Department of Health and Human Services 
OFFICE OF 
 
INSPECTOR GENERAL 
 
 
 
 
 
 
 
 
M  R C
EDICAL  ESERVE  ORPS 
 
V N Y
O  LUNTEERS IN  EW  ORK 
 
N J D
AND  EW  ERSEY  URING 
S S  
UPERSTORM  ANDY 
 
Suzanne M. Murrin   
Deputy Inspector General for 
Evaluation and Inspections 
 
May 2015 
OEI-04-13-00350   
EXECUTIVE SUMMARY:  MEDICAL RESERVE CORPS VOLUNTEERS IN NEW 
YORK AND NEW JERSEY DURING SUPERSTORM SANDY  
OEI-04-13-00350 
 
WHY WE DID THIS STUDY 
 
Superstorm Sandy resulted in 72 fatalities, and damage estimates totaled nearly $50 billion in the 
United States.  Although many States in the northeastern United States were impacted by 
Superstorm Sandy, New York and New Jersey experienced the most damage.  To assist with the 
response, the Department of Health and Human Services network of volunteers, the Medical 
Reserve Corps (MRC), deployed volunteers in these two States.  Previous Office of Inspector 
General reports identified State and local challenges in incorporating volunteers into emergency 
preparedness and response plans. Therefore, we sought to determine how these volunteers were 
used during the response to Superstorm Sandy and any challenges or successes associated with 
their use during that response. 
 
HOW WE DID THIS STUDY 
 
We collected information from five groups of MRC stakeholders in New York and New Jersey.  
These stakeholders were (1) MRC volunteers, (2) local health department staff, (3) local MRC 
coordinators, (4) State MRC coordinators, and (5) the regional MRC coordinator.  Using the 
information we collected, we described MRC volunteers response in New York and New Jersey 
for Superstorm Sandy.  We also described the challenges and successes that these five groups of 
MRC stakeholders reported regarding the MRC volunteer response.    
 
WHAT WE FOUND 
 
MRC units in New York and New Jersey deployed over 2,000 MRC volunteers during the 
Superstorm Sandy response and reported that these volunteers provided over 18,000 hours of 
service. A large part of the MRC volunteer response included assisting shelter operations, such 
as distributing food and clothing or providing medical care.  MRC stakeholders reported several 
challenges and successes during Superstorm Sandy.  These challenges and successes were most 
frequently associated with communication, shelter staffing, and shelter operations.   
 
WHAT WE RECOMMEND 
 
Although our review was limited to the MRC response in New York and New Jersey, the 
challenges that MRC stakeholders reported experiencing there are ones that other States may 
encounter when using MRC volunteers during future incident responses.  Conversely, the 
successes that MRC stakeholders identified may highlight practices for States, including 
New York and New Jersey, to improve their future responses.  We recommend that the Assistant 
Secretary for Preparedness and Response (ASPR) work with States and localities, as appropriate, 
to strengthen plans for volunteer communication, shelter staffing, and shelter operations.  ASPR 
concurred with our recommendations. 
 
   
TABLE OF CONTENTS 
 
Objectives ....................................................................................................1 

Background..................................................................................................1 

Methodology................................................................................................7 

Findings........................................................................................................9 

MRC units in New York and New Jersey deployed over 
2,000 MRC volunteers during the Sandy response....................9 

The challenges and successes during Sandy that MRC stakeholders 

reported were most frequently associated with communication, 

shelter staffing, and shelter operations ...........................................11 
 
Conclusion and Recommendations ............................................................19 

Agency Comments and Office of Inspector General Response .....22 

Appendixes ................................................................................................23 

A: Detailed Methodology .............................................................23 

B: Sandy Challenges Reported by MRC Stakeholders Within  

New York and New Jersey, 2013 ...................................................28 

C: Sandy Successes Reported by MRC Stakeholders Within    

New York and New Jersey, 2013 ...................................................30 

D: Other Sandy Challenges and Successes Reported by MRC 

Stakeholders Within New York and New Jersey, 2013 .................31 

E: Agency Comments  ...................................................................32 

Acknowledgments......................................................................................38 

 
 
   
   
OBJECTIVES 
1. 	  To describe Medical Reserve Corps (MRC) volunteers response in 
New York and New Jersey during Superstorm Sandy. 
2. 	  To describe the challenges and successes associated with the MRC 
volunteer response to Superstorm Sandy. 
BACKGROUND 
On October 29, 2012, Superstorm Sandy (hereinafter referred to as Sandy) 
made landfall in the northeastern United States, severely damaging coastal 
areas.1  Although Sandy had weakened from a hurricane to a superstorm  
by the time it reached the United States, the storm surge combined with 
high tides to cause widespread flooding along coastal areas, particularly in 
New York and New Jersey (see Figure 1). The storm resulted in 
72 fatalities and damage estimates totaled nearly $50 billion in the 
United States.2  To assist with the response, the Department of Health and 
Human Services (HHS) network of volunteers, the MRC, deployed 
volunteers in New York and New Jersey. 
 
