Information on the Use of Medical Reserve Corps Volunteers during Emergencies (GAO-20-630)
Summary
A GAO report to congressional committees, GAO-20-630, dated September 2020, on public health preparedness and the Medical Reserve Corps, a network of health care volunteers who can augment federal, state and local capabilities in public health emergencies such as wildfires, hurricanes and infectious disease outbreaks. GAO reports that almost all states have such a network. According to federal data, 48 states and the District of Columbia reported 102,767 health care volunteers in 838 Medical Reserve Corps units as of September 2019, with nurses making up 43 percent. The report gives information on how these volunteers are used during emergencies.
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United States Government Accountability Office
Report to Congressional Committees
PUBLIC HEALTH
September 2020
PREPAREDNESS
Information on the
Use of Medical
Reserve Corps
Volunteers during
Emergencies
GAO-20-630
September 2020
PUBLIC HEALTH PREPAREDNESS
Information on the Use of Medical Reserve Corps
Volunteers during Emergencies
Highlights of GAO-20-630, a report to
congressional committees
Why GAO Did This Study What GAO Found
The Medical Reserve Corps consists of Almost all states have a network of health care volunteers—the Medical Reserve
health care volunteers—medical and Corps—who can augment federal, state, and local capabilities in response to
public health professionals—who public health emergencies, such as those arising from wildfires and hurricanes,
donate their time to help strengthen a and infectious disease outbreaks. Having sufficient, trained personnel, such as
response to public health emergencies these volunteers, is critical to a state’s capability to respond and recover from
and build community resilience. These public health emergencies. According to federal data, 48 states and the District of
volunteers prepare for and respond to Columbia reported 102,767 health care volunteers in 838 Medical Reserve Corps
public health emergencies, which may units as of September 2019, with nurses making up 43 percent.
include natural disasters—such as
hurricanes and wildfires—as well as Number of Medical Reserve Corps Volunteers by Type, as of September 2019
disease outbreaks, whether intentional
or natural.
The Pandemic and All-Hazards
Preparedness and Advancing
Innovation Act of 2019 included a
provision for GAO to review states’ use
of health care volunteers during public
health emergencies. This report
describes (1) the number and type of
Medical Reserve Corps volunteers; (2)
the types of public health emergencies
volunteers have participated in; and (3)
how HHS has assisted in developing Note: These data illustrate 90 percent of total health care volunteers. The remaining five types
volunteer capabilities. volunteers each make up less than 5 percent of the total. Other Public Health Medical volunteers may
include cardiovascular technicians, sonographers, and phlebotomists.
To conduct this work, GAO analyzed
data reported to HHS as of September
Medical Reserve Corps volunteers in states included in GAO’s review—Alabama,
2019; reviewed HHS documentation on California, North Carolina, and New Mexico—were deployed in response to
four states’ use of volunteers, which natural disasters in 2018 and 2019, migrants at the southern border in 2019, and
GAO selected based on population, COVID-19 in 2020. Department of Health and Human Services (HHS)
number of volunteers, and event; and documentation shows these volunteers performed a variety of health care
interviewed officials from HHS who activities, such as providing medical services, setting up and providing support at
oversee the Medical Reserve Corps shelters, and distributing medical supplies. Volunteers from these four states and
program. others also participated in the response to COVID-19 by supporting testing sites,
collecting specimens, and performing administrative tasks, such as data entry.
GAO plans to further examine how
For example, one unit deployed four volunteers a day for 3 days to work
states have used health care
alongside nurses at a drive-through testing site. In addition to responding to
volunteers to respond to public health
emergencies, including COVID-19, and public health emergencies, volunteers participated in preparedness activities,
any associated challenges to doing so such as an initiative to train the public on how to respond to emergencies.
in a future report. HHS oversees the Medical Reserve Corps program and has assisted units in
GAO provided a draft of this report to developing their volunteer capabilities. For example, HHS
HHS. In response, HHS provided • funded the development of a checklist of activities that should occur
technical comments, which were
during volunteer deployment such as re-verifying medical credentials;
incorporated as appropriate.
• provided training to new unit leaders on developing, managing, and
View GAO-20-630. For more information,
sustaining Medical Reserve Corps units; and
contact Mary Denigan-Macauley at (202) 512- • issued generally accepted practices, such as periodically re-evaluating
7114 or deniganmacauleym@gao.gov. volunteer recruitment procedures.
United States Government Accountability Office
Contents
Letter 1
Background 6
Medical Reserve Corps Units Reported More Than 100,000
Volunteers, with Nurses Comprising the Highest Percentage 7
Medical Reserve Corps Volunteers in Selected States Deployed in
Response to Natural Disasters, Migrant Border Crossings, and
COVID-19 11
ASPR Has Assisted Medical Reserve Corps Units in Developing
Volunteer Capabilities 14
Agency Comments 16
Appendix I Medical Reserve Corps Unit Health Care Volunteers, by State, as of
September 2019 18
Appendix II Mechanisms for Licensure Coverage between States 23
Appendix III The Emergency System for Advance Registration of Volunteer
Health Professionals 25
Appendix IV GAO Contact and Staff Acknowledgments 27
Tables
Table 1: Medical Reserve Corps Unit Health Care Volunteers, by
State, as of September 2019 18
Table 2: Number of Medical Reserve Corps Units by State, as of
September 2019 20
Figures
Figure 1: Medical Reserve Corps Health Care Volunteers by
State, as of September 2019 8
Figure 2: Medical Reserve Corps Health Care Volunteers by Type,
as of September 2019 9
Page i GAO-20-630 Medical Reserve Corps
Abbreviations
ASPR Office of the Assistant Secretary for Preparedness and
Response
ESAR-VHP Emergency System for Advance Registration of Volunteer
Health Professionals
HHS Department of Health and Human Services
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Page ii GAO-20-630 Medical Reserve Corps
Letter
441 G St. N.W.
Washington, DC 20548
September 14, 2020
The Honorable Lamar Alexander
Chairman
The Honorable Patty Murray
Ranking Member
Committee on Health, Education, Labor & Pensions
United States Senate
The Honorable Frank Pallone, Jr.
Chairman
The Honorable Greg Walden
Republican Leader
Committee on Energy & Commerce
House of Representatives
Recent major and concurrent natural disasters, such as the 2018-2019
wildfires in California and hurricanes in North Carolina, resulted in
massive federal, state, local, and territorial emergency response
operations. 1 More recently, in January 2020, the Secretary of Health and
Human Services declared a novel coronavirus, Coronavirus Disease
2019 (COVID-19), to be a nationwide public health emergency. 2 The
COVID-19 pandemic has affected the entire country and has required
support from all of the nation’s existing systems and structures, including
from the Department of Health and Human Services (HHS), that help
1For more information see GAO, Disaster Assistance, accessed May 27, 2020,
https://www.gao.gov/key_issues/disaster_assistance1/issue_summary.
