The opioid crisis in the United States was declared a public health emergency in 2017 and remains one of the most devasting health challenges of the 21st century. The Medical Reserve Corps (MRC) is on the front lines of the battle in communities across the U.S. In 2024, local MRC units in 43 states and territories engaged in activities that aimed to prevent opioid abuse, enhance community education and training around the risk of opioids, and reduce the number of opioid-related deaths.

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Arkansas and Ohio 
April 2024   

On April 8, 2024, the skies darkened as a total solar eclipse cast its shadow across the United States. While millions gazed in awe at the rare event, three health care coalitions (HCCs)—the West Central Ohio Healthcare Preparedness (WCO HCC), the Central Ohio HCC, and Arkansas' Northcentral HCC—worked diligently behind the scenes to prepare their communities were an emergency or disaster to strike during the eclipse.

As thousands of people traveled to areas with higher eclipse visibility, preparation was key to supporting local communities. Central to this preparation were HCCs, networks of local health care and response organizations partnering to support emergency response. ASPR's Hospital Preparedness Program (HPP) supports the WCO, Central Ohio, and Northcentral Arkansas HCCs, along with hundreds of others across the nation. With the support of HPP funding and guidance, HCCs unite health care and emergency response partners to prepare for, respond to, and recover from threats and emergencies by emphasizing a comprehensive, community-focused approach. HCCs also use HPP funding to invest in preparedness and response resources like patient tracking dashboards and mobile broadband kits. As the nation prepared for the rare solar event, HCCs and their partners assembled plans, protocols, and resources to prioritize the safety of all residents and visitors. 

To prepare for an influx of over 1.5 million visitors across Ohio, the WCO HCC and the Central Ohio HCC organized, planned, and collaborated with partners. Both coalitions focused on preparing their regions to handle the expected surge of visitors and any potential disruptions. Their efforts, which began more than two years prior to the eclipse, involved numerous health care organizations, emergency management agencies, local health departments, and other key partners. 

To prepare, the WCO HCC drew upon lessons from past emergencies, such as the 2019 Memorial Day Tornados and the Oregon Dis trict Shooting. The HCC organized multiple meetings, assessments, and exercises, including presentations on previous eclipse events, a meeting with representatives from major broadband companies, and county-specific Incident Action Planning Templates to inform placement of staff and resources. On the day of the eclipse, every county in West Central Ohio opened or partially opened its Emergency Operations Center. Using the Ohio Emergency Management Agency Ohio-Specific Eclipse Event Dashboard, the WCO HCC used technology that tracked planned events and real-time traffic, ensuring that resources were optimally allocated should an emergency occur. The careful planning combined with increased technological capabilities enabled the WCO HCC to handle an influx of visitors without disrupting day-to-day health care services.

Similarly, the Central Ohio HCC proactively tackled logistical challenges, such as adjusting staffing schedules and ensuring early resource deliveries to minimize disruptions during the eclipse. They pre-positioned mobile clinics in key counties to bolster health care capabilities and provided extensive public messaging to manage visitor expectations and traffic. The Central Ohio HCC used statewide patient tracking dashboards, which prompted all hospitals in the area to report bed availability data twice daily. They also held calls with planning partners to share new information and address emerging issues in real time, prioritizing situational awareness among all involved parties before, during, and after the event. 

Meanwhile, Arkansas' Northcentral HCC demonstrated a comprehensive and collaborative effort in preparing for the eclipse. Their efforts, too, began months in advance and focused on community engagement and education, along with distributing resources in key locations. HCC representatives conducted over 20 workshops and training sessions across the state, educating the public on eclipse safety and preparedness and outlining additional resources available. The HCC also coordinated with local clinics, positioning mobile medical units in areas of Arkansas expected to experience high visitor traffic . They further used their mobile communications trailer – a resource purchased with HPP funds – as a mobile command center. The mobile command center provided advanced communication capabilities, including a secure network for voice and data communications, automatic dispatch consoles, and radio capability, all of which helped the Coalition, and its partners have continuous connectivity even if traditional networks failed.  

Taken together, the WCO HCC's use of the Ohio Emergency Management Agency's dashboard and Arkansas' Northcentral HCC's deployment of a mobile command center showcased the roles of technological integration and resource allocation in mitigating potential crises during the eclipse. This, long with the HCCs' proactive public education and coordination with local agencies created a blueprint for managing future mass gatherings and events.   

