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Commanders Corner 

Andy Swartzell- Deputy Team Leader

Hurricane Season is living up to it's name again this year. Maybe not quite as destructive as last year but pretty close. Almost all of the on-call month DMATs were deployed, staged or alerted to Hurricanes Florence and Michael and the HI-1 DMAT is currently in Saipan assisting with hospital decompression and shelter missions in the wake of Typhoon Yutu. Several CA-6 team members (including me!) have been busy backfilling positions on those teams. And the teams have appreciated the support. But the season isn't over and we are one of the on-call teams for November. And like the teams who recently deployed we have needed to fill some positions on the roster with members from other teams. It is not too late to sign up for this month however. We still have some vacant positions even with other teams assisting. For those able to deploy in November, now is time to pack your bags, notify significant others and employers; if not already done. Check the Hot News area of the team website and emails frequently for the latest updates and potential deployments. Let's be ready to respond again when help is need.

The link below is a good article on a deployment to Hurricane Florence. We had 4 team members on the DMAT mentioned in the article.

Link to article

Speaking of getting ready...have you had your flu shot this year? The CDC just released flu season statistics for last year. It was one of the worst in recorded history with 79,000+ deaths (180 children) and more then 970,000 Emergency Department/Hospital visits. Protect your self, your family/friends and those you care for by getting vaccinated.

Team Meeting

The agenda for the team meeting and supporting documents can be found on the Training Documents area of the team website. We will discuss the Holiday Party, calendar of events (on-call months and team meetings) for 2019. And some new ideas for member participation in the team's direction. Hear some of the experiences from team members on their recent deployments. Bring your "Go Bags" to share and compare what you take with you on a deployment. 

Direct Hiring Authority

The process for re-hiring current team members and new prospective team members is continuing but at avery slow speed. Team Commanders continue to seek clarification on the hiring process and an update on staus of team member applications. Yesterday, Team Leaders held thelr their own conference call to discuss an umber of issues and send a message to NDMS leadership on how the process and recent changes are affecting team morale and the abiliity to deploy.  Team Commanders are dependent on team members providing information on the status of their applications; not the other way around. And Team Leaders are recommending that team members call or email, every couple of weeks, the POC listed on the USAjob applications or in the emails/letters thay may have received. Some team members are finally receiving letters of tentative job offers and have had to respond several times accepting the tentative job offer. Team members should check email spam filters for notifications. Some notifications are generic but you need to respond to them when requested. Some team members have received certified mail with job offers with instructions on how to reply.  Click here for an example of a recent email notification. Because of the generic messaging, some of the information may not be applicable.  There may be several notifications; one being a tentative job offer with another the final job offer "to follow soon". Soon can be 4-8 weeks apparently. It is important that you follow up after accepting the job offer. NDMS said many people had not responded to job offers, when in fact some team members responded two or three times before being acknowledged.  And even if you accept an offer of employment,  it may be several more weeks before you are on-boarded with a new start date for your job.   I will have more information on hiring at our team meeting.

The Cross Section of ESF 6 & ESF 8

Lisa Vjgrt-Smith- Deputy Team Leader

In the past two years, many DMAT teams have been deployed to support shelter operations during hurricanes in Texas, Florida, North Carolina and Puerto Rico. Although, this is not the first time DMAT has been deployed for these missions, there does seem to be an increase in the need for DMATs at shelters and that the most common mission for hurricane season this year was in fact sheltering.

As first responders, it is important to understand the National Incident Management System (NIMS) and how different functions need to work together to meet the needs of the population during a disaster.