2The Secretary of Health and Human Services may declare a public health emergency if
the Secretary determines, in consultation with other public health officials as may be
necessary, that (1) a disease or disorder presents a public health emergency; or (2) a
public health emergency, including significant outbreaks of infectious disease or
bioterrorist attacks, otherwise exists. See 42 U.S.C. § 247d.
In March 2020, the World Health Organization characterized COVID-19 a pandemic, and
the President declared COVID-19 a national emergency pursuant to the National
Emergencies Act and an emergency under the Robert T. Stafford Disaster Relief and
Emergency Assistance Act (Stafford Act). The President has also declared major
disasters in all 50 states, the District of Columbia, and five territories pursuant to the
Stafford Act.
Page 1 GAO-20-630 Medical Reserve Corps
manage public health emergencies across multiple federal departments,
as well as state agencies. 3
Additionally, Medical Reserve Corps volunteers can deploy in response to
a federal, state, local, or tribal public health emergency. 4 The Medical
Reserve Corps consists of health care volunteers—medical and public
health professionals—as well as others who donate their time to help
strengthen a response to public health emergencies, such as the COVID-
19 pandemic, by augmenting federal, state, and local capabilities and
building community resilience. 5 Medical Reserve Corps volunteers can
help communities prepare for, respond to, and recover from a variety of
public health emergencies, which may include emergencies related to
natural disasters—such as wildfires, hurricanes, tornadoes, blizzards, and
floods—as well as other emergencies that affect public health, such as
infectious disease outbreaks, and chemical spills and attacks, whether
intentional or natural. For example, Medical Reserve Corps volunteers
can participate in vaccination clinics, provide health education, and supply
first aid at large gatherings, among other things.
HHS’s Office of the Assistant Secretary for Preparedness and Response
(ASPR) leads the nation’s medical and public health preparedness and
response to public health emergencies. ASPR is responsible for the
planning and coordination of federal public health, health care delivery,
and emergency response systems to minimize or prevent health
emergencies from occurring, among other things. As part of its role,
3GAO, COVID-19: Opportunities to Improve Federal Response and Recovery Efforts,
GAO-20-625 (Washington, D.C.: June 25, 2020).
4Willing members of the Medical Reserve Corps may be deployed to areas of need during
a public health emergency, whether or not the Secretary of Health and Human Services
has declared a public health emergency under section 319 of the Public Health Service
Act. See 42 U.S.C. § 300hh-15(e). A public health emergency may arise from, or be
related to, other types of emergencies and disasters, including (1) a national emergency
declared by the President under the National Emergencies Act, and (2) an emergency or
major disaster declared by the President under the Stafford Act.
5According to HHS, community health resilience is the ability of a community to use its
assets to strengthen public health and health care systems and to improve the
community’s physical, behavioral, and social health to withstand, adapt to, and recover
from adversity.
The capability to respond and recover from public health emergencies consists of the
resources—personnel, training, equipment, and systems—and the mechanisms to
effectively and efficiently direct those resources toward a specific effort in the response or
recovery.
Page 2 GAO-20-630 Medical Reserve Corps
ASPR oversees the Medical Reserve Corps program and supports the
units by providing communication, grants and contract oversight, and
information for communities to establish, implement, and maintain
Medical Reserve Corps units, among other things.
The Pandemic and All-Hazards Preparedness and Advancing Innovation
Act of 2019 included a provision for GAO to review states’ use of health
care volunteers in the event of a public health emergency. 6 This report
describes
1. the number and type of health care Medical Reserve Corps volunteers
by state who may respond to public health emergencies;
2. the types of public health emergencies that volunteers have
participated in; and
3. how HHS has assisted in the development of Medical Reserve Corps
capabilities.
To describe the number and type of health care Medical Reserve Corps
volunteers by state who may respond to public health emergencies, we
analyzed data provided by ASPR from its Medical Reserve Corps
database on units by state, as well as the District of Columbia, as of
September 2019, which is when ASPR extracted the data based on our
request. 7 According to ASPR officials, data on the number and type of
Medical Reserve Corps volunteers were self-reported by the units in each
state and not independently confirmed by ASPR. To ensure that the data
are accurate, complete, and reliable, ASPR relies on Medical Reserve
Corps unit leaders’ adherence to guidance regarding profile updates and
conducts routine data reviews. ASPR’s data do not include sub-
specialties of provider types, or the status of providers’ credentials or
licenses. To learn more about the number and types of volunteers, we
also reviewed Medical Reserve Corps unit names from ASPR’s data to
identify special capabilities, such as the ability to respond to radiological
emergencies. We obtained additional details on these capabilities from
the Medical Reserve Corps website, as needed. We also reviewed
6Pub. L. No. 116-22, § 208(b), 133 Stat. 905, 929 (2019). We also plan to examine how
states have used health care volunteers to respond to public health emergencies,
including COVID-19, and any associated challenges to doing so in a future report.
7We excluded Medical Reserve Corps units and volunteers in U.S. territories. We also
focused on health care volunteers for humans, and therefore excluded veterinarians and
non-public health non-medical volunteers from our analysis. Medical Reserve Corps units
consisting of only veterinarian volunteers were not included in the total count of Medical
Reserve Corps units.
Page 3 GAO-20-630 Medical Reserve Corps
Medical Reserve Corps program guidance that provides information on
Medical Reserve Corps reporting requirements, interviewed agency
officials, and obtained information from them on how ASPR reviews these
data. We concluded the data were sufficiently reliable for our purposes.
To describe the types of public health emergencies that volunteers have
participated in, we reviewed ASPR documentation for four selected states
on the activities Medical Reserve Corps volunteers in each state
conducted during selected public health emergencies. This
documentation included information reported by the Medical Reserve
Corps units on their responses to public health emergencies, such as the
number of volunteers deployed, the activities performed by the Medical
Reserve Corps volunteers, and the number of hours Medical Reserve
Corps volunteers were deployed.