The solar eclipse was more than just a special event; it was an example of the power of HCCs. Enabled by HPP guidance and funding, these HCCs established key partnerships, built comprehensive preparedness plans and community education efforts, and coordinated resources to mitigate potential surge or interruption in communication. The coalitions' efforts will continue to support and inform future mass-gathering planning and response efforts. The Ohio and Arkansas coalitions' stories highlight the importance of HCCs as a leader of community-centered disaster planning, collaboration, and resource allocation.  

Los Angeles County, California
September 2023 

When extreme weather threatens power infrastructure stability and elevates wildfire risk, power utilities in California initiate public safety power shutoffs. Triggered by conditions such as high winds, dry vegetation, and extreme heat, these shutoffs are a proactive measure to reduce the likelihood of catastrophic fires. During these power shutoffs, hospital operations can be severely affected. To adequately prepare health care facilities during these times of crisis, the Los Angeles County Health Care Coalition (LA HCC) created the Healthcare Facility Emergency Power Resilience Playbook. The playbook provides practical guidance and resources to help health care facilities maintain patient care during power disruptions.

The LA HCC is a health care coalition that receives funding and guidance from the Administration for Strategic Preparedness and Response (ASPR) Hospital Preparedness Program. With support from the Hospital Preparedness Program, the LA HCC establishes partner networks, coordinates health care and emergency response, and participates in regularly required trainings and exercises. The coalition collaborates with over 1,000 partner organizations, including public health, health care, and government entities, as well as nontraditional partners like power and fuel companies, to strengthen local readiness ahead of disasters and emergencies.

In 2019, the LA HCC used Hospital Preparedness Program funding to launch a multi-year emergency power preparedness initiative to assess health care entities’ ability to operate during power disruptions, with the goal of addressing power challenges proactively. California, especially Los Angeles County, frequently experiences power outages due to seasonal weather events, high energy demands, and an aging power grid. Power outages affect more than just heating, cooling, and electricity – they also impact the use of medical equipment like dialysis machines, ventilators, and electrocardiogram machines. Additionally, power outages pose challenges to accessing patient medical records, performing surgeries, and maintaining a safe and temperature-controlled environment for patients and medications. Preparing for and responding to power outages is crucial in order to limit disruptions to patient care and protect the most vulnerable patients during emergencies.

The LA HCC serves several types of communities across the county, each of which experiences unique challenges during power outages. While some areas are urban and dense with minimal storage for generators and fuel, other areas are rural with limited accessibility for resource distribution. Some hospitals, dialysis centers, and long-term care facilities have robust, redundant emergency power systems, while others lack a backup generator. To address these challenges, the LA HCC developed an efficient and adaptable plan to help all types of health care entities prepare for and respond to power emergencies.

In 2023, the LA HCC published the Healthcare Facility Emergency Power Resilience Playbook to address gaps identified through the power preparedness initiative. The playbook details promising practices for safeguarding emergency power and provides recommended protocols for power outages. To develop this playbook, the LA HCC established and led the Emergency Power Resilience Work Group, which brought together members of the energy and health care sectors, including hospitals, skilled nursing facilities, and local power providers. The group created comprehensive protocols for each phase of the emergency management planning and operational continuum, including assessment, mitigation, response, and recovery. The playbook’s actionable guidance and resources, such as checklists, assessment tools, and tabletop exercises, help every partner understand their role in maintaining patient care during power disruptions.

This unified, community-based approach represents the health care coalition model in action. By building and maintaining partnerships with health care entities across the county, the LA HCC knew the right people to bring together to identify and mitigate a threat to the public’s health. As a result of this effort, LA HCC member organizations and community partners are equipped with the resources, tools, and protocols they need to assess vulnerabilities, implement mitigation strategies, and respond effectively so that health care entities can continue to provide critical services when the power goes out, minimizing the impact of unpredictable outages on patient care.

The LA HCC’s approach to power outage planning provides a proactive, collaborative, and adaptable framework for maintaining patient care during emergencies. By developing the Healthcare Facility Emergency Power Resilience Playbook, the LA HCC not only addressed the immediate challenges posed by power disruptions but also set a model for local preparedness and resilience. Hospital Preparedness Program funding empowered the LA HCC to bring the right partners together to solve an urgent, local challenge and protect the public’s health through meaningful, lasting partnerships.

Soon after Hurricane Idalia swept through north-central Florida, a team of health care providers from the National Disaster Medical System (NDMS) walked into the emergency department at Doctor's Memorial Hospital in Perry, Florida. The emergency department was the only area within the hospital still treating patients, and they were at capacity with very few hospital staff available after the storm.

"We can breathe now," said one of the nurses. "They are here to help."