Under NIMS, Emergency Support Function (ESF 6) #6 is Mass Care, Emergency Assistance, Temporary Housing ans Human Services.  The main mission is “to provide life-sustaining resources, essential services and statutory programs when the needs of the disaster survivors exceeds local government capabilities (FEMA, 2016)”.  The scope would include Mass Care through congregate shelters, feeding operations and distribution of emergency supplies.  Family reunification, coordination of unaffiliated volunteers, management of donations, support to individuals with access and functional needs and support to pets should also  be provided. There are many other services that are included and may be expanded based on the type of the disaster, its duration and the population impacted.  Each Operational Area will decide who the core service providers for ESF #6 functions will be.  Often times the county will direct Health and Human Services Divisions to serve this function in partnership with their local public health departments, law enforcement, non-governmental organizations (NGOs) and other groups. The American Red Cross serves a unique position, one in which they serve as an NGO, but also holds a federal charter to assist with the provision of many of the functions spelled out in ESF #6.  This allows them to seek reimbursement and other funds of financial support through cost-recovery post event. In many operational areas, the Red Cross works with local emergency preparedness planners to pre-identify locations for shelters, pre-stage resources such as cots and blankets and work with the different agencies to quickly establish evacuation centers and shelters in times of needed.  In larger disasters, and longer term events, the American Red Cross can mobilize both regional, and national resources to the area and assist with ESF #6 functions. The Red Cross will work with many other organizations to obtain the needed resources, this can include the Salvation Army, ASPCA, and several faith-based organizations.

The Emergency Service Function #8 is Public Health and Medical Services.  The purpose of the function is to provide the “mechanism for coordinated Federal assistance to supplement local resources in response to a public health and medical disaster, potential or actual incidents requiring a coordinated Federal response, and/or during a developing potential public health and medical emergency” (FEMA, 2016). The scope of ESF#8 is quite extensive and includes: Assessment of public health/medical needs’ health surveillance; medical care personnel; health/medical/veterinary equipment and supplies; patient evacuation; patient care; safety and security of drugs, biologics and medical devices; blood and blood products; and food safety and security. Just as with ESF#6, the Operational Area must decide who the core service provider for this function will be.  This is often the Public Health department in partnership with the many public and private sector healthcare system providers.  As the definition of the core functions indicates, the system must be prepared for potential public health and medical emergencies, such as those that can occur during a disaster, or when a large population of people is housed together.

Over the past few years, we have seen a shift in the provision of mass care.  Previous concepts and plans would focus on establishing general population shelters and medical needs shelters.  While some operational areas, still very much focused on this concept, more areas are establishing general population shelters with co-located medical care shelters, or establishing general population shelters that provide extended medical care to those who need it.  The reason for this shift varies, but strong arguments include: an aging population with more complex chronic medical needs, not wanting to separate families, consolidation of resources, or even the lack of planning and preparedness for the varied population.  Because of this shift, more and more people with medical needs are being housed in the mass care shelters and often times they come lacking the appropriate items to care for their medical needs, and the shelter managers and staff are not trained to manage these needs.  Many emergency planners now struggle with the cross section of ESF#6 and ESF#8 for disasters.  Many feel the American Red Cross will continue to provide services including medical care and are unaware that this is not defined in the federal charter. They may lack the partnerships needed to address these issues or may simply over rely on the partnerships in place. With the right coordination and planning, many operational areas should be able to manage the extended basic medical needs in shelters and the health care system handle the more complex needs.  When the health care system is impacted through evacuations and closure, then the lines blur even more.  Independent living facilities, intermediate care facilities and skilled nursing facilities with poor preparedness and response plans, tend to rely on the emergency medical system too heavily and often end up evacuated to these mass care shelter. In these cases, a higher acuity of needs is then placed at the shelter, resulting in the need for more robust and coordinated medical resources.  Ideally, a tiered approach to ESF#8 should be considered and planned for.  This would include reserving state and federal assets to augment medical systems of care, i.e. hospitals, dialysis, skilled nursing facilities; And through stronger planning efforts local health care coalitions, NGOs and other groups such as MRCs should work together with ESF#6 planners for the provision of medical care in shelters. Until then, expect continued deployments to shelters with the missions of serving the chronic medical needs of the population.



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