We chose the four states in our review to provide a variety of examples of
volunteer capabilities in various settings. State selection was based on
population size, the number of Medical Reserve Corps volunteers in the
state, and the types of public health emergencies that occurred in the
state in 2018 and 2019. 8 To the extent possible, we chose states that
experienced the same type of event in 2018 and 2019, such as wildfires
and hurricanes, among others. We also chose states to ensure we
included at least one of each of the following types of declarations: (1) a
public health emergency declared by the Secretary of Health and Human
Services, (2) a major disaster declared by the President under the
Stafford Act, (3) an emergency declared by the President under the
Stafford Act, and (4) a national emergency declared by the President
under the National Emergencies Act. Based on these criteria, we selected
Alabama (tornadoes, Stafford Act major disaster declarations), California
(wildfires, Stafford Act major disaster and emergency declarations, and
public health emergency declaration), New Mexico (border security,
National Emergencies Act declaration), and North Carolina (hurricanes,
8States were divided into large, medium, and small categories based on the size of the
state’s population using U.S. Census Bureau data. The number of Medical Reserve Corps
volunteers in a state was divided into high, medium, and low categories using data
provided by ASPR.
Page 4 GAO-20-630 Medical Reserve Corps
Stafford Act major disaster and emergency declarations, and public
health emergency declaration). 9
For the selected declarations, we reviewed 2018-2019 data reported by
Medical Reserve Corps units in these states to ASPR’s web-based
activity system. ASPR has provided Medical Reserve Corps units
guidance and instructions on how to submit activity information, which is
periodically reviewed by ASPR to determine that units are providing
updated data. We reviewed ASPR’s guidance and instructions, and
interviewed ASPR officials, and determined these data were reliable for
our purposes. Additionally, during the course of our review, states began
responding to the COVID-19 pandemic. As a result, we included Medical
Reserve Corps volunteer participation for the four states in our review and
additional states that responded to the COVID-19 pandemic by deploying
Medical Reserve Corps volunteers. To do so, we reviewed two ASPR
internal reports on Medical Reserve Corps response to COVID-19 by
state, reviewed ASPR data on the number of Medical Reserve Corps
units that have responded, and interviewed ASPR officials to determine
how states have used Medical Reserve Corps volunteers to respond to
COVID-19 in 2020. We judgmentally chose examples of Medical Reserve
Corps volunteers’ activities to give a breadth of activities conducted by
volunteers during the response to COVID-19. The information we
obtained on activities Medical Reserve Corps volunteers conducted
cannot be generalized to all such activities.
To describe how HHS has assisted in the development of Medical
Reserve Corps capabilities, we reviewed ASPR guidance and
documentation it provided to Medical Reserve Corps units, such as a
guide for deployment of volunteers funded by ASPR and generally
accepted practices for success of the Medical Reserve Corps units. We
also interviewed officials from ASPR and the National Association of
County and City Health Officials involved in overseeing Medical Reserve
Corps units. 10 The National Association of County and City Health
9The majority of California’s wildfire events were Fire Management Assistance
declarations. The Federal Emergency Management Agency can approve declarations for
fire management assistance when the Administrator determines that a fire or fire complex
on public or private forest land or grassland threatens such destruction as would constitute
a major disaster. See 44 C.F.R. § 204.21 (2019). We interpreted “event” broadly to include
California’s wildfires that were Fire Management Assistance declarations, as well as those
declared major disasters or emergencies, because Medical Reserve Corps units deployed
volunteers to respond to these events.
10The National Association of County and City Health Officials is an association of local
health departments across the United States.
Page 5 GAO-20-630 Medical Reserve Corps
Officials has a cooperative agreement with ASPR for work related to the
Medical Reserve Corps, such as to award funding to Medical Reserve
Corps units.
We conducted this performance audit from October 2019 to September
2020 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit to
obtain sufficient, appropriate evidence to provide a reasonable basis for
our findings and conclusions based on our audit objectives. We believe
that the evidence obtained provides a reasonable basis for our findings
and conclusions based on our audit objectives.
ASPR, on behalf of the Secretary of Health and Human Services, leads
Background the public health and medical services response for the National
Response Framework during a disaster, emergency, or incident that may
lead to a public health emergency. 11 Per this framework, ASPR’s
responsibility is to coordinate the assistance and associated capabilities
provided in response to an actual or potential public health and medical
disaster or incident, including medical surge support. While local, state,
tribal, and territorial area officials retain primary responsibility for meeting
public health and medical needs, ASPR is responsible for coordinating
with states to integrate federal assets with state plans and assets. This
can include civilian volunteers deployed from local, state, and other
authorities, including those deployed through the Medical Reserve Corps.
11The National Response Framework is an all-hazards response structure to coordinate
federal resources during emergencies and disasters. It divides the federal response into
15 emergency support functional areas that are most frequently needed during a national
response. See Department of Homeland Security, National Response Framework, Fourth
Edition (Washington, D.C.: Oct. 28, 2019), and Emergency Support Function #8 – Public
Health and Medical Services Annex (Washington, D.C.: June 2016).
Page 6 GAO-20-630 Medical Reserve Corps
According to ASPR data, as of September 2019, Medical Reserve Corps
Medical Reserve units in 48 states and the District of Columbia reported 102,767 health
Corps Units Reported care volunteers in 838 units across the United States. 12 The number of
registered health care volunteers per state ranged from 12,014 in New
More Than 100,000 York to 17 in Montana. 13 Units in eight states reported more than 4,500
Volunteers, with registered Medical Reserve Corps health care volunteers, while units in
Nurses Comprising 30 states and the District of Columbia reported fewer than 1,500. The
number of Medical Reserve Corps units also varied by state, ranging from
the Highest one unit each in Montana, North Dakota, and Rhode Island, to 75 units in
Percentage Ohio. See figure 1 and appendix I for more information on the number of
Medical Reserve Corps volunteers and units.
12Alaska and South Dakota did not report any Medical Reserve Corps health care
volunteers as of September 2019. Additionally, there were 75,421 Non-Public Health Non-
Medical volunteers registered in Medical Reserve Corps units. Some Medical Reserve
Corps units may include these volunteers who can provide education, logistics,
communication, coordination, and other support. We did not include these volunteers in
our analysis.
13Medical Reserve Corps volunteers are registered in an electronic system for states that
can be used to verify volunteer credentials.
Page 7 GAO-20-630 Medical Reserve Corps
Figure 1: Medical Reserve Corps Health Care Volunteers by State, as of September 2019
Note: Alaska and South Dakota did not report any Medical Reserve Corps health care volunteers as
of September 2019. Additionally, we excluded veterinarians and Non-Public Health Non-Medical
volunteers from our review. States had a total of 2,619 veterinarians and 75,421 Non-Public Health
Non-Medical volunteers registered in Medical Reserve Corps units as of September 2019. Because
we excluded veterinarians from our review, four Medical Reserve Corps units focused exclusively on
veterinarian services were not included in our analysis.