Figure 1: Sandy Flooding 
 
 
 
 
 
 
 
 
 
 
Photo courtesy of Paul Scharff Photography.  Used with permission. 
 
The Disaster Relief Appropriations  Act (DRAA) was enacted in 
January 2013 to provide several Federal agencies with disaster response 
and recovery funds to assist States impacted by Sandy.  The DRAA 
 ____________________________________________________________ 
1 National Hurricane Center, Tropical Cyclone Report: Hurricane  Sandy  (AL182012). 
Accessed at http://www.nhc.noaa.gov/data/tcr/AL182012_Sandy.pdf  on April 29, 2014.  
2 Ibid.   At least 147 deaths across the Atlantic basin were reported as having  been directly  
caused  by Sandy.  Of these fatalities, 72  occurred in the mid-Atlantic and  northeastern 
United States. 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   1 
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provided $800 million to HHS to assist in its Sandy response and recovery 
efforts.3    
National Response Framework and Emergency Support 
Functions 
Issued by the Department of Homeland Security, the National Response 
Framework  (hereinafter referred to as the Framework) serves as a guide 
for national preparedness for and response to natural and manmade 
incidents.4  It lists 15 Emergency Support Functions (ESFs)for example, 
transportation (ESF #1) and communications (ESF #2).5  The Framework 
also charges Federal departments and agencies with the responsibilities for 
specific ESFs to assist States, tribes, and localities when incidents occur.    
HHS is the lead agency for ESF #8public health and medical services.  
As such, it manages the Federal public health and medical response to an 
incident. One of the ESF #8 roles is to engage civilian volunteers 
among them, MRC volunteersto help fill needs for health professionals.6  
In addition, HHS is one of the support agencies for ESF #6mass care, 
emergency assistance, temporary housing, and human services.  Mass care 
involves sheltering, feeding operations, emergency first aid, the bulk 
distribution of emergency items, and collecting and providing information 
on victims to family members.7  Although MRC units are not typically the 
lead organizations for mass care and shelter operations, they may provide 
volunteer staff to support general and medical operations within shelters. 
____________________________________________________________ 
3 DRAA, 2013, P.L. No. 113-2 (Jan. 29, 2013).  Some of the Federal agencies included  
the Department of Homeland Security and Environmental Protection Agency. 
4 Department of Homeland Security, National Response Framework (May 2013), p. 1  
Accessed at http://www.fema.gov/media-library-data/20130726-1914-25045-
1246/final_national_response_framework_20130501.pdf on April 30, 2015.  The 
Frameworkfirst released in January 2008succeeded the National Response Plan, 
which was issued in 2004.   In  May 2013, the Department of Homeland Security released  
a newer version of the Framework.   Note that the January 2008 version was in effect at  
the time of  Superstorm Sandy. 
5 Federal Emergency Management Agency  (FEMA), National Preparedness Resource 
Library.  Accessed at http://www.fema.gov/national-preparedness-resource-library on  
March 18, 2015; Department  of Homeland Security, National Response Plan (December 
2004). Accessed at http://fas.org/irp/agency/dhs/nrp.pdf on  May 5,  2015. 
6 FEMA, Emergency Support  Function #8Public Health  and Medical Services Annex, 
p. 5.  Accessed at http://www.fema.gov/media-library-data/20130726-1914-25045-
3446/final_esf_8_public_health_medical_20130501.pdf on April 30, 2014. 
7 FEMA, Emergency Support Function #6  Mass Care, Emergency Assistance,  Housing, 
and Human Services, p. 2. Accessed at http://www.fema.gov/media-library-
data/20130726-1913-25045-6921/final_esf_6_mass_care_20130501.pdf on  April 30, 
2015. 
 
