Medical Reserve Corps

1
Southwest Alabama Medical Reserve Corps
Orientation
2
SWAMRC - What we do

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Alabama, Federal
• Public Health Initiatives

3
MRC History

• Following 9-11 attacks
• Thousands of unaffiliated volunteers show up at
  sites
• No way to ID or credential
• Not covered under liability laws
• No Incident Command System (ICS) training
• Difficult to manage
• 2002 President George W. Bush State of the Union
• 2006 SWAMRC established

4
Status - Current Local Units
5
MRC Admin Organization

• National Office of the Civilian Volunteer
  Medical Reserve Corps (OCVMRC)
• Region MRC Region IV (AL, FL, GA, KY, MS, NC,
  SC, TN), Atlanta.
• State Alabama Department of Public Health
  (ADPH), Montgomery
• Local Southwest Alabama MRC
• Mobile, Baldwin, Escambia and Washington
  counties will be in Clarke, Monroe and Conecuh
  by end of 2009- early 2010

6
Office of the Civilian Volunteer Medical Reserve
Corps (OCVMRC)

• Functions
• Clearinghouse for information and best
  practices
• Coordinates federal deployments with ASPR (HHS)
• Housed in the Office of the Surgeon General
• Medical Reserve Corps gt Citizen Corps gt USA
  Freedom Corps
• Citizen Corps MRC, Neighborhood Watch, Community
  Emergency Response Team (CERT)
• USA Freedom Corps Citizen Corps, AmeriCorps,
  Senior Corps, and the Peace Corps

7
SWARMC Admin Organization

• Unit Coordinator
• Advisory Board
• County Medical Directors
• NP/PA Director
• Nursing Director
• Pharmacy Director
• EMS Director
• Public Health Director

8
SWARMC Medical Branch

• Medical Director/Board
• County Medical Directors (Mobile, Baldwin,
  Washington, Escambia)
• Medical Branch Team leaders
• Shelters Team leader Dr. Joel Laughlin
• Field Team Leader
• Pandemic Team leader
• CBRNE Team leader
• Specialty Team leaders (General surgery,
  Pulmonary/ICU, etc.)
• Training Director Dr. E. Flotte
• Recruitment Director

9
SWARMC Advisory Board

• Establish policies and strategic priorities
• Meets quarterly
• Provide guidance and support
• Program Planning
• Public Relations
• Funding Leadership
• Program Evaluation

10
SWARMC Advisory Board

• Ronnie Adair
  Diana Brinson, Executive
  Director
• Mobile County EMA Volunteer Mobile, Inc.
•  
• Walt Dikerson, Bert
  Eichold, M.D., Director
• Mobile County EMA Mobile County Health
  Department
•  
• Marilynn Hammond, M.D. Representative Jamie Ison
•  
• Sheree LaCoste, Executive Director Sharon
  Lavender, Asst. Director
• Medical Society of Mobile County Department of
  Human Resources
•  
• David MacRae, M.D. Raphael Maharaj
• Alabama State Defense Force
•  
• Margaret OBrien, M.D. Ken Poston
• Assoc. Dean of USA Medical American Red Cross
•  
• Tuerk Schlesinger, Executive Director Kim
  Zweifler, PhD
• Mobile Mental Health

11
SWAMRC Members

• Volunteer Count
• Physicians    16
• Physician Assistants   3
• Nurse Practitioners   8
• Nurses   9
• Pharmacists 15
• Dentists    0
• Veterinarians 1
• Mental Health Professionals    16
• EMS Professionals    10
• Respiratory Therapists 1
• Other Public Health/Medical 10
• Non-Public Health/Non-Medical  8
• Total 97

12
SWAMRC Certifications

• SWAMRC General Certification
• Training SWAMRC Orientation (ICS-100, 700)
• Capabilities Hospital care, shelter care, public
  health activities. Just-in-time Training.
• SWAMRC Field Certification
• Training BLS/BDLS, Triage, Hazardous
  materials/CBRNE, Exercise Participation
• Optional CERT, ACLS/ADLS
• SWAMRC Deployment Certification
• SWAMRC Leadership Certification
• Requirements for each listed on SWAMRC Website

13
General Certification

• In disaster, we will need MDs in the hospitals
  and shelters
• Need contact info and stated desire to be
  available
• Need to be told where to go and what to do to
  practice their specialty
• Are not interested in disaster site
  first-responder, deployment, being incident
  commander, etc.

