mercedes-Benz Stadium in Atlanta, there are numerous Superbowl festivities planned throughout Cobb County. ME offices throughout the Metro have MOUs to assist each other in disastrous events, but that is not enough. CDPH already has close to 1 million people to deal with a regular basis. Being from a large metropolitan area, continuity and community resiliency is an issue, if a disastrous event was to happen. The care and management of the dead is one of the most difficult aspects of disaster response and recovery operations. CDMRC would play a pivotal role in a MFI which would improve emergency preparedness and resiliency of the community in a MCI/MFI. The CDMRC Medical Scribe program for a MFI was created by a conversation of need between the Chief Medical Examiner at the GBI and the CDPH EPR Healthcare Liaison in 2016. Over the course of the next year, a partnership program was launched and the curriculum for training was constructed. The first training in morgue operations began in November 2017. Now, more than a year later, this partnership and training has proven to be mutually beneficial for both organizations as we plan and prepare for Superbowl LIII. CDMRC has both medical and non-medical volunteers trained and ready to assist in any way possible. CDMRC volunteers are on a multi-tiered training program. Tier 1 Core is the basic training: Personal and Family preparedness, ICS 100, 700, Blood Borne Pathogens. Tier 2 Intermediate is more involved training: ICS 200, 800, Psychological First Aid, Cultural Competency, PODs, and Epidemiology. Tier 3 Advanced is the intensive training: Radiological D-con, Leadership and Decision Making. Majority of CDMRC volunteers are on a Tier 2 level or higher. The Specialty Medical Scribe curriculum involves lessons learned from MCI/MFI like 9/11, on-going morgue operations training and any other additional trainings as deemed necessary by the Chief ME. Medical Scribe volunteers will know every form, policy and procedure of the ME office as if they were employed there. Stakeholders and Community partners include: CDPH, GBI, Region N Healthcare Coalition, GDPH, State MRC, Metro Atlanta Mass Fatality workgroup, State Mass Fatality workgroup and other community partners (State and County Emergency Management agencies, County Medical Examiners and Coroners). CDPH EPR understands in an emergency we cannot succeed alone. We know that team work is the dream work. Collaboration and relationships are where success lies in disaster response and recovery. This partnership between the GBI ME office and CDPH EPR is unique. There has been no cost involved in the development of this program. In a MFI when resources are already low for morgue operations, the GBI can request DMORT, a federally funded team of usually 40 to 50 experienced forensic and mortuary personnel, at the cost of the requesting agency, which is very expensive. When DMORT members are activated, they are temporary federal employees. They are paid hourly which includes covering their travel expenses and lodging. Our specially trained CDMRC medical scribes have a cost range of $20.37 to $87.37 per hour of time volunteered, per the HHS MRC website. In a 12-hour shift that is a approx. $250 to $1050 per volunteer. Since they are local, they go home after their shifts. A substantial savings.
Goal: To increase community resiliency during MFI through response coordination and management of the dead in the most difficult aspect of disaster response and recovery. Objective: To expand personnel capacity to assist in surge situations in partnership with the GBI ME office by recruiting medical Cobb & Douglas Medical Reserve Corps (CDMRC) volunteers to assist in morgue operations in a MFI as Medical Scribes (Emergency Support Function (ESF) 8, Public Health and Medical Services). Objective: To develop a MFI Medical Scribe curriculum for surge capacity in partnership with the GBI ME office. Objective: To provide specialty-training using the MFI Medical Scribe curriculum to twenty medical CDMRC volunteers each year. All goals and objectives have been met for this project. The development of the curriculum for mass fatality surge capacity for the MFI Medical Scribe was completed in September 2017. The decision to shoot for 20 volunteers within the first year was made then. The first morgue operations training was November 2, 2017. Since this project has never been done before, CDMRC volunteers were recruited in 2 phases. The first phase of 12 volunteers, began morgue operations training in November of 2017. Although the volunteers are medically trained volunteers, they normally deal with the living not the dead. We needed to make sure the volunteers could handle the aspects of morgue operations. Also, we needed to build relationships with the GBI ME staff, physicians, techs and investigators. Everyone at the GBI needed to be comfortable and confident in CDMRC abilities to assist in a MFI. Second training was on February 8, 2018. We began to recruit the second phase of 8 volunteers in April 2018. The third training session was held on April 12, 2018, the fourth training session was July 12, 2018 and the fifth training session was September 27, 2018. We will have a MFI Superbowl exercise on January 16, 2018. GBI ME staff and MRC volunteers were given evaluation forms after each training session. On the content of the training 85% of the participants strongly agreed the training was relevant to the needs of a Medical Scribe in a MFI and the remaining 15% agreed the training was relevant. While 100% of the participants strongly agreed there was an overall eagerness to learn. The majority of the participants (88%) thought the time devoted to various training sessions was adequate. However, the remaining 12% wanted extra training sessions in the morgue operations. Success is also measured by the GBI Chief ME and CDPH EPR Healthcare Liaison's outlook on the program. Both have concluded, with the willingness to teach and learn, this partnership is on track for increasing community resiliency during MFI through response coordination and management of the dead.
CDPH's stakeholders and community partners include: GBI, Region N Healthcare Coalition, GDPH, State MRC, Metro Atlanta Mass Fatality workgroup, State Mass Fatality workgroup and other community partners (State and County Emergency Management agencies, County Medical Examiners and Coroners). Each organization is vested in the continuation of this program long-term. Relationship cultivation with the partners will be maintained. This is a resource that is believed to be a great benefit to us in a MFI. CDMRC is just one of 19 MRC units throughout the State of Georgia. Our hope is to expand this project throughout the State. Georgia is a special state since we employ both Medical Examiner's and Coroners. This expansion of the program will require the State MRC coordinators and the other Healthcare Liaisons around the State to build relationships with each one of them. The Medical Association of Georgia (MAG) is a society of physicians, that has a Statewide MRC unit, is headquartered here in Cobb County. MAG MRC and CDMRC train together on occasion; therefore, we plan for their team to be the first expansion unit to receive this unique training.
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