The Metropolitan Medical Response System Grant Program. Sebastian E Heath VetMB, PhD NAS-IOM, DC April 23, 2009

Transcription

1 The Metropolitan Medical Response System Grant Program Sebastian E Heath VetMB, PhD NAS-IOM, DC April 23, 2009

2 Background on Metropolitan Medical Response in the US 1995: DHHS developed prototype Metropolitan Mobile Strike Team (MMST) in DC in response to Sarin gas attacks in Tokyo 1996: System replicated in Atlanta for Olympics 1997: 25 additional cities per year supported by DPP Integrated pre-hospital, hospital and public health response capability Health system, not equipment Referred to as Metropolitan Medical Response System (MMRS) 1998: PPD 62 Moved MMRS to HHS 2003: MMRS moved to DHS First to EP&R then SLGCP 2003: OMB-PART Recommends termination : Grants Zero funding in President s Budget Congress supports every year Once funded administered as grants 2006: Congress authorizes MMRS Grants Program

3 Domestic Preparedness Program (DPP) Nunn-Lugar-Domenici Act designed to improve the federal government s ability to prevent and respond to terrorist attacks involving WMD (Note: this was the rationale for administering MMRS funds as contracts) intended to prepare select cities to manage the consequences of a possible attack by terrorists using WMD (Note: prepare cities did not require them to establish their own emergency response program)

4 MMRS Contract Deliverables Meeting with Project Officer MMRS Development Plan Primary MMRS Plan Component MMRS Plan Forward movement of patients utilizing NDMS Responding to Chemical, radiological, nuclear or explosive WMD event MMST (optional) Managing heath consequences of a biological WMD Local hospital and healthcare system plan Training Pharmaceutical and equipment procurement and maintenance Monthly Progress Reports

5 Preparing for Terrorism (IOM Study, 2002) Preparedness is a meaningless abstract concept, since threats vary among communities and change over time, perhaps even in response to a community s level of preparedness; readiness should be seen as a process than a state (p113-4) Evaluation <of MMRS> by OEP should be multi level Periodic review of documents and records Observation of community-initiated exercises and drills On-site assessment 23 essential capabilities with nearly 500 preparedness indicators No large community could become well prepared solely as a result of the relatively meager funding provided by the OEP contracts (p165)

6 Rating OMB-PART MMRS 2003 Report Results not demonstrated Recommendation Discontinuation of this program in 2004 since large increase in the 2003 budget completes the mission of providing 122 cities with necessary funding to establish a base level of preparedness

7 MMRS History (Recap) Originally funded through Nunn-Lugar-Domenici (Domestic Preparedness Program funds) managed as contracts with jurisdictions 124 predetermined jurisdictions by HHS 2003 by DHS (ODP) 2003 program was sunset managed as grants (DHS) to States Supplemental funds Since 2005 managed as part of HSGP MMRS Grant Program was first authorized in 2006 Convention, not the law predicates funding of 124 jurisdictions

8 MMRS Survey Findings (2008) In most programs planning and operational areas are the same The average MMRS program covers 8.9 cities 4.1 counties 4.7 other entities 3,077 square miles Very few programs are multi-state or international in scope

9 Which Agencies Administer MMRS grants? Emergency Management Agencies (46.3%) Fire Departments (30.6%) Departments of Public Health (8.3%) Emergency Medical Services (4.6%) Hospitals (0.9%) Other (9.3%)

10 MMRS Primary Implementation Areas Mission Area Planning Asset Acquisition Training and Exercises Response Augmentation Response Public Health Community Participation Hazmat Priority (Ranked by %) 22.4% 17.0% 15.5% 11.5% 10.2% 8.5% 7.8% 7.0%