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Additional Training

• WWW.SWAMRC.ORG
• MRC-TRAIN www.mrc.train.org
• Contains training modules on a variety of
  subjects
• AARTC Advanced Regional Response Training
  Center at USA

16
Southwest Alabama Threats

• Hurricane
• Mass casualty (airplane, train, bus, building
  collapse)
• Pandemic
• Tornado
• Nuclear, Biologic, Chemical

17
Black Swan Scenario

• Plane crash (low-altitude), most victims (150)
  alive but seriously injured
• 40 patients with surgical needs
• Where do you send them? Where are the surgeons?
• Saturday - only one on call for MIMC, USA, Prov,
  SMC
• Where are the backup surgeons?
• How do you contact them? Can they get to the
  hospitals?
• Do we need to bring in outside MDs?
• Same for general surgery, CV surgery,
  orthopedics, pulmonary/CC, neurosurgeons, etc
• Chemical disaster nephrologists, cardiologists
• Need coordinators for each specialty

18
SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

19
SWAMRC Role in Local Disaster

• Identifying physician and AHP need
• Field
• Shelters
• Hospitals
• Fulfilling physician and AHP need
• Contacting physicians/AHP
• Transporting physicians/AHP
• Handling deployees in our area

20
Local Activation

• Activation Procedures
• SWAMRC will be activated by state or county
  agencies ADPH, county HD or EMA
• IC or unit coordinator (or designate) will
  contact volunteer to request they accept
  assignment to a hospital, shelter, or disaster
  site
• Bring MRC ID Card, MRC shirt (or scrubs)
• Transportation
• Transportation will be arranged as own vehicle or
  emergency vehicle (MCEMA)

21
Local Activation

• Reporting
• Volunteer will report to the hospital/shelter
  physician leader or incident commander
• Communication with the MRC UC or IC will be via
  the shelter or hospitals emergency radio
• Deactivation volunteer will be notified of
  deactivation by hospital leader, specialty
  leader, IC, or UC
• Debriefing volunteer will be debriefed by unit
  coordinator at a future date

22
Command Structure

• Incident Command System (ICS)
• National Incident Management System (NIMS)
• Hospital Incident Command System (HICS)
• Alabama Incident Management System (AIMS)
• The SWAMRC Field Commander may end up being the
  Incident Commander for the entire disaster site

23
ICS is

• Command Hierarchy System
• Based on Military and Fire Management Systems
• Common Language between agencies - (Fire, Police,
  EMA, Hospitals, Public Health)
• Provides logistical and administrative support to
  operational personnel
• Flexible, adaptable modular system
• Span of Control 3 to 7 units maximum under each
  level of control
• Can be used by any size team for any size problem

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ICS Supervisory Titles
25
ICS
Incident Commander
Public Information Officer
Liaison Officer
Safety and Security Officer
Logistics Chief
Planning Chief
Finance Chief
Operations Chief
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ICS Management Process
Incident Occurs
Tactical Response
ICS Launched
Incident Reported Identified
Chiefs Meeting Develop Strategy Tactics to
Meet Objectives
IC Sets Objectives
Action Plan Preparation
Chiefs Officers Meet with IC to Evaluate
Reports
Tactical Response Initiated
Operation Reports Tactical Results,
Needs, Engage Liaison, Logistics,
Planning, Finance for support
Planning Evaluates Progress Reports
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NIMS

• National Incident Management System
• Comprehensive federal system directing response
  agencies to function in an organized manner
• The Hospital Emergency Incident Command System
  (HEICS) incorporates NIMS terminology, principles
  and practices

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Alabama Emergency Operations Plan
29
Incident Management Advisory Group/ CEP
Incident Commander
ADPH Incident Command System
Positions Chart May 22, 2006
 
Subject Matter Experts Biological
Chemical Radiation Zoonotic
Infection Control
Safety and Security Officer
Public Information Officer
Liaison Officer External
Legal Officer
Liaison Officer Internal
Planning Chief
Finance Chief
Logistics Chief
Operations Chief
Social Services Coordination Branch Leader
Communications Unit Leader
Situation Status Unit Leader
Time Unit Leader
Patient Tracking Unit Leader
Damage Assessment Unit Leader
Human Resources Unit Leader
Laboratory Branch Leader
Procurement Unit Leader
Strategic Epidemiology Unit Leader
Environmental Branch Leader
Transportation Unit Leader  
Medical Branch Leader
Materials Supply Unit Leader
Strategic Surveillance Unit Leader
Surveillance Epidemiology Investigation Branch
Leader
Nutrition Supply Unit Leader
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Incident Management Advisory Group/ CEP
Incident Commander
 