 
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Within HHS, the Assistant Secretary for Preparedness and Response 
(ASPR) organizes HHSs activities for preparedness and emergency 
support. ASPR, in coordination with the Centers for Disease Control and 
Prevention (CDC), also provides technical assistance on emergency 
preparedness to States and localities.      
Medical Reserve Corps Volunteers 
Formally authorized by Congress in 2006, the MRC was established in 
2002 by the Office of the Surgeon General, part of HHSs Office of the 
Assistant Secretary for Health.8 In 2013, responsibility for the MRC 
moved from the Office of Surgeon General to ASPR.   
The MRC is a national network of volunteers that are organized into local 
units and managed by coordinators at the local level.  These units are 
composed of medical and public health professionals as well as those 
without health care backgrounds.9 MRC units prepare for and respond to 
natural disasters and other emergencies affecting public health.10  
The combined fiscal year 2012 and 2013 budgets for the MRC were 
approximately $22 million, and in September 2014, there were over 
1,000 MRC units nationwide.11   These units collectively had more than 
205,000 MRC volunteers. MRC volunteers are a critical component of 
incident response because they assist in emergency preparedness, 
response, and recovery.  Because an incident is constantly changing, 
volunteer response must be flexible.   
Within ASPRs Office of Emergency Management, the Division of the 
Civilian Volunteer Medical Reserve Corps (DCVMRC) provides guidance 
to local MRC units regarding recommended training.  Since May 2009, 
the DCVMRC has recommended that all MRC members and coordinators 
receive training on two systems for incident response:  the Incident 
____________________________________________________________ 
8 Congress authorized the MRC with the 2006 Pandemic and All-Hazards Preparedness 
Act, P.L. No. 109-417  (Dec. 19, 2006). 

9 Division of the Civilian Volunteer Medical Reserve Corps (DCVMRC), MRC Strategic 
 
Plan 20112013.  Accessed at https://www.medicalreservecorps.gov/pageViewFldr/  

About/StrategicPlan1113#report on April 25, 2014. 

10 DCVMRC,  About the Medical Reserve Corps.  Accessed at  
https://www.medicalreservecorps.gov/pageviewfldr/About on  March 17, 2015.  
11 The number of MRC units includes volunteers in local areas within States and  
territories.  DCVMRC, Fiscal Year 2014  4th Quarter Progress Report, p. 1.  Accessed at 
https://mrc-cms.icfwebservices.com/File/DCVMRC_FY14_Quarterly_Report_4.pdf on  
January 26, 2015.  The combined fiscal year budgets provide funding for program  
guidance and development.  
 
 
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Command System and the National Incident Management System.12 MRC 
units have the flexibility to develop additional training on the basis of their 
individual needs. 
DCVMRC Responsibilities in Preparation of an Incident. DCVMRC staff 
work with local, State, and regional MRC coordinators to support MRC 
activities.13 The DCVMRC supports the MRC by providing technical 
assistance; coordination; communications; strategy and policy 
development; oversight for grants and contracts; training; and other 
associated services.14  For instance, the DCVMRC directly oversees and 
coordinates communication among the MRC regional coordinators who 
represent the 10 MRC regions across the United States and its territories.  
The DCVMRC also functions as a clearinghouse for information and 
practices to help communities establish, implement, and maintain local 
MRC units nationwide. The DCVMRC also provides strategy 
development, policy development, and incident response coordination.15   
Local, State, and Regional MRC Coordinators Responsibilities in 
Preparation for and During an Incident. MRC coordinators have several 
responsibilities at the local, State, and regional levels.  Local MRC 
coordinators are responsible for recruiting and retaining MRC volunteers 
prior to an incident, as well as for managing MRC units.16  DCVMRC staff 
told us that during incident response, the local MRC coordinators are 
____________________________________________________________ 
12 DCVMRC,  NIMS Guidance.  Accessed at https://www.medicalreservecorps.gov/  

searchFldr/NIMSGuidance#3  on January 23, 2015.  The Incident Command System is 
 
designed to enable effective and efficient domestic incident management by integrating a 

combination  of facilities, equipment, personnel, procedures, and communications  

operating  within a common organizational structure.  This system is normally structured 
 
to facilitate activities in five  major functional areas:  command  operations; planning; 

logistics; intelligence and investigations; and  finance and administration.   FEMA, 

Incident Command  System Resources.  Accessed at https://www.fema.gov/national-
incident-management-system/incident-command-system-resources  on April 30, 2014.  