Page 8 GAO-20-630 Medical Reserve Corps
Our analysis of ASPR data shows that as of September 2019, nurses
comprised 43 percent of the total number of Medical Reserve Corps
health care volunteers, while 10 percent of the Medical Reserve Corps
health care volunteers were physicians. Over 22,000 Other Public Health
Medical volunteers supported these medical providers, including an
unspecified number of cardiovascular technicians, sonographers, and
phlebotomists, among others. See figure 2 for a breakdown of Medical
Reserve Corps health care volunteers by provider type. 14
Figure 2: Medical Reserve Corps Health Care Volunteers by Type, as of September
2019
14ASPR’s data on Medical Reserve Corps as reported by units in each state does not
distinguish among sub-specialties of provider types, such as whether registered mental
health professionals are psychologists or psychiatrists, so we are unable to provide a
further breakdown of volunteers by sub-specialty.
Page 9 GAO-20-630 Medical Reserve Corps
Notes: Other Public Health Medical volunteers may include cardiovascular technicians,
sonographers, and phlebotomists.
We excluded veterinarians and Non-Public Health Non-Medical volunteers from our review. States
had a total of 2,619 veterinarians and 75,421 Non-Public Health Non-Medical volunteers registered in
Medical Reserve Corps units as of September 2019.
Descriptions of some Medical Reserve Corps units on ASPR’s website
indicate that some units provide specialized care such as behavioral
health, radiological, or mortuary services. 15 For example, a Medical
Reserve Corps unit in Arizona is described as being comprised of
specialized behavioral health volunteers skilled in working with survivors
of trauma. Additionally, the Durham Medical Reserve Corps unit in North
Carolina, in partnership with Duke University’s State Medical Assistance
Team, is described as being able to provide decontamination services for
chemical, biological, radiological, nuclear, and explosive events; mass
prophylaxis; mass fatalities management; and care to populations with
special medical needs. 16 ASPR’s website describes other Medical
Reserve Corps units with the ability to provide pediatric, mortuary,
acupuncture, or pharmacological services. Furthermore, in some
communities, the Medical Reserve Corps units were affiliated with
educational institutions including high schools, technical training
programs, and universities, according to ASPR’s website. Also, some
Medical Reserve Corps units serve specific communities, such as the
Colorado Muslim Society, Chicago’s Familia Latina Unida, and units
serving different tribal populations.
15Office of the Assistant Secretary for Preparedness and Response, Medical Reserve
Corps website, unit descriptions accessed from May 4 through May 21, 2020,
https://mrc.hhs.gov/HomePage.
16Duke University Trauma Center, NC 400 State Medical Assistance Team, accessed
May 21, 2020, https://trauma.duhs.duke.edu/disaster-response/nc400-smat.
Page 10 GAO-20-630 Medical Reserve Corps
Our review of ASPR documentation shows that Medical Reserve Corps
Medical Reserve units in selected states deployed volunteers in response to a range of
Corps Volunteers in different events. 17 Specifically, Medical Reserve Corps volunteers in three
of the four states in our review—Alabama, California, and North
Selected States Carolina—deployed to respond to natural disasters in 2018 and 2019.
Deployed in Volunteers in the fourth state, New Mexico, deployed to respond to the
migrant border crossings in 2019. Additionally, Medical Reserve Corps
Response to Natural volunteers in Alabama, California, New Mexico, and North Carolina
Disasters, Migrant deployed to respond to the COVID-19 pandemic in 2020. According to
ASPR data we reviewed, Medical Reserve Corps volunteers from an
Border Crossings, additional 38 states and the District of Columbia deployed in response to
and COVID-19 the COVID-19 pandemic. The following are examples of activities Medical
Reserve Corps volunteers performed in 2018, 2019, and in response to
COVID-19. (See sidebar for information on Medical Reserve Corps
preparedness activities.)
Natural Disasters Alabama tornadoes. ASPR documentation shows that in March 2018,
90 volunteers from one Medical Reserve Corps unit provided over 345
hours of service while deployed in response to a tornado in Jacksonville,
Alabama. These Medical Reserve Corps volunteers operated first aid
stations at local volunteer fire departments and other locations. They also
stocked and inventoried supplies. Volunteers also provided non-health
care services, such as debris cleanup.
In March 2019, a Medical Reserve Corps unit deployed in response to a
tornado in Alabama’s Lee County, ASPR documentation shows. Seventy-
six Medical Reserve Corps volunteers spent 1,150 hours providing a
variety of medical services, including triage, first aid, and medication
verification and replacement. For example, volunteers provided first aid
for citizens, first responders, and workers. The unit also utilized a mobile
unit to deliver services.
17According to ASPR officials, volunteers may have been counted more than once if they
were deployed for multiple activities for the same event.
Page 11 GAO-20-630 Medical Reserve Corps
Examples of Medical Reserve Corps California wildfires. California experienced several wildfires in 2018 and
Preparedness Activities 2019. 18 ASPR documentation showed that Medical Reserve Corps
The Medical Reserve Corps is a network of health volunteers contributed over 15,000 service hours by providing services
care volunteers who can augment federal, state, and
local capabilities when events, such as wildfires and such as medical support at shelters and distributing protective masks in
hurricanes, lead to public health emergencies. 2018. For example, 11 Medical Reserve Corps units deployed 81
Medical Reserve Corps units have conducted
activities to prepare for such emergencies. For
volunteers who provided medical and general shelter support to
example, according to Office of the Assistant evacuees of the Camp Fire wildfire in Butte County in November 2018—
Secretary for Preparedness and Response (ASPR) the most destructive wildfire in California history according to the
documentation, units participated in a variety of
events in fiscal year 2019, including training and California Department of Forestry and Fire Protection. 19 One unit also
educating the public about how to respond to worked with the Sacramento County Coroner’s Office to process human
emergencies.
remains.
According to ASPR documentation, during National
Stop the Bleed Month in May 2019, more than 50
Medical Reserve Corps units participated in or led In fiscal year 2019, Medical Reserve Corps units supported wildfire
Stop the Bleed training events in their communities.
Stop the Bleed is a national initiative that
response efforts by assisting with sheltering operations and providing
encourages the general public to become trained medical care, ASPR documentation shows. For example, during the
and empowered to help reduce deaths from bleeding October Kincade wildfire in Sonoma County, at least 10 Medical Reserve
in emergencies before professional help arrives.
Units also conducted similar personal preparedness Corps volunteers provided 120 hours of service in at least five different
trainings–such as first aid, naloxone administration evacuation shelters.
for opioid overdoses, and active shooter training–for
community audiences throughout the year.