Safety and Security Officer
Public Information Officer
Subject Matter Experts Biological
Chemical Radiation Zoonotic
Infection Control
Legal Officer
Liaison Officer Internal
Liaison Officer External
Operations Chief
Social Service Coordination Branch
Laboratory Branch
Environmental Branch
Medical Branch
Surveillance/Epidemiology Investigation Branch
Montgomery Lab Group
Food Safety Group
Shelter Group
Staging Unit
Birmingham Lab Group
Mass Prophylaxis Vaccinations Group
Mobile Lab Group
Mass Prophylaxis SNS Group
EMS Group
ADPH Incident Command System
Positions Chart - Operations May 22, 2006
Patient Management Group
Patient Transfer Unit
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Subject Matter Experts Biological
Chemical Radiation Zoonotic
Infection Control
 
Operations Chief
Continued Previous Page
Medical Branch
Mass Prophylaxis Vaccinations Group
Patient Transfer Unit (PTU)
Patient Management Group
Staging Unit
Shelter Group
Staff Volunteers Field Management
Pre-hospital Triage/Treatment Locations
Mass Vaccination Clinics
Team Deployment
Support/Coordinate Statewide Health Care System
Staff Volunteers Deployment
Patient Tracking
Community Support
Evacuee/Patient Reception Centers
Protect Support Statewide Health Care Resources

Mass Shelter Support
Mass Prophylaxis SNS Group
EMS Group
Field Hospitals
Manage Patient Transfer Requests Statewide
Coordinate with Logistics
Non-traditional Treatment Centers
Pharmaceuticals
Coordinate Patient Transportation
SNS
MNS Supplies / Equipment initial re-supply
Coordinate EMS Support for MNS Locations
Health Departments
Monitor Health Care Capacity (AIMS) Statewide
Community Support
Coordinate w/PTU Arrange medical care for
evacuees
Coordinate State Health Care System Federal
Assets
ADPH Incident Command System
Functions Chart - Operations May 22, 2006
Protect Medical Community
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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM HEICS
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Medical Staff Unit Leader

• Collect available physicians at a central point.
• Emergency Credential volunteer medical staff as
  necessary.
• Assist in the assignment of available medical
  staff as needed.
• Often moved to Operations under
• Medical Staff Director

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OPERATIONS SECTION
Providence Hospital Emergency Incident Command
System
Medical Care Director S. Breslin C. Krogsgard
Surgical Services Unit leader
Inpatient/Outpatient
PACU
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SWARMC Incident Command

• SWAMRC Unit Coordinator Toni Marie Jones
• Acts as XO
• External Liaison MCEMA, MCHD, ARC, AL3 DMAT
• Public Information/ Communication
• Internal Communication Physicians, RNs, etc.
  and MRC chain of command
• Finance/Logistics etc.
• Usually at EOC (MCEMA McGregor Ave.)

38
SWARMC Incident Command

• SWAMRC Incident Commander
• Acts as CO
• May be physician or AHP
• Generally the most senior/experienced person for
  the situation
• Selected by consensus of UC and directors, team
  leaders
• Example CBRNE team leader for chemical
  disaster, Pandemic team leader for pandemic,
  etc.
• Or Baldwin County Director for disaster primarily
  affecting Baldwin County

39
ICS
Incident Commander
Public Information Officer
Liaison Officer
Safety and Security Officer
Logistics Chief
Planning Chief
Finance Chief
Operations Chief
40
SWARMC Incident Command

• SWAMRC Incident Team example
• Individualize for situation (e.g. hurricane with
  building collapse)
• Incident Commander
• Field (Disaster Sites) Branch Director
• Field Team Leaders
• Shelters Branch Director
• Shelter Team Leaders
• Hospital Deployment Branch Director
• Physician Specialty Leaders (eg. Ortho, CV
  surgery)
• Hospital Team Leaders (if necessary)
• Allied Health Branch Director
• Allied Health Team Leaders (RNs, pharmacists,
  etc)
• County Directors (Baldwin, Escambia, etc)

41
ICS Supervisory Titles
42
SWAMRC Role in Local Disaster

• Identifying physician and AHP need
• Field
• Shelters
• Hospitals
• Fulfilling physician and AHP need
• Contacting physicians/AHP
• Transporting physicians/AHP
• Handling deployees in our area

43
SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

44
Hospital Surge Capacity Physician Need

• If need more MDs of any specialty in any
  hospital
• Use local physicians first
• Feel free to call partners and others yourself
• If not sufficient then notify Hospital Medical
  Staff Director (or IC).
• They will call MRC representative (UC/IC) at the
  county EOC to request additional MDs by
  specialty.
• Procedures should be in the hospital EOP