At the request of state health officials, the Administration for Strategic Preparedness and Response deployed 14 NDMS personnel – including doctors, nurses, paramedics, and safety and administrative personnel – to this small, rural hospital to help care for the community. Most of the hospital's staff were personally affected by the hurricane and could not report for duty. In situations like this, NDMS support becomes vital.

"We have the training and experience to treat almost anything that walks through the door," said Dr. Alisa Roberts, one of the NDMS emergency physicians who arrived in Perry to help.

The team worked alongside hospital staff to treat 325 patients in eight days. Many patients arriving at the emergency department had minor injuries or illnesses. Several patients required care that normally would be beyond the services available at a small, rural hospital. Instead of transferring them to Tallahassee, away from their homes and family, the expertise of the DMAT providers allowed the patients to be treated onsite and discharged quickly. Here are their stories. (Names have been changed to protect patient privacy.)

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‘Patrick', an older adult, came to the hospital in distress with a wooden toothpick lodged in his airway. Wooden objects don't routinely appear in X-rays, making removal more difficult. In such situations, a small, rural hospital would likely air transport the patient to a regional hospital for removal. Dr. Roberts didn't want to wait because the foreign body might move and entirely obstruct the patient's ability to breathe. Waiting also would increase the risk of infection and the possibility of an airway perforation. Pulling the team together, Dr. Roberts sedated the patient with the help of NDMS Nurse Scott Kress and used a video laryngoscopy to visualize the foreign body and retrieve it using a pair of forceps. The patient was placed on antibiotics and discharged without having to transport him away from his community.

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'Lisa,' a woman in her 50s, arrived at the hospital in the evening. She had fallen and was complaining about head and chest pain. Concerned about a possible blood clot, the doctor ordered a CT scan. However, they could not digitally transfer the image for interpretation due to inconsistent power issues. With NDMS onsite and a CT scan in hand, Dr. Roberts could read the CT imagery. She confirmed no blood clot in the brain and chest, allowing the patient to avoid an unneeded and costly transport to Tallahassee and preserving limited EMS resources.

Evelyn, a 15-month-old having an allergic reaction to medication, was brought to the hospital by ambulance. Although EMS had administered epinephrine and diphenhydramine to relieve breathing symptoms, an antihistamine blocker was needed to provide additional relief and help prevent symptoms from returning. Without access to the proper child-size medication dosage, NDMS members worked with what they had in the field.

"Working in austere environments is challenging and requires innovative thinking," explained NDMS Supply Management Lead Steven Kress. "With no access to an onsite pharmacist, we called on our NDMS pharmacist who was working at another location. We explained what medication was available at the hospital and what we had in our own cache of medical supplies. With his help, we were able to prepare a pediatric dosage using the only medication available at the hospital."

To help administer the medication, the NDMS team used an apple banana smoothy from within its cache of MREs (Meals Ready to Eat). Evelyn drank the smoothy, and even asked for more. Later that day, she left the hospital with a souvenir, the MRE that helped relieve her symptoms and keep her out of the hospital.

Sarah, a middle-aged woman, presented with a complicated forearm fracture that needed to be aligned and splinted. In larger hospitals, an orthopedic or emergency physician would be available to set the arm while another doctor would administer and monitor sedation. However, most rural hospitals do not have this level of expertise inhouse. The NDMS team stepped in. With expertise in reducing and splitting fracture bones and extra staff to administer and monitor sedation, the fracture was stabilized for later treatment by a specialist. The patient was discharged locally so she could return home that afternoon.

"DMAT is one of the best kept secrets in our emergency response system," said Lauren Faison-Clark, interim CEO for Doctor's Memorial Hospital. "They swooped in immediately after Idalia and offered critical support. They allowed us to take care of our community and our staff who were suffering their own personal crises."

According to Ashley Biddy, director of nursing at Doctor's Memorial Hospital, DMAT has been a lifesaver to our staff and patients. "Post-storm we saw a surge of patients with injuries related to storm clean up. The patients and our staff were so complimentary of the DMAT's expertise and help with patient experience. They immediately merged into our facility and became family."

Georgia and HHS Region 4
April, 2023 

Small-town Georgia is a peaceful place away from the hustle and bustle of big cities. But when disaster strikes, tranquil rural life can be scary because lifesaving care is far away.

In April 2023, local EMS providers in rural Georgia received a 911 call about a suspected case of food poisoning. However, by the time that the emergency medical technicians (EMTs) arrived on the scene, what they saw was far from a simple case of food poisoning. One patient was unconscious, and two others were displaying symptoms indicative of a far more serious, life-threatening problem. It was a case of phosphene gas exposure, which threatened both patient and responder health and safety.