The National Incident Management System is a systematic, proactive approach to  guide 

departments and agencies at all levels of  government, nongovernmental organizations, 

and the private sector to  work together and  manage incidents involving all threats and 

hazardsregardless of cause, size, location, or complexityin order to reduce loss of 

life, loss of property, and  harm  to the environment.  FEMA, National Incident  

Management System.  Accessed at https://www.fema.gov/national-incident-management-
system on January 27, 2015. 

13 Regional coordinators support MRC activities across multiple States. 

14 DCVMRC,  About the Division of the Civilian Volunteer Medical Reserve Corps. 

Accessed at https://www.medicalreservecorps.gov/pageViewFldr/About/DCVMRC on 
 
April 23, 2014. 

15 Ibid. 

16 DCVMRC,  About Leading. Accessed at https://www.medicalreservecorps.gov/  

leaderfldr/Lead on  April 24, 2014. 
 
 
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primarily responsible for disseminating requests to MRC volunteers from  
local agencies (e.g., local health departments or emergency management 
agencies).17  Local MRC coordinators also communicate with MRC 
volunteers to conduct situational awareness and to help coordinate the 
local MRC response. 
According to DCVMRC staff, State MRC coordinators facilitate 
information sharing and communication among local MRC units within 
their State and with others outside of the State.  Regional coordinators 
determine the needs of MRC stakeholders at the State and local level, 
provide technical assistance based on those needs, and communicate the 
needs to their Federal counterparts, as appropriate.  Regional coordinators 
also monitor and facilitate information flow between State and local MRC 
stakeholders prior to and during incidents.18    
MRC Volunteer Deployment and Responsibilities During an Incident. 
MRC volunteers are typically requested and activated by a local health 
department or emergency management agency within an area affected by 
the incident.19  Depending on the size and severity of the incident, local 
leadership may request resources and personnel from outside the 
jurisdiction, such as other MRC units within the State, MRC units from  
other States within the region, or the Federal government.20   Additionally, 
according to DCVMRC staff, volunteers may provide several services 
during an incident, such as working in shelters, distributing medication, or 
assisting with patient care in hospitals.21 
 ____________________________________________________________ 
17 Local health  departments are tasked with carrying out local public health activities, 
such as enforcing laws to  protect health and safety and developing  disaster  preparedness 
plans.   Although these agencies are not part  of the MRC network, they may request MRC  
volunteers during incidents, if necessary.  Such requests are typically sent to  volunteers 
via local MRC coordinators.  Local coordinators may work extensively with local health 
departments, but they are not  required to be  employees of these departments or of HHS.  
18 DCVMRC,  About Regional MRC Coordinators. Accessed at 
https://www.medicalreservecorps.gov/pageViewFldr/Coordinators/Regional  on April 30, 
2014. 
19 DCVMRC,  Guide to Emergency Operations for MRC Units, p. 2.  Accessed 
https://www.medicalreservecorps.gov/file/Promising_Practices_Toolkit/Guidance_Docu 
ments/Emergency_Preparedness_Response/MRC-EmergencyOperations.pdf  on April 30, 
2014.  Depending on the locality, MRC volunteers may be requested  by  other entities, 
such as a State health department. 
20 HHS, Getting Started: A Guide for Local Leaders.  Accessed at 
https://www.medicalreservecorps.gov/File/TASeries/0_Getting_Started_%28FINAL%29 

.pdf on  April 30, 2014. 

21 MRC staff stated that prior to an incident, MRC volunteers typically engage in training.  

Immediately preceding an incident, they are in  contact with their local coordinator or 

other management official to  determine a location for the  assembly of personnel and 

resources before  deploying. 
 
 
 