45
Hospital Surge Capacity Physician Need

• SWAMRC IC/UC (or designate) will contact
  additional physicians in the needed specialty
• If local physicians are insufficient, IC/UC
  leader will request MDs from (in order)
• Counties within SWAMRC
• Other MRC units in Alabama (e.g. NAMRC)
• OCVMRC (Wash DC)
• Same system can be used for AHP

46
SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

47
Shelter Assignment

• Physicians will be asked to staff shelters by the
  IC/UC
• Physicians will be rotated if feasible
• Physicians acting as backup should plan to stay
  throughout the event, but may come and go if
  feasible cleared with IC
• A cot and meals usually provided
• Shelter Types
• Mass Shelters
• Medical Needs Shelters
• Special Needs Shelters
• All-Hazards
• Federal Assets

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Shelter Assignment

• Mass Shelters
• General Evacuees
• Managed by Red Cross
• May or may not need staffing by MRC
• Medical Needs Shelters
• Require mild/moderate assistance with ADLs
• Criteria portable ventilator, stable oxygen,
  nebulizer, or sleep apnea treatment, foley/
  supra-pubic catheter, incontinent, ostomies
• Staffed by County Health Department or ADPH
• MRC acts as backup to CHD physicians/NPs
• Location Collins-Rhodes Elementary (Eight Mile)

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Shelter Assignment

• Special Needs Shelters
• More advanced chronic conditions (e.g.
  paraplagia) than MNS
• In between MNS and hospital
• Run by MCEMA, State Defense Force, and Volunteers
  of America (VOA)
• SWA MRC supplies all health care personnel
• Run by SWAMRC Shelters Leader (or designate)
• Likely situated at VOA at Zeigler and University

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Shelter Assignment

• All-Hazards
• Triage Centers/Field Hospitals utilized as
  hospital overflow in the event that hospitals
  reach surge capacity
• Set up outside hospitals
• AKA Community Care Centers (nationally)
• Run by volunteer organizations
• Example Mt. Hebron Baptist Church is the
  all-hazard for U.S.A. Medical Center
• Medical staff is supplied by the organization
  (e.g. Mt. Hebron Baptist Church and U.S.A.)
• Given 1 adult and 1 pediatric palette of medical
  supplies by ADPH
• MRC may be asked to supply additional medical
  staff as it would for the hospitals

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Federal Assets

• Strategic National Stockpile
• Federal Medical Contingency Stations

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Strategic National Stockpile

• Federal medical supplies delivered to disaster
  areas
• 12 hour PUSH Packages
• Prepackage, standardized
• Ready for immediate deployment
• Arrives within 12 hours
• Managed Inventory Packages
• Assembled based on the needs of the situation.
• Arrives within 24-36 hours

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What types of items are in the SNS Push Package?
Oral Antibiotics
IV Supplies
Nerve Agent Antidotes (CHEMPACK)
Airway Supplies
Pediatric Supplies
Med/Surg Supplies
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Past SNS Deployment

• Pre-Positioned Products
• Republic National Convention
• Democratic National Convention
• Olympics (in Greece)
• Managed Inventory Deployment
• Anthrax Events in 2001 New Jersey, Florida,
  and D.C.
• Push Package Deployment
• The first push package was sent to Mississippi
  following Hurricane Katrina in 2005.

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Activating the SNS

• Clinic physicians, emergency room personnel, and
  pharmacists will likely be among the first to
  discover an incident.
• Pharmacists may notice an unusual increase in
  demand of over the counter medications.

Suspect Bioterrorism or Large Emergency
Notify Local Health Department
Notify State Health Department
Contact CDC
CDC Authorizes Deployment of SNS
SNS is received and broken down at the receiving
site.
Receiving, Staging and Storing (RSS) SNS assets
received at an undisclosed location in
Alabama Assets delivered to treatment centers,
points of dispensing sites (PODs) and other
locations
Product is sent to treatment centers, PODs, etc.
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POD Site

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Federal Medical Contingency Station
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SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

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Field Team Assignment

• Field Personnel will generally be requested and
  directed by Mobile County EMA
• Details contingent on situation
• Examples massive natural disaster (e.g.
  hurricane), accident (plane, train, bus),
  industrial disaster (chemical, etc), structural
  disaster (building collapse), terrorist attack
• Teams (one or multiple) composed of field
  certified MRC members
• Teams will usually assemble at central point
  (e.g. MCEMA)
• Will be involved in on-site treatment and triage

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SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

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MRC Pandemic Response

• Will generally be requested directed by Mobile
  County Health Department (or ADPH)
• May be composed of
• Hospital Surge
• Shelters
• Vaccination
• Pandemic Team Leader will develop SWAMRC
  Pandemic Response Plan (in conjunction with MCHD)