Thus, the race against the clock kicked off, where the patients needed to be transported to receive medical care before it was too late. 

The SRDRS in Atlanta, Georgia, a part of ASPR’s Regional Disaster Health Response System, anticipated rural health crises like this and has been developing, implementing, and scaling their tele-EMS system to increase access to care and the speed it is provided. This initiative has been supported in part by ASPR funding, allowing the SRDRS to expand coverage of the network to communities across Georgia. Due to this system, cases like the phosphene gas exposure can be quickly identified and treated through the tele-EMS system.

The tele-EMS system virtually connects the EMS clinicians in an ambulance with expert clinicians that may not be available locally. The experts then help diagnose the patient and guide the care EMS provides, while simultaneously coordinating with receiving facilities to ensure their care teams are prepared to provide the right treatment. This system enables local, rural EMS and medical facilities to save valuable time and improve patient outcomes, expanding patient access to a higher level of care through virtual coordination.

Without this system the EMTs, likely unaware of how to properly provide care, would rush the patients to a farther-away, larger hospital with more expertise than is available at a closer rural hospital. That transport could take hours and waste valuable time that could otherwise be used to provide care as the clock races for the patient.

The Phosphene Gas Case

When EMTs arrived at the scene in rural Georgia they discovered one severely ill patient and two in stable but guarded condition. The SRDRS’ tele-EMS system helped them get a head start in their race against the clock to stabilize these patients and get them to definitive care. 

The EMTs were able to connect with toxicologists in Atlanta who helped determine that the incident was not food poisoning as initially suspected, but actually a phosphene gas exposure that resulted from snake poison placed inside a home two days earlier. The nature of a gas exposure posed a potential hazard to the EMTs and other first responders and required a different, more complex course of treatment. The virtual experts helped direct the on-scene response, instructing the EMTs on how to protect themselves when entering the building. Even a world-renowned expert on phosphene gas exposure, located in India, connected with the rural EMTs to guide their response.

As the patients were transported to their local hospital, the same experts – connected through tele-EMS – advised the receiving hospital staff ahead of the patient’s arrival. This guidance ensured that the rural receiving hospital knew what protective measures to take for their staff and other patients, and how to properly provide care, avoiding a need to move the patients further from their community, such a delay may have cost the patients’ lives.

Leading Practice: Developing the Tele-EMS System and Why It Works

Emory University Hospital started the tele-EMS initiative in partnership with local EMS agencies, focusing on rural areas in Georgia. The goal of the system is twofold: 1) expand the reach of clinical expertise, and 2) mitigate the effects of rural hospital closures, which have resulted in longer patient transport times and delays in care.

The SRDRS has used ASPR funding to scale and expand the program beyond rural parts of the state. Currently, the SRDRS is working to further expand the program across the Southeast.

One of the tele-EMS system’s keys to success is that it uses technology users are familiar with. Ambulances are equipped with hardware that enables EMTs to contact an expert clinician on a telemedicine shift at Emory University Hospital. The clinician receives a stream of real-time ambulance data, allowing them to monitor data points such as heart rate and blood pressure. They can also use a camera to see the patient as they discuss courses of action with EMTs on the scene.

The advising clinician also coordinates with receiving hospitals to provide direction on a patient’s course of care. This is essential as it equips local receiving hospitals with context and guidance to provide better care, which can help expedite treatment by preventing the need to transport a patient to a different facility that has the required specialty expertise in-house.

The tele-EMS system fits into the SRDRS’ wider telehealth strategy to better support disaster patients with telehealth systems that are easy for clinicians to use and reflect areas where clinicians need additional tools in their day-to-day work. SRDRS is also piloting telemedicine concepts in emergency medicine, critical care, and observational medicine.

About ASPR’s Regional Disaster Health Response System

These initiatives are a direct result of ASPR funding through the Regional Disaster Health Response System, and ASPR funding will continue to help the SRDRS serve more areas in both the state of Georgia, and the Southeastern United States.

The Regional Disaster Health Response System is a unique program that provides all-hazards regional coordination in order to support a more coherent, comprehensive, and capable health care disaster response system within and across multi-state regions. During responses to disasters and emergencies, Regional Disaster Health Response System demonstration sites increase surge capacity within their regions by coordinating patient load-balancing, resource allocation, and access to specialty care (e.g., trauma, burn, infectious disease), reducing the need for federal support during the response. Regional Disaster Health Response System demonstration sites also enhance regional health care preparedness efforts by maturing models for intra- and inter-regional collaboration that ultimately saves lives. 

Access the Regional Disaster Health Response System web page to learn more about this important ASPR program.