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MRC volunteers serve under the direction of their local leadership but 
may work with several different organizations during their response to an 
incident. For instance, deployed MRC volunteers may work at shelters 
run by local governments or nonprofit organizations (e.g., the American 
Red Cross) to provide services, such health assessment and treatment.22    
Previous OIG Work 
In 2014, the Office of Inspector General (OIG) found that 89 percent of 
hospitals reported experiencing substantial challenges during the Sandy 
response.23  These challenges represented a range of interrelated problems, 
from infrastructure breakdowns (such as electrical and communication 
failures) to community collaboration issues over resources (such as fuel, 
transportation, hospital beds, and public shelters).  OIG recommended that 
ASPR continue to promote Federal, State, and community collaboration in 
major disasters.  ASPR concurred with the recommendation.  
In September 2009, OIG released two reports focused on preparedness for 
pandemic influenza.  In one report, OIG found that 6 of 10 selected 
localities had not started to recruit, register, and train medical volunteers.24   
Additionally, the staff in the four localities that had started to do so were 
concerned that volunteers might not show up because of competing work 
commitments or concerns that they would not be legally protected during 
an incident. Additionally, the 10 selected localities conducted a total of 
41 medical surge exercises, but the fewest number of these focused on 
the use of volunteers.25  OIG, in part, recommended that ASPR should 
encourage States and localities to use existing Federal volunteer programs, 
such as the MRC. In addition, OIG recommended that ASPR address the 
issue of legal protections for medical professionals and volunteers who 
respond to public health emergencies.  ASPR concurred with OIGs 
recommendations.   
____________________________________________________________ 
22 DCVMRC,  Joint Memorandum: American  Red Cross and  the MRC. Accessed at 
https://www.medicalreservecorps.gov/partnerfldr/JointMemoTemplate/ARCMRCJointM 
emo on  April 30, 2014. 

23 OIG,  Hospital Emergency Preparedness and Response During Superstorm Sandy 
 
(OEI-06-13-00260), September  2014. 

24 Ibid. 

25 OIG,  Local Pandemic Influenza Preparedness: Medical Surge, OEI-02-08-00210, 

September 2009.  Medical surge is the ability to provide adequate medical evaluation  

and care during incidents that  exceed the limits of the normal medical infrastructure of an 
 
affected community.  The CNA Institute for Public Research,  Medical Surge Capacity 

and Capability:  A Management System for Integrating Medical and  Health Resources 

During Large-Scale Emergencies, p. I-5.  Accessed at http://www.phe.gov/ 

preparedness/planning/mscc/handbook/documents/mscc080626.pdf on  January 27, 2015. 

 
 
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In the second report, OIG found that while 10 selected localities generally 
planned to use individuals from various sources, such as the MRC, to 
assist in the distribution and dispensing of vaccines and antiviral drugs 
during an influenza pandemic, these localities typically had not adequately 
estimated staffing needs.26  OIG recommended, in part, that CDC should 
identify sufficient staff necessary to fill positions for distributing vaccines 
and antiviral drugs to and dispensing them at shelters.  CDC agreed that 
localities need to develop actionable plans that identify personnel needed 
to staff these positions.   
METHODOLOGY 
We sent an electronic questionnaire to 466 MRC stakeholders in 
New York and New Jersey.  These stakeholders were in one of the 
following five groups: (1) MRC volunteers, (2) local health department 
and office of emergency management staff (hereinafter referred to as local 
health department staff), (3) local MRC coordinators, (4) State MRC 
coordinators, and (5) the regional MRC coordinator.   
We limited our questionnaires to MRC stakeholders in New York and 
New Jersey because these States experienced the most damage from  
Sandy, and the largest numbers of MRC volunteers were deployed in these 
two States. 
We received responses from 262 of the 466 stakeholders.  See Appendix A  
for a more detailed description of our methodology, including the number 
and response rate of MRC stakeholders who responded to our 
questionnaire. 
We analyzed data from these stakeholders to describe MRC volunteers  
Sandy response in New York and New Jersey from October 2012 to 
March 2013. We also analyzed the data to determine the challenges and 
successes associated with the MRC volunteer Sandy response in 
New York and New Jersey.   
Limitations 
We did not independently verify the self-reported data we collected.  
Because of the low response rate by MRC volunteers, we do not project 
the data from our respondents to the populations of MRC stakeholders in 
New York, New Jersey, or nationwide.  
____________________________________________________________ 
26 OIG,  Local Pandemic Influenza Preparedness: Vaccine and Antiviral Drug  
Distribution and Dispensing, OEI-04-08-00260, September 2009. 
 
 
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Standards 
This study was conducted in accordance with the Quality Standards for 
Inspection and Evaluation issued by the Council of the Inspectors General 
on Integrity and Efficiency. 
 
