The Medical Reserve Corps – An Interview with Leaders Captain Rob Tosatto and Commander Skip Payne

The following is an excerpt from the summer 2017 issue of NACCHO Exchange. The issue features in-depth articles about the work of Medical Reserve Corps (MRC) units across the country. In this condensed article, NACCHO explores the history and significance of the MRC program in an interview with program leaders Captain Rob Tosatto and Commander Skip Payne. Read the full article and download the issue in the NACCHO Bookstore at http://eweb.naccho.org/prd/?na766pdf.

By Brennan J. Leddy, M.A.Ed (Ctr), Communications Specialist, Medical Reserve Corps Program, Partner Readiness and Emergency Programs Division, Office of Emergency Management, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services

The Medical Reserve Corps is a national network of volunteers, organized locally to improve the health and safety of their communities. This year, the MRC celebrates its 15-year anniversary!

NACCHO recently sat down with Captain Rob Tosatto, Director of the Medical Reserve Corps Program, and Commander Skip Payne, Deputy Director, to discuss and reflect on the program’s history, its mission, and the resilient strength of its network.

NACCHO: You each followed a unique path to your leadership role within the MRC Program. Can you briefly share a bit about your background and how you arrived in your current position?

Captain Tosatto: I joined the U.S. Public Health Service (USPHS) in 1988 while I was still a pharmacy student. After several tours with the Indian Health Service as a Clinical Pharmacist, I decided to pursue graduate degrees in public health and business administration (MPH/MBA) with a focus on health care organization and policy. Subsequent USPHS positions helped to hone my organizational and leadership capabilities, especially as I was tasked with developing new programs. Deployments gave me experience in the preparedness and response realm.

Commander Payne: I started my public health career in the state of Ohio as a local public health epidemiologist and bioterrorism readiness coordinator. It was there that in 2005, I had the fortune of starting a local Medical Reserve Corps unit. Feeling the pull to serve at a national level, I commissioned in the USPHS in 2007 and served as a Consumer Safety Officer in the U.S. Food and Drug Administration (FDA) Detroit District Office for a couple of years. While serving at the FDA, I joined the USPHS Rapid Deployment Force Team 3, a team comprised of USPHS Commissioned Corps Officers who are prepared to respond during a disaster or other public health emergencies. During one of our training rotations, I had the opportunity to reengage with the local Medical Reserve Corps members who were in attendance and shortly after, applied and accepted a program officer position within the MRC National Program Office.

NACCHO: Captain Tosatto, you took the leadership helm in 2003. What was the program’s vision and growth plan at that time?

Captain Tosatto: It’s fun for me to think back to those early years, particularly the excitement and innovation we felt as we worked to build the program and create our vision together as a network. The demonstration project in 2002 and that initial cadre of MRC units really sought to prove a concept—that communities could establish a mechanism to credential, train, and activate local health professionals and volunteers to meet public health and emergency needs.

At the time, we felt that concept was both viable and sustainable, but there were certainly a lot of “what if?” questions that we were asking ourselves. I think those first two years of the demonstration project, when the number of communities awarded grants to form MRC units quickly grew from 42 to 166, helped to solidify our vision and proved that the MRC model would work. We were building a national program with a national mission, carried out at the local level.

Regarding a specific growth plan, we set fairly modest goals in the beginning and wanted to focus more on building capabilities and the strength of each unit. As the network grew, we began to see what at one point seemed like dream goals come to fruition. I will say, it was pretty awesome when we reached 1,000 units in 2014.

NACCHO: Building on that initial vision and plan for the program, what are your thoughts on where the MRC stands today?

Commander Payne: Our MRC program and network continue to be strong and sustainable. I say this not only because of the sheer number of units across the country, but because of the partnerships, initiatives, and capabilities that our units have built and continue to grow. I like to think that we, at the Program Office, are really leading “a network of networks.” Essentially, we’re bending the network back on itself so that our seasoned units and mentors can help lead by example.

Using the four stages of group development, forming, storming, norming, and performing, individual units may be in various stages themselves—ranging from new to more seasoned units—but our program as a whole is in the norming stage. Our mission remains unchanged and we’re standardizing our capabilities. For example, we’re currently in the process of building mission ready packages (MRPs) for specific MRC preparedness and response capabilities. Sharing these across the network, which also include templates and training plans, will help with standardization and best practice replication while still allowing units to be customizable to their communities’ needs. We want to ensure that an MRP that one unit has built to showcase their mass vaccination capabilities need not have to be recreated by others hoping to demonstrate and offer the same services in their communities.

NACCHO: Has MRC volunteer recruitment strategy changed over the years as units have grown in numbers and size?

Captain Tosatto: We offer best practices and technical assistance at the national level, but volunteer recruitment is carried out primarily at the local level and it can vary widely. A lot of MRC units look first to their medical associations and societies, professional schools, and other similar organizations for volunteers. Being able to offer medical professionals with continuing education credits as part of their volunteer service and training is a huge plus. Other units choose to place ads and commercials in local media. Many units recruit while conducting local public health activities in the community.