North Carolina hurricanes. ASPR documentation also shows that 135
volunteers from nine North Carolina Medical Reserve Corps units
deployed in response to Hurricane Florence in 2018. These volunteers
set up and provided support at shelters and treatment centers, acute care
treatment centers, and mobile disaster hospitals. In at least one shelter,
the Medical Reserve Corps volunteers received assistance from federal
responders.
Source: National Association of County and City Health Officials. |
GAO-20-630
18Some of these wildfires were Fire Management Assistance declarations, which the
Federal Emergency Management Agency can approve when the Administrator determines
that a fire or fire complex on public or private forest land or grassland threatens such
destruction as would constitute a major disaster. See 44 C.F.R. § 204.21 (2019). If a
wildfire increases in size and intensity in a manner that overwhelms the ability of state,
tribal, territorial, or local governments to respond effectively, a state or tribal government
can request, and the President can approve, a major disaster declaration under the
Stafford Act. See 42 U.S.C. § 5170. The declarations can be found on the Federal
Emergency Management Agency’s website. Federal Emergency Management Agency,
Disasters, accessed January 17, 2020, https://www.fema.gov/disasters.
19Two additional Medical Reserve Corps units deployed volunteers that were outside the
scope of our review. One of these units deployed veterinarian volunteers who participated
in the search and rescue, fairground sheltering, and wellness checks on the animals
affected in the Butte County wildfires, among other activities.
Page 12 GAO-20-630 Medical Reserve Corps
In response to Hurricane Dorian in 2019, 48 North Carolina Medical
Reserve Corps volunteers from four separate units deployed to different
sites around the state, ASPR documentation shows. For example,
volunteers from one unit set up and provided medical care at shelters,
including a shelter established for displaced nursing home and home
health individuals. Volunteers from another Medical Reserve Corps unit
deployed to disaster relief stations and provided first aid.
New Mexico Migrant To assist with the national emergency declared in 2019 concerning the
Border Crossing security of the southern border of the United States, 60 Medical Reserve
Corps volunteers deployed in New Mexico to provide medical assistance,
translation, and operational support at shelters and medical clinics, ASPR
documentation shows. 20 These shelters and medical clinics were set up
by state and local entities to assess the health of migrants who were
apprehended in the United States during the spring 2019 by the
Department of Homeland Security. The Medical Reserve Corps
volunteers provided medical triage, distributed medications, distributed
food, and set up cots for sleep, among other activities, for at least 290
individuals.
COVID-19 Pandemic According ASPR officials, Medical Reserve Corps units have deployed
volunteers in 42 states and the District of Columbia in response to the
COVID-19 pandemic, as of May 26, 2020. According to ASPR
documentation, Medical Reserve Corps volunteers have been conducting
a variety of activities, such as supporting a local health department
epidemiology team with contact tracing for positive COVID-19 cases. 21
Medical Reserve Corps volunteers are also supporting testing sites,
including drive-through testing, by collecting specimens and performing
administrative tasks, such as data entry and screening calls to manage
testing appointments. For example, a Medical Reserve Corps unit in
Georgia deployed four volunteers a day to work alongside district public
health nurses at a drive-through testing site for 3 days in March 2020.
20The President issued Proclamation 9844 on February 15, 2019, which stated that the
situation at the southern border presented a border security and humanitarian crisis that
threatened core national security interests and constituted a national emergency under the
National Emergencies Act. See 84 Fed. Reg. 4,949 (Feb. 20, 2019).
21According to the Centers for Disease Control and Prevention, contact tracing, a core
disease control measure employed by state and local health department personnel, is a
key strategy for preventing further spread of COVID-19. In contact tracing, public health
staff work with a patient to help them recall everyone with whom they have had close
contact during the time frame while they may have been infectious. Public health staff are
then to warn these exposed individuals (contacts) of their potential exposure as rapidly
and sensitively as possible.
Page 13 GAO-20-630 Medical Reserve Corps
These Medical Reserve Corps volunteers also assisted with the logistics
and coordination of setting up a state mobile surge unit at a hospital.
Additionally, Medical Reserve Corps volunteers made reusable face
masks; coordinated the logistics, storage, and delivery of personal
protective equipment and supplies; and screened the population by
performing temperature and symptom checks for visitors at hospitals,
municipal buildings such as a courthouse and jail, and homeless shelters,
among other tasks.
ASPR documentation shows that Medical Reserve Corps units have
registered additional volunteers in response to COVID-19. For example,
after a call for volunteers from the Mayor of the District of Columbia in
March 2020, over 3,000 registrations were received for that unit as of
April 2020. As of May 5, 2020, the District of Columbia had more than
4,800 registered volunteers. Another Medical Reserve Corps unit in
Allegheny County, Pennsylvania, had 425 registered volunteers as of
September 2019, ASPR data show. ASPR’s documentation showed the
same unit received more than 300 new volunteer registrations by the end
of March 2020—an almost 71 percent increase.
ASPR has provided resources to assist Medical Reserve Corps units in
ASPR Has Assisted developing their volunteer capabilities by issuing a guide and other
Medical Reserve information to assist with the recruitment, retention, and deployment of
volunteers. Specifically, ASPR has provided the following resources to
Corps Units in Medical Reserve Corps units:
Developing Volunteer
Deployment readiness guide. ASPR provided funding for the
Capabilities •
National Association of County and City Health Officials to develop
and publish a 2019 Deployment Readiness Guide that created a
national recommended standard for volunteer deployment readiness
for Medical Reserve Corps units. While allowing for modification to fit
the unique missions of each unit, the guide contains a common set of
tools for Medical Reserve Corps unit leaders to use to develop the
capabilities of their Medical Reserve Corps volunteers to support
medical and public health emergency responses. For example, the
guide includes a checklist of activities that should occur during the
phases of a deployment—pre-deployment, deployment, and post-
deployment—such as re-verifying volunteers’ medical credentials and
ensuring that necessary equipment and resources are available. The
guide also includes sample Mission Sets, which the Medical Reserve
Page 14 GAO-20-630 Medical Reserve Corps
Corps unit leaders can use to demonstrate their units’ capabilities. 22
For example, a Mission Set for medical surge—that is, volunteers who
could provide both clinical and non-clinical support to hospitals and
clinics after a public health emergency—contains information such as
whether volunteers are required to be licensed or certified; the type of
volunteer that should be part of the response, such as a physician or
nurse; and training required, such as an annual exercise on triage
procedures within the facility. According to officials from the National
Association of County and City Health Officials, the Mission Set is a
way to standardize information on unit capabilities and can be used by
ASPR to determine the number of units that have developed a
particular capability.
