Tools for Evaluating the Metropolitan Medical Response System Program Phase I Report (2001) / Chapter Skim
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teams, with plans, training, and equipment centered around dealing with chemical agents, some of the other early MMRS cities changed the MMST concept by integrating on duty existing fire, emergency medical services, and police personnel into a "MMST response." In addition, their plans incorporated local public health officials, non-governmental organizations, state agencies, including the National Guard, federal military and non-military officials, and private healthcare organizations. OEP soon amended the initial contracts to focus more attention on coping with a covert release of a biological agent and changed the name of the program to the Metropolitan Medical Response System.
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Additionally, TOM shall establish appropriate evaluation methods, tools, and processes, based upon the performance measures, to assess the MMRS development process. The products of this work will assist OEP in determining appropriate mechanisms to assess the effectiveness of, and identify barriers related to, the MMRS development process.
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First, there is much to be learned from analysis of the local, state and federal responses to the terrorist attacks on the World Trade Center and the Pentagon in September 2001, but the committee believes that CBR terrorism incidents of the scale envisioned by OEP are unlikely to occur on a regular basis. As a result, any evaluation of a response system will have to be indirect, in that it will have to measure the intermecliate consequences of the MMRS program rather than the ultimate goal, which is to save lives and minimize morbidity from a terrorism incident.
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Some cities operate their own emergency medical services; others depend on county or state assets. OEP has dealt with this variation by not attempting to impose a single mode} or acceptable plan on all its MMRS cities, instead opting to encourage cities to build their own plans around available structures, resources, and vuinerabilities.
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; 2. MMRS Development Plan (within 3 months of contract award)
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OEP further asked the committee to "include the following considerations": QUESTION A: How can OEP determine, at the program level, whether the strategies, resources, mechanisms, technical assistance, and monitoring processes provided to the MMRS development process are effective? ANSWER A: This question concerns the performance of the OEP staff, as opposed to the performances of the MMRS cities, which are the focus of most of the succeeding questions.
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. OEP staff, PHS project officers, and contractors have identified two objectives as being especially important: Deliverable 2 (the MMRS development plan)
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If standards do not exist, how can new standards be created or how can the performance objectives be validated? ANSWER D: Many of the personnel, professions, organizations, and jobs referred to in the plans of MMRS cities are governed by existing standards; some of these are legally mandated (Occupational Safety and Health Administration tOSHA]
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None explicitly addresses CBR terrorism or an emergency of the scale described in the MMRS program contract, and attempts to apply these standards to such scenarios in the past have often proved counterproductive (e.g., misinterpretation of OSHA hazardous waste operations standards has led to expectations that hospital emergency department tED] personnel should have Level A chemical protective suits)
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Although biological agents were not ignored, DOD and DO; training and equipment programs begun in 1997 reinforced that emphasis on chemical agents, and as a result their equipment money and training was most often directed at firefighters and emergency medical technicians rather than hospital personnel. Most cities used their MMRS program contracts to expand their capabilities by incorporating CBR-specific training and equipment for city personnel, primarily those involved with public safety, into existing alI-hazard plans.
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, law enforcement, public works, public health, and emergency management A 100-page "Tool Kit" provided for use by the state and local personnel assigned to fill out the forms, but could be the basis of peer interviews State assessment designed to be a compilation of local assessments, so it is really a local instrument Public Health Assessment Instrument for Public Health Emergency Preparedness (CDC! Ten essential public health services amplified specifically for preparedness for CBR terrorism events Nineteen "indicators," each with multiple subparts requiring mostly yes-or-no answers Part of DOJ state assessment instrument Assessment of Community Linkages in Response to a Bioterrorism Event Draft product of ICAHCO and SATC for AHRQ due out in June 2001 —Forty-item questionnaire for hospitals (yes-or-no and short answers)
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He reports that no common template or database of findings is available for possible use in evaluating the preparedness of MMRS program communities. He anticipates that a current effort by FEMA, the National Emergency Management Association, and others to create an emergency management accreditation program will eventually include performance standards as well as preparedness indicators based on LCAR.
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that hinder preparedness in at least some MMRS cities. Most prominent is the difficulty of sharing funding or material purchased with OEP contract dollars with adjacent jurisdictions and private-sector entities, especially hospitals and physicians.
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. In each table the far left column, labeled "Plan Elements," lists the required elements of the deliverable, numbered in accord with the checklist supplied to FY 2000 MMRS cities by OEP under the title "2000 MMRS Contract Deliverable Evaluation Instrument." The remaining three columns of the tables present the committee's suggested preparedness indicators for each plan element.
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All three types of indicators are, however, merely surrogate or proxy measures of MMRS effectiveness that are based on the judgment of knowledgeable students of the field but that have never been truly validated (and cannot be, short of an actual mass-casualty CBR terrorism incident)
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federal agencies in the nation's largest cities make it impossible to unequivocally assign credit for improvements in preparedness. However, the committee believes that OEP's emphasis on collaboration, the use of existing agencies and programs, and the promotion of local discretion in addressing preparedness gaps, although difficult to measure, has been an undeniable contribution.
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