Commander Payne: I will say that what we’ve found is that the best way to recruit is through word of mouth. That direct referral from a friend or family member seems to attract volunteers who both understand the personal commitment and are committed to the program mission.

NACCHO: As the MRC celebrates its 15th anniversary this year, what have been some of the largest or most impactful responses in which units have participated?

Captain Tosatto: In the early years, the 2004 and 2005 hurricane seasons really stand out. Florida was hit especially hard with Hurricanes Charley, Frances, Ivan, and Jeanne in 2004. And then Hurricanes Katrina and Rita hit Louisiana and Texas in 2005. During each event, local MRC units stepped up immediately and showed their value. And what I think may have been initially surprising to many that early on was that the units were not only able to supplement local emergency response capabilities, but that they were able to assist the states, federal government, and non-governmental organization partners like the Red Cross in their response efforts. These hurricanes were really the first large-scale emergency responses for the MRC and our success showed that the demonstration project was worth it.

I also think of the MRC’s response during the H1N1 outbreak in 2009–2010 as a pivotal time for our program. Before the H1N1 vaccine was developed, our units were extremely active in health education and outreach, teaching the public proper hand-washing techniques and cough etiquette. Then, when the vaccine came out, units quickly organized and assisted with mass vaccination clinics in communities across the country.

Commander Payne: There are two additional events that come to mind for me: the Reno Air Races in 2011 when a plane crashed into the crowd during the air show, and the Boston Marathon bombing in 2013 where MRC members were volunteering under the Boston Athletic Association. In both circumstances, MRC units were working the events in their traditional capacities, leading and working in first aid stations, managing traffic and crowd control, etc. As soon as tragedy struck, they were able to switch gears immediately and assist emergency responders with a mass casualty event. We often say that MRC volunteers are “ready, willing, and able,” and I think the circumstances of both of these events speak to those abilities.

Captain Tosatto: It’s also important to point out that while we just listed a few high-profile responses, when you think about the real impact of MRCs over time, it is more likely the public health initiatives that have a far greater reach. It’s the physical activity and healthy eating initiatives, the vaccination clinics, the blood pressure screenings—all of the things that local health departments would love to do if they had sufficient money and staffing. MRCs can help fill those gaps and I believe that impact on the community is significant.

NACCHO: Are there any emerging public health challenges or initiatives in which you see the MRC taking a lead role?

Commander Payne: I think we’ve already seen the MRC begin to play a significant role in combating the opioid crisis locally, primarily because our volunteers live in these communities and have seen the devastating impact first-hand. They also understand the value the MRC can bring to help. From outreach and education, to hosting drug take-back events, to training law enforcement on the use of nasal naloxone, units have really been at the forefront of this issue for a few years now.

Another initiative that I see the MRC starting to take a lead role on is the recently-launched “You are the Help Until Help Arrives” curriculum. This program, spearheaded by a number of federal partners, aims to educate and empower the public to take action in an emergency situation before professional help arrives. Many MRC units have already begun to promote the program locally and host training events for the community. I’m excited to see it take off!

Captain Tosatto: Not necessarily a public health challenge, but an initiative where I’ve seen a lot of growth in recent years is youth engagement. MRCs are working with local schools and organizations like HOSA-Future Health Professionals to channel the energy and enthusiasm of young people and make them better informed peer educators. It’s really inspiring to watch.

NACCHO: What are some of the more innovative responses or initiatives you’ve seen MRC units undertake?

Captain Tosatto: That’s a tough one, as there is so much innovation amongst the MRCs. Some units have established community gardens. It’s an initiative that I wouldn’t have thought of myself, but I love the idea. Local, healthy food made available to the community, and even distributed through the Women, Infants, and Children program and food banks, which I know at least one of the unit’s has done, certainly has a positive impact on public health.

I also think about the MRC’s role during the Ebola response, and the unit in Minnesota that created a Cultural Services Unit to reach the community’s West African population. Through their creativity and sensitivity, the MRC really became a trusted messenger and knowledge source. This was especially important at the time when there was a lot of mistrust and misinformation circulating around Ebola.

Commander Payne: When I think of innovation, some of our alternative MRC units come to mind as well. For example, there is an acupuncture unit in Colorado that has provided services to first responders and survivors after traumatic events. They established their unit based on community need and are doing a wonderful job sharing resources and success stories within the network. In fact, just this spring, the unit developed an Acupuncture Mission Ready Package.

We also have units that are dedicated to animal health issues. Particularly in rural areas with a lot of farm animals, those units meet the unique needs of their communities. This spring, the Oklahoma MRC’s Animal Response Team was critical during a tornado response in Elk City.

That’s one of the things that I love so much about the MRC Program as a whole. Every single unit is different based on community need, volunteer capabilities, funding resources, and a host of other variables, yet the mission of improving public health and safety remains constant.

Read the rest of the article and download the issue in the NACCHO Bookstore at http://eweb.naccho.org/prd/?na766pdf.