**[Matrix of Roles and Responsibilities]{.underline}**

Execution: After the decision has been made to activate the Medical
Reserve Corps, consequence management actions will be implemented in the
following three-phase process. Activation (Phase I), Response (Phase
II), and Recovery/Termination/Debrief (Phase III)

**[Concept of Operations]{.underline}**

1\. Phase One - Preparedness and Prevention

This phase includes preparation for an event of public health
significance and prevention of circumstances leading to emergencies.

Notification (Phase I): Following a large mass casualty incident,
natural or man-made disaster, the Emergency Operation Center (EOC) will
be activated. The DeKalb County Board of Health, as the lead agency for
Emergency Support Function 8- Health and Medical Services (ESF-8), will
coordinate all health and medical needs for the district. It is
predicted that the current disaster response infrastructure, including
hospital response, will quickly become overwhelmed and would require
additional surge capacity. In such an event, the District Emergency
Preparedness Director will direct the District Incident Commander to
activate the DeKalb Medical Reserve Corps to assist in the response
effort. Once activated, r**egistered** MRC members with ID badges and
the required training will have access to the volunteer staging area
(designated assembly point) and receive a situation briefing, training
and a specific duty assignment. Before deploying, proper personal
protective equipment (PPE) and communication equipment will be
distributed as required.

Spontaneous Unaffiliated Volunteers (SUV) that have not attended a MRC
Orientation or training will need to complete the required paperwork
(MRC application, signed liability form, and documentation of a family
preparedness plan), background checked and license verification before
being trained, assigned and deployed.

MRC volunteers will be notified about deployment utilizing the following
Communication methods:

1)  [Team leader alert rosters and call down lists.]{.mark}

2)  [Blast Fax/call.]{.mark}

3)  [E-mail.]{.mark}

4)  [Phone.]{.mark}

5)  [Public Service Announcements (PSA) thru the media, including public
    radio and public television.]{.mark}

2\. Phase Two - Detection and Response

This phase includes the detection of and response to an event of public
health significance. Depending upon the nature of the incident, the
appropriate response will be determined and acted upon using appropriate
annexesof the DeKalb EOP. In support of this phase, the DeKalb Medical
Reserve Corps volunteers will assist in responding to healthcare needs
in the following areas:

a)  [Medical Hotline]{.mark} - ESF-8 has an agreement with County
    government officials to become the medical hotline for the residents
    of the County to call following a biological terrorism attack or an
    emergency involving an infectious disease. Physicians, Physician
    Assistants, or Nurses will be utilized as medical consultants to
    assist the phone operators in answering medical questions, provide
    phone triage/assessment and direct the public to appropriate
    treatment areas. The medical consultants will be in direct contact
    with ESF-8 in the Emergency Operations Center. This link is
    essential to better communicate needs and respond to the situation.
    Medical hotline workers will be given information about the
    biological agent or infectious disease involved, treatment locations
    and triage instructions. These individuals will need to make
    assessments and refer people based on the information from ESF-8 and
    information given by the callers.

b)  [Points of Dispensing]{.mark} - Following a biological terrorism
    attack, an influenza pandemic or an emergency involving an
    infectious disease, ESF-8 might need to open Points of Dispensing to
    provide Mass vaccinations or medication and education to members of
    the community. Physicians working in a Point of Dispensing will need
    to conduct medical screening and provide medical assessment of those
    with chronic medical conditions and determine what types of
    treatment or medications might be needed. Point of Dispensing
    medical professionals will be given information about the biological
    agent or infectious disease involved and the treatments being
    provided, including contraindications for treatment.

c)  [Alternate Sites of Care]{.mark} - Following a large-scale disaster
    that exceeds the community's current hospital surge capacity, ESF-8
    will open alternate sites of care. These acute care sites will be
    utilized to care for non-critical patients allowing the hospitals to
    treat the critically ill. Physicians working in an Alternate Site of
    Care will provide for the healthcare needs of the patients, as well
    as other public health department employees, volunteer, and support
    staff. These sites will act as either an in-patient facility
    treating patients affected by the disaster or an out-patient
    facility providing routine medical care for those not directly
    affected by the disaster.

d)  [Triage / First Aid Site]{.mark}- Triage/First aid sites have the
    potential to be utilized in various scenarios. Following a large,
    mass casualty disaster, ESF-8 might assist Emergency Medical
    Services in opening First Aid Field Centers to treat the walking
    wounded. Medically trained personnel at these sites will need to
    perform health assessments to determine severity of injuries and
    various first aid tasks, including CPR. Following an infectious
    disease outbreak, natural or terrorism related, patient assessment
    sites will be established to assess and refer patients coming to
    public collection points for treatment. After initial assessment, if
    further medical assessment is required, patients will be sent to the
    medical triage area to be evaluated by a physician. The physician
    will assess and refer patients to the appropriate treatment location
    as directed by ESF-8.

3\. [Phase Three -- Recovery/Mitigation]{.underline}

Recovery is the transition to normal operations. Short-term recovery
actions are taken to assess damage and return vital life-support systems
to minimum operating standards. Long-term recovery may go on for years
and involve the development, coordination, and execution of services.

Mitigation minimizes the adverse impact of an emergency and reduces
vulnerability to future emergencies. Mitigation measures may be
implemented at any time.

DeKalb MRC activation could possibly remain active for extended periods
of time at the discretion of the district health director, which will be
conducted in 12-hour shifts. The District Health Director in
coordination with the County Emergency Management Director will
recommend termination of MRC operations to the District Incident
Commander.

**[Recovery/Termination/Debriefing]{.underline}**

Debriefing is mandatory for all MRC Volunteers; MRC volunteers and BOH
staff trained in Critical Incident Stress Debriefing (CISD) will conduct
debriefing. At the end of the disaster response, volunteers will be
provided with an exit survey or an onsite "hot wash" debriefing to
formally end their response time. The exit survey will be provided by a
trained mental health professional.

The CISD is designed to achieve the goal of psychological closure
subsequent to a critical incident or traumatic event, a forum for
psychological triaging so as to facilitate access to a higher level of
psychological support. The CISD is designed to be used with small groups
of 4 to 25 participants, but 8 to 10 is recommended. It will be
facilitated through 2 to 4 specially trained crisis interventionists.

There should also be a formal recognition of the MRC volunteer's service
through a thank-you card, certificate of appreciation or formal letter
of appreciation within 2 weeks -1month after the disaster response.

**[Authorities and References]{.underline}**

The Medical Reserve Corps is part of the Citizen Corps. Information
about the Citizen Corps can be found at
[www.citizencorps.gov](http://www.citizencorps.gov/). Additional
information can be found about the Medical Reserve Corps at
[www.medicalreservecorps.gov](http://www.medicalreservecorps.gov/). The
Medical Corps is sponsored by the Surgeon General of the United States.