• Training resources. ASPR also provided webinars and other training
resources to assist local Medical Reserve Corps units with recruiting
and retaining volunteers to build unit capabilities. According to ASPR
officials, ASPR Regional Liaisons have facilitated new leader
orientation that provides an overview of the program, the duties and
responsibilities of unit leaders, and resources available to help unit
leaders develop, manage, and sustain their Medical Reserve Corps
units; coordinated calls with state Medical Reserve Corps
coordinators; and conducted workgroups on Medical Reserve Corps
priority areas, such as the use of the Emergency Management
Assistance Compact. 23 See appendix II for more information on the
Emergency Management Assistance Compact.
• Generally accepted practices. In February 2017, ASPR issued
generally accepted practices associated with volunteer or non-profit
organizations. According to ASPR documentation, these practices
can, among other things, help Medical Reserve Corps units enhance
their capacity to assist their communities, including when preparing for
and responding to public health emergencies. For example, these
22According to officials from the National Association of County and City Health Officials,
the Mission Set was introduced in August 2019. Officials do not know the number of
Medical Reserve Corps units that have completed a Mission Set, but said they have heard
that some Medical Reserve Corps units are using the tool. Officials had planned to
conduct a workshop on the 2019 Deployment Readiness Guide, including the Mission Set,
but have had to reschedule because of the COVID-19 pandemic.
23The Emergency Management Assistance Compact is a congressionally ratified
interstate mutual aid mechanism that is supported through legislation enacted by all 50
states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the
Commonwealth of the Northern Mariana Islands. See Pub. L. No. 104-321, 110 Stat. 3877
(1996). The Emergency Management Assistance Compact established a structure for
participating states to request and deploy assistance, reimburse states that provide
assistance, and confer liability and workers’ compensation protections.
Page 15 GAO-20-630 Medical Reserve Corps
practices include the expectation that Medical Reserve Corps units
will develop a volunteer retention and recognition program and the
unit will periodically re-evaluate its volunteer recruitment procedures
in accordance with changes in community needs or Medical Reserve
Corps unit capabilities.
• Technical assistance. ASPR Regional Liaisons have provided
technical assistance to Medical Reserve Corps units, such as
conducting assessments of Medical Reserve Corps unit capabilities,
according to ASPR officials. Additionally, according to ASPR officials,
Regional Liaisons may help Medical Reserve Corps units identify
potential partners the units may want to work with, such as
universities and schools of nursing.
ASPR has also provided states guidelines to develop and maintain their
volunteer registration systems, called the Emergency System for Advance
Registration of Volunteer Health Professionals (ESAR-VHP). ESAR-VHP
can be used by a state to register and verify credentials of potential health
professional responders, including the credentials of Medical Reserve
Corps volunteers and other volunteers who can be called upon in case of
a public health emergency. 24 See appendix III for information on ESAR-
VHP requirements.
We provided a draft of this report to HHS for review and comment. HHS
Agency Comments provided technical comments, which we incorporated as appropriate.
We are sending copies of this report to the appropriate congressional
committees and the Secretary of Health and Human Services. In addition,
the report is available at no charge on the GAO website
at https://www.gao.gov.
If you or your staff have any questions about this report, please contact
me at (202) 512-7114 or DeniganMacauleyM@gao.gov. Contact points
for our Offices of Congressional Relations and Public Affairs may be
24See 42 U.S.C. § 247d-7b.
Page 16 GAO-20-630 Medical Reserve Corps
found on the last page of this report. GAO staff who made key
contributions to this report are listed in appendix IV.
Mary Denigan-Macauley
Director, Health Care
Page 17 GAO-20-630 Medical Reserve Corps
Appendix I: Medical Reserve Corps Unit Appendix I: Medical Reserve Corps Unit Health
Care Volunteers, by State, as of September
Health Care Volunteers, by State, as of
2019
September 2019
The Medical Reserve Corps is a national network of local health care and
other volunteers who can strengthen public health, reduce vulnerability,
build resilience, and improve preparedness, response, and recovery
capabilities. Medical Reserve Corps units support community public
health missions, participate in local and regional exercises across the
nation, and respond during federal, state, local, and tribal public health
emergencies. In addition to responding to public health emergencies,
Medical Reserve Corps health care volunteers assist with activities to
improve public health in their communities, such as increasing health
literacy, supporting prevention efforts, and eliminating health disparities.
Medical Reserve Corps health care volunteers can assist with activities
including health screenings, vaccination clinics, disaster medical support,
and first aid during large public gatherings.
The Office of the Assistant Secretary for Preparedness and Response
(ASPR) in the Department of Health and Human Services collects
information on units by state, as well as the District of Columbia, in its
Medical Reserve Corps database. According to agency officials,
information on health care volunteers is self-reported by units in each
state and not independently confirmed by ASPR. See table 1 for ASPR’s
information on the number of Medical Reserve Corps health care
volunteers by provider type and state as of September 2019, which is
when ASPR extracted the data based on our request.