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SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

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Intra-state (AL) Deployment

• MOU with North Alabama MRC
• Request made by MRC at disaster site
• MRC volunteers given approval to deploy by MRC
  state coordinator and local unit coordinator
• Volunteers provided with food and lodging,
  responsible for travel
• Volunteers are covered under the immunity laws of
  the state of Alabama
• Register with ADPH LCMS (Alabamas version of
  ESAR-VHP) at
• http//www.adph.org/extranet/

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Federal Deployment

• MRC volunteers may become part of the MRC Federal
  Deployment Cadre
• Participation in a deployment will be voluntary.
• MRC members would be deployed for 2 weeks.
• MRC members will need to meet the MRC Deployment
  Competencies, which are in development.

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Federal Deployment

• Members will be deployed to augment federal Teams
  such as DMAT
• MRC members would be deployed as individuals or
  small groups (not entire units)
• Includes following legal protections Liability
  protections, Workers compensation, Employment
  protections

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SWARMC Roles

• Local Disaster Response
• Field
• Shelters
• Hospitals
• Pandemic Response
• Remote Deployment
• Intra-state, Inter-state
• Public Health Initiatives

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Public Health Initiatives

• Emails sent out by Unit Coordinator
• May opt out
• Health screenings
• Smoking Cessation
• Health Literacy/Education
• Vaccinations
• Public relations field days, etc.
• Sherriff's Flotilla Body Recovery
• Junior MRC ages 14 to 18 (high schools)

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Surgeon Generals Priorities

• Surgeon Generals priorities for public health
• Increasing prevention efforts
• Eliminating health disparities
• Improving public health preparedness

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Issues for MRC Members

• External Coordination
• Public Information
• Mental Health
• Liability

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External Coordination

• American Red Cross (MOU)
• Mobile County EMA
• Mobile County Health Department
• Hospitals
• Police, Fire, EMS departments
• Questions/problems with other agencies should be
  referred to the members MRC incident commander,
  who will then refer them to the unit coordinator

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External Coordination

• Hospital staff need Hospitals, County Medical
  Society
• Shelters
• MNS ARC, County Health Department
• SNS EMA, SDF, VOA
• Disaster Site Mobile County EMA
• DMAT, police/fire, EMS
• DMAT Federal. Focused on Emergency
  Medicine/Trauma. Not prepared for primary care
  role. Usually unfamiliar with area of deployment
  and local health care facilities and personnel.
• Pandemics County Health Department

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Provider Response Resources
National - DMAT
State Public Health Teams
Cross Borders MRC Teams
Local Private Providers
Local Volunteers
Local Public Health
Local MRC Team
Local Community / Disaster Area
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Communications

• The only person authorized to speak to the media
  is the Public Information Officer. If this isnt
  you, dont answer questions.

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Deactivation and Mental Health

• Deactivation debriefing and support will be
  coordinated by the MRC Unit Coordinator
• Resources will be available on the SWAMRC website

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Liability

• Sovereign Immunity - Constitution of Alabama of
  1901, Article 1, 14 provides the State shall
  never be a defendant in a suit at law or in
  equity. Includes qualified or state agents
  immunity for volunteers performing a state
  function. Does not protect against simple
  negligence.
• Emergency Management Act - Code of Ala. 1975,
  31-9-1, et seq., especially 31-9-16. Operating
  under the Governors emergency powers, state
  workers and volunteers are granted civil immunity
  except for willful misconduct, gross negligence
  or bad faith. Any emergency management worker
  is granted state officer immunity.
• Emergency Management Mutual Assistance Compact -
  authorized mutual aid among the states for
  immunities of other states workers.
• State Volunteer Service Act Code of Ala. 1975
  6-5-336. This act provide negligence immunity for
  a person performing services gratuitously for a
  nonprofit organization or corporation, a hospital
  (public, private or nonprofit), or a governmental
  entity. The volunteer is immune from civil
  action if acting in good faith within the scope
  of duties and not caused by willful misconduct
  or wanton misconduct.
• The Good Samaritan Act Good Samaritan acts
  gratuitously and in good faith and renders first
  aid or emergency care at the scene of an accident
  or disaster. Even if a tort occurs, the Good
  Samaritan is not liable for any civil damages.
  The greatest legal question is whether the Good
  Sam is providing the service at the scene.
  Alabamas courts have not decided that issue.
• BOTTOM LINE You have full immunity as long as
  you are operating within your scope of training

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WWW.SWAMRC.ORG
When Everyone is PreparedNothing Happens