11 MMRS Stakeholder Involvement Agencies Regularly Engaged with MMRS Programs Frequency of Engagement Agencies Regularly Engaged with MMRS Programs Frequency of Engagement Emergency Medical Services 90.40% State Public Health 47.40% Local Emergency Management 88.60% Community Health Centers 46.50% Local Public Health 84.20% Strategic National Stockpile (HHS-ASPR) 45.60% Hospital ER representative from major receiving hospitals 81.60% Cities Readiness Initiative (HHS-CDC) 44.70% Law Enforcement 77.20% Local private sector 43.90% Public & private hospital representation, including Veteran s 68.40% Urban Area Security Initiative Grant coordinator, if applicable 39.50% Local Homeland Security Advisor/Coordinator 63.20% Local public schools, colleges and universities 37.70% 911 Services 59.60% Medical Examiner 36.80% American Red Cross 58.80% State Homeland Security Advisor 31.60% Medical Director 57.90% National Guard 29.80% Public Health Emergency Preparedness (HHS-CDC) 55.30% State Public Health Director 29.80% Representatives with mutual aide agreements 51.80% Laboratory Services 24.60% Citizen Corps Council representative 50.00% Poison Control Centers 23.70% Mental Health 49.10% State Emergency Management Agency Director 19.30% State Emergency Management 47.40% Other 19.30%

12 Contribution of MMRS Grant Funding to Mass Casualty Incident Preparedness All With UASI Without UASI With CRI Without CRI % of Federal Funding % of Total Funding

13 Trends in MMRS Implementation Current trend is for MMRS programs to move away from jurisdictions towards Metropolitan Statistical Areas (MSA) Over 20% of States (9/41) already allocate MMRS funds to MSA s not jurisdictions Several MMRS jurisdictions have merged into MSAbased programs There are regular requests from States each year for additional MSA-based programs and reallocation of funds based on MSA

14 MMRS Grants Basis of Funding Allocation 1. Current allocations are based on methods from the 1990 s a. Repeated and predictable allocations to same jurisdictions have led to a wide range of performance 2. Risk-based allocation provides rational basis for a. Allocation of funds to areas with highest risk (lots of people) b. Regionalized approach (consistent with local administrative structure) c. Equitable program expansion (all States and Territories) d. Consistency with other HS grant programs 3. Risk-based allocation of FEMA grants is priority for Congress and administration a. Leads to greatly improved program efficiency

15 The Top 10 Urban Areas Have widely varying number of MMRS programs Metropolitan Statistical Area Population 2 MMRS Cities 3 Los Angeles-Long Beach-Santa Ana, CA 12,875,587 6 New York-Long Island, NY 1 12,381,586 2 Chicago-Naperville-Joliet, IL-IN-WI 9,524,673 1 Newark-Edison, NJ-PA 1 6,434,402 2 Dallas-Fort Worth-Arlington, TX 6,145,037 5 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 5,827,962 1 Houston-Sugar Land-Baytown, TX 5,628,101 1 Miami-Fort Lauderdale-Pompano Beach, FL 5,413,212 3 Washington-Arlington-Alexandria, DC-VA-MD-WV 5,306,565 1 Atlanta-Sandy Springs-Marietta, GA 5,278,904 1 Notes 1. NYC MSA split into two parts, following UASI program precedent residential population, U.S. Census Bureau estimates; all other MSAs are smaller than 5M 3. From the 124 cities listed in the FY2009 MMRS program guidance

16 Approach to Convert MMRS to Risk-based (4 Steps) 1. Identify a risk parameter that reflects the mission of the MMRS grants program (protect population) 2. Align current MMRS jurisdictions according to risk (population aggregated by MSA) 3. Make all States and Territories eligible for funding (national program) 4. Support local program continuity (individual funding adjustments)

17 Risk-based Approach Increases Program Efficiency Under current MMRS program (jurisdictionbased) 67 million Americans in 124 cities are included Only 43 States and no Territories have programs Under risk-based MMRS program (State-based) 207 million Americans in 116 MSA s are included All 50 States and 6 Territories would have programs Conversion to risk-based would also provide an opportunity to make other program adjustments

18 Federal-State-Local Integration Strengths MMRS is one of the longest standing preparedness grant programs Challenges Frequent confusion of (still) thinking of MMRS as a federal asset (not!) instead of as a federal assistance program

19 Community-based Preparedness Define tangible mission Reduce morbidity and mortality Define objectives The MMRS program supports the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard Define outcomes Successful MMRS grantees reduce the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before the incident occurs