Table 1: Medical Reserve Corps Unit Health Care Volunteers, by State, as of September 2019
Provider type
Other
public
Mental Respiratory health
State Dentist EMS health NP Nurse PA Pharmacist Physician therapist medicala Total
Alabama 96 206 116 61 1,205 25 87 545 83 2,079 4,503
Alaska 0 0 0 0 0 0 0 0 0 0 0
Arizona 5 85 179 65 279 11 44 84 5 116 873
Arkansas 3 17 6 4 51 6 13 17 2 50 169
California 53 872 240 186 3,206 189 303 718 101 2,143 8,011
Colorado 3 77 67 17 206 15 7 58 1 196 647
Connecticut 47 134 50 61 818 19 29 156 2 370 1,686
Delaware 4 29 35 16 431 1 26 28 4 347 921
District of
Columbia 0 137 0 3 83 21 15 83 1 175 518
Florida 19 244 143 163 1,068 48 96 306 47 588 2,722
Page 18 GAO-20-630 Medical Reserve Corps
Appendix I: Medical Reserve Corps Unit Health
Care Volunteers, by State, as of September
2019
Provider type
Other
public
Mental Respiratory health
State Dentist EMS health NP Nurse PA Pharmacist Physician therapist medicala Total
Georgia 9 125 76 67 756 38 58 140 28 429 1,726
Hawaii 8 7 7 15 208 5 98 26 5 156 535
Idaho 7 160 131 33 655 20 35 27 21 733 1,822
Illinois 47 232 154 92 1,669 21 68 213 20 335 2,851
Indiana 21 74 27 36 693 1 35 46 5 227 1,165
Iowa 1 54 55 11 161 1 10 3 2 48 346
Kansas 0 18 15 5 124 2 5 2 2 50 223
Kentucky 22 207 30 74 917 27 52 62 8 196 1,595
Louisiana 16 138 32 14 381 10 23 154 13 360 1,141
Maine 0 16 10 4 63 1 3 10 0 31 138
Maryland 68 279 452 153 2,420 73 671 639 64 735 5,554
Massachusetts 36 611 255 162 2,694 37 120 316 29 2,145 6,405
Michigan 4 152 41 14 310 11 18 25 8 114 697
Minnesota 17 278 339 35 1,557 9 101 153 15 1,352 3,856
Mississippi 0 57 17 23 229 1 15 17 4 74 437
Missouri 9 221 39 38 713 7 52 65 25 171 1,340
Montana 0 3 0 0 12 0 0 1 0 1 17
Nebraska 1 109 16 6 198 4 6 14 0 20 374
Nevada 1 46 17 10 171 8 12 20 7 48 340
New
Hampshire 4 69 24 15 176 7 15 10 3 62 385
New Jersey 47 306 101 102 1,670 17 109 265 22 317 2,956
New Mexico 5 119 49 13 108 20 11 48 4 82 459
New York 338 799 1,938 549 3,999 328 423 2,349 81 1,210 12,014
North Carolina 2 430 25 19 514 36 35 122 20 219 1,422
North Dakota 11 286 93 35 590 9 12 27 13 83 1,159
Ohio 40 433 262 107 2,937 38 224 236 39 2,006 6,322
Oklahoma 10 348 415 167 2,736 37 62 110 23 502 4,410
Oregon 6 153 49 59 659 17 44 212 11 158 1,368
Pennsylvania 27 309 135 69 975 83 141 363 13 1,231 3,346
Rhode Island 5 527 54 30 450 18 67 80 7 170 1,408
South Carolina 5 48 68 26 299 3 15 33 18 40 555
South Dakota 0 0 0 0 0 0 0 0 0 0 0
Tennessee 38 190 54 83 1,257 22 103 196 11 319 2,273
Page 19 GAO-20-630 Medical Reserve Corps
Appendix I: Medical Reserve Corps Unit Health
Care Volunteers, by State, as of September
2019
Provider type
Other
public
Mental Respiratory health
State Dentist EMS health NP Nurse PA Pharmacist Physician therapist medicala Total
Texas 33 298 262 107 1,740 91 82 1,407 24 971 5,015
Utah 12 273 43 33 354 10 51 73 5 160 1,014
Vermont 0 49 10 15 131 3 2 20 2 55 287
Virginia 58 228 264 182 2,437 37 232 180 29 1,056 4,703
Washington 22 130 97 85 1,059 27 51 161 5 368 2,005
West Virginia 12 78 18 23 515 10 48 48 7 108 867
Wisconsin 0 35 4 0 61 5 5 4 0 34 148
Wyoming 0 11 12 0 10 0 2 1 0 3 39
Total 1,172 9,707 6,526 3,087 43,955 1,429 3,736 9,873 839 22,443 102,767
Legend:
EMS = emergency medical services
NP = nurse practitioner
PA = physician assistant
Source: GAO analysis of Office of the Assistant Secretary for Preparedness and Response data. | GAO-20-630
Note: We excluded veterinarians and Non-Public Health Non-Medical volunteers from our review.
States had a total of 2,619 veterinarians and 75,421 Non-Public Health Non-Medical volunteers
registered in Medical Reserve Corps units as of September 2019. Additionally, Medical Reserve
Corps units and volunteers in U.S. territories are not included in this analysis.
a
Other Public Health Medical volunteers may include cardiovascular technicians, sonographers, and
phlebotomists.
See table 2 for the number of Medical Reserve Corps units by state as of
September 2019.
Table 2: Number of Medical Reserve Corps Units by State, as of September 2019
State Medical Reserve Corps units
Alabama 8
Alaska 0
Arizona 13
Arkansas 9
California 38
Colorado 18
Connecticut 23
Delaware 4
District of Columbia 5
Florida 24
Georgia 18
Page 20 GAO-20-630 Medical Reserve Corps
Appendix I: Medical Reserve Corps Unit Health
Care Volunteers, by State, as of September
2019
State Medical Reserve Corps units
Hawaii 4
Idaho 7
Illinois 71
Indiana 26
Iowa 15
Kansas 8
Kentucky 37
Louisiana 6
Maine 8
Maryland 7
Massachusetts 38
Michigan 16
Minnesota 23
Mississippi 5
Missouri 29
Montana 1
Nebraska 6
Nevada 4
New Hampshire 13
New Jersey 24
New Mexico 9
New York 29
North Carolina 16
North Dakota 1
Ohio 75
Oklahoma 32
Oregon 14
Pennsylvania 10
Rhode Island 1
South Carolina 5
South Dakota 0
Tennessee 13
Texas 32
Utah 14
Vermont 8
Virginia 24
Washington 23
Page 21 GAO-20-630 Medical Reserve Corps
Appendix I: Medical Reserve Corps Unit Health
Care Volunteers, by State, as of September
2019
State Medical Reserve Corps units
West Virginia 12
Wisconsin 8
Wyoming 4
Total 838
Source: GAO analysis of Office of the Assistant Secretary for Preparedness and Response data. | GAO-20-630
Note: Four Medical Reserve Corps units focused exclusively on veterinarian services. We excluded
veterinarians from our review; therefore, these Medical Reserve Corps units are not included in the
table.
Page 22 GAO-20-630 Medical Reserve Corps
Appendix II: Mechanisms for Licensure
Appendix II: Mechanisms for Licensure
Coverage between States
Coverage between States
States have responded to public health emergencies in recent years—
such as those arising from natural disasters, infectious diseases, and
other events—through deployment of health care volunteers within their
state and across state lines when needed. The federal government can
waive state licensing requirements for the purposes of federal
programs—Medicare, Medicaid, and the Children’s Health Insurance
Program—if the Secretary of Health and Human Services has declared a
public health emergency and the President has declared an emergency
or major disaster under the Robert T. Stafford Disaster Relief and
Emergency Assistance Act or a national emergency under the National
Emergencies Act. 1 Outside of these federal programs, deployment of
health care volunteers across state lines has raised issues related to
licensure coverage.
For health care professionals deployed across state lines, there are
mechanisms that allow for the recognition of out-of-state licenses. The
Emergency Management Assistance Compact is a congressionally
ratified interstate mutual aid mechanism that is supported through
legislation enacted by all 50 states, the District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands, and the Commonwealth of the Northern
Mariana Islands. 2 The compact established a structure for states to
request and deploy assistance, reimburse states that provide assistance,
and recognize out-of-state licenses and permits, among other things. The
compact only applies to the sharing of state resources and personnel,
such as health care professionals employed by the state, and does not
apply to private sector health care volunteers. Therefore, coverage for
professional licensure under the compact does not apply to these private
sector volunteers. States must take action, either through legislation,
executive order, or another mechanism, to extend licensure coverage to
private sector public health and medical volunteers deployed to another
state. According to National Emergency Management Association
officials, some states are unable to deploy private sector volunteers
across state lines because the states do not have enabling legislation
allowing them to do so. 3 However, they can send state officials, such as
1See 42 U.S.C. § 1320b-5(b)(2). This codifies section 1135 of the Public Health Service
Act; waivers under this section are commonly referred to as “section 1135 waivers.”
2See Pub. L. No. 104-321, 110 Stat. 3877 (1996).
3The National Emergency Management Association is a professional association of
emergency management directors from all 50 states, eight U.S. territories, and the District
of Columbia. The association works on the implementation of the Emergency
Management Assistance Compact and integration of non-state resources into the
Emergency Management Assistance Compact process, among other things.
Page 23 GAO-20-630 Medical Reserve Corps
Appendix II: Mechanisms for Licensure
Coverage between States
state-employed health care professionals, according to Department of
Health and Human Services documentation. Mechanisms that may allow
for the deployment of materials and volunteers across state lines include
a memorandum of understanding, memorandum of agreement, governor
executive order, intergovernmental agreement, contract, and legislation.
National Emergency Management Association officials said legislation is
the preferred enabling mechanism because it helps to establish
procedure and protocol for how to respond during a public health
emergency. According to the National Emergency Management
Association, as of April 2020, 12 states and the District of Columbia do
not have sufficient authority to deploy volunteer resources across state
lines. Of the states with such authority, 29 have legislation as the
enabling mechanism, two use policy, 13 have a memorandum of
agreement, and eight have a governor executive order, according to the
National Emergency Management Association. 4
In March 2020, the Secretary of Health and Human Services sent a letter
to states recommending that they use mechanisms for the Coronavirus
Disease 2019 (COVID-19) response that allow licensed health care
professionals to provide aid in another state without being licensed in that
state. According to the National Conference of State Legislatures, as of
April 16, 2020, 44 states have taken action related to licensure for the
COVID-19 response.
4The categories of enabling mechanisms are not mutually exclusive and will not add to 38
as some states use multiple mechanisms, according to the National Emergency
Management Association. For example, Colorado uses legislation, memorandum of
agreement, and a governor executive order.
Page 24 GAO-20-630 Medical Reserve Corps
Appendix III: The Emergency System for
Appendix III: The Emergency System for
Advance Registration of Volunteer Health
Advance Registration of Volunteer Health
Professionals
Professionals
The Public Health Security and Bioterrorism Preparedness and Response
Act of 2002 created a state-based system—the Emergency System for
Advance Registration of Volunteer Health Professionals (ESAR-VHP)—to
collect and verify information on the identity, licensure status, privileges,
and credentials of medical volunteers, including those from Medical
Reserve Corps units. 1 The ESAR-VHP program was created to support
states and territories in establishing standardized volunteer registration
programs for public health emergencies. According to the Department of
Health and Human Services’ Office of the Assistant Secretary for
Preparedness and Response (ASPR), which manages the ESAR-VHP
program at the federal level, volunteers’ identities, licenses, credentials,
accreditations, and hospital privileges are all verified in advance of an
emergency by registering through ESAR-VHP.
ASPR has provided guidelines on the data elements that are required in
each state’s ESAR-VHP system. ASPR guidelines require that the
volunteer’s name, address, contact information, and occupation specific
credentials and the data needed to verify them—such as the name on a
license, license number, and the date of expiration—be included in the
state’s ESAR-VHP system. ASPR guidelines also require that a state’s
ESAR-VHP system be able to record all volunteer health professional and
emergency preparedness affiliations of an individual, including local,
state, and federal entities. 2
According to ASPR guidelines, to make the most effective use of health
care volunteers who may have varying levels of clinical competency, the
ESAR-VHP program has developed a uniform process for classifying and
assigning volunteers into one of four credential levels, based on the
credentials provided and verified:
• Level 1: Identifies volunteers who are clinically active in a hospital,
either as an employee or by having hospital privileges.
• Level 2: Identifies volunteers who are clinically active in a wide variety
of settings, such as clinics, nursing homes, and shelters.
1Pub. L. No. 107-188, § 107, 116 Stat. 594, 608 (2002) (codified, as amended, at 42
U.S.C. § 247d-7b).
2The purpose of this requirement is to avoid the potential confusion that may arise from
having a volunteer appear in multiple registration systems, such as Medical Reserve
Corps units and the National Disaster Medical System. Public health and medical
responders registered through the National Disaster Medical System include doctors,
nurses, and paramedics.
Page 25 GAO-20-630 Medical Reserve Corps
Appendix III: The Emergency System for
Advance Registration of Volunteer Health
Professionals
• Level 3: Identifies volunteers who meet the basic qualifications
necessary to practice in the state in which they are registered.
• Level 4: Identifies volunteers who have health care experience or
education that would be useful for assisting clinicians and providing
basic health care not controlled by the scope of practice laws (may
include health profession students or retired health professionals who
no longer hold a license).
According to ASPR officials, ESAR-VHP systems are not connected
between states, and are not able to communicate across systems.
However, ESAR-VHP program guidelines standardize the data elements
for licensing and credentialing nationally, and because the systems all
use the same data definitions, ASPR considers ESAR-VHP to be
interoperable.
Page 26 GAO-20-630 Medical Reserve Corps
Appendix IV: GAO Contact and Staff
Appendix IV: GAO Contact and Staff
Acknowledgments
Acknowledgments
Mary Denigan-Macauley, (202) 512-7114 or
GAO Contact DeniganMacauleyM@gao.gov.
In addition to the contact named above, Kelly DeMots (Assistant
Staff Director), Sarah Resavy (Analyst-in-Charge), Anne Hopewell, and William
Acknowledgments Horowitz made key contributions to this report. Also contributing were
Sam Amrhein, Kaitlin Farquharson, Rich Lipinski, Diona Martyn, and Vikki
Porter.
(103899)
Page 27 GAO-20-630 Medical Reserve Corps
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