 
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FINDINGS 
Large-scale incidents like Sandy present constantly changing scenarios that  
require a swift and flexible public health response.  The MRC is a national 
network of volunteers that serves as a critical component to support local 
public health resources during an incident.  During the Sandy response, we  
found that MRC units in New York and New Jersey deployed over  
2,000 MRC volunteers and reported that these volunteers provided over 
18,000 hours of service.  However, even a well-planned response can 
experience both challenges and successes during an incident.  For instance, 
the same shelter and/or stakeholder may experience successes in one area 
(e.g., sufficient staff) but undergo challenges in another (e.g., insufficient  
medical supplies) during an incident.  Further, a challenge that is reported at  
the beginning of the response may have been corrected during the response 
and may later be reported as a success  (e.g., insufficient medical supplies at 
the beginning of the response and sufficient medical supplies later on).  We  
found that across several MRC stakeholder groups, both challenges and 
successes during Sandy were most frequently associated with 
communication, shelter staffing, and shelter operations.   
MRC units in New York and New Jersey deployed 
over 2,000 MRC volunteers during the Sandy  
response  
To support response efforts in New York and New Jersey, a total of 
2,027 MRC volunteers deployed from October 2012 to March 2013.  Of 
these volunteers, 63 percent deployed in New York and 37 percent 
deployed in New Jersey.  Additionally, 81 percent of the MRC volunteers 
in New York were from the New York City MRC unit.  Table 1 shows the 
number and percentage of total MRC volunteers who deployed in 
New York and New Jersey.    
Table 1: Number and Percentage of MRC Volunteers Who Deployed in 
New  York and New  Jersey During the Sandy Response  
Percentage of Total  
Number of MRC  
Deployment Location   Deployed MRC 
Volunteers  
Volunteers  
New York*   1,267   63%  
New Jersey   760  37% 
     Total   2,027   100%  
                                       Source:  OIG analysis of Sandy  MRC questionnaire  data, 2014. 

                                       *Includes  New  York  City.  
  
 
 
 
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During the Sandy response, the 2,027 deployed MRC volunteers were 
members of 37 of the 53 active local MRC units in New York and 
New Jersey.  These MRC volunteers deployed to areas in 24 local health 
department jurisdictions in New York and New Jersey.   
Of the MRC volunteers who deployed, 52 percent were either nurses 
(26 percent) or physicians (also 26 percent).  The remaining 48 percent of 
MRC volunteers were health care workers with other specialties 
(e.g., social workers, emergency medical technicians) or were nonmedical 
personnel. MRC units in New York and New Jersey reported that MRC 
volunteers provided over 18,000 hours of service during the Sandy 
response from October 2012 to March 2013. 
Local MRC coordinators from 34 of the 37 volunteer-deploying MRC 
units reported that their MRC volunteers assisted with shelter operations 
during the response. Shelter operations included food and clothing 
distribution, as well as medical triage and treatment (see Figure 2, 
depicting a shelter). The remaining three local MRC coordinators 
reported that their volunteers provided other assistance, such as providing 
wellness and occupational health services to other volunteers. 
 
Figure 2. Shelter During the Sandy Response  
 
 
 
 
 
 
 
 
 
 
 
 
Photo courtesy of Hunterdon County  Division of Public Health Services.  Used with permission. 
Shelters were supported by volunteers from several organizations.  For 
example, MRC volunteers from 22 local MRC units worked at shelters 
supported by the American Red Cross and/or other nonprofit 
organizations, such as the Salvation Army.  In these shelters, MRC 
volunteers also worked alongside other Federal response partners, 
including National Disaster Medical System (NDMS) teams and the 
 
 
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Federal Emergency Management Agencys Community Emergency 
Response Teams.27    
The challenges and successes during Sandy that 
MRC stakeholders reported were most frequently 
associated with communication, shelter staffing, and
shelter operations 
Nearly all MRC stakeholders (180 of 189) reported challenges and/or 
successes for the Sandy response.28 One hundred forty-two of 
one hundred eighty-nine stakeholders (75 percent) reported one or more 
challenges; most frequently, these challenges were associated with 
communication, shelter staffing, and shelter operations.  (See Appendix B 
for the list of challenges that these stakeholders reported.)  In addition, 
177 of 189 MRC stakeholders (94 percent) reported successes associated 
with the Sandy response. These successes fell into the same three areas in 
which MRC stakeholders identified challenges.  (See Appendix C for the 
list of successes that these stakeholders reported.)  
 
Communication challenges were most frequently associated 
with infrastructure failures and communication gaps among 
stakeholder groups  
Seventy-nine of one hundred eighty-nine MRC stakeholders (42 percent) 
reported challenges associated with communication during the Sandy 
response. 
The most frequently reported communication challenge was infrastructure 
failure (e.g., power outages, downed servers, and damaged electric 
equipment) that caused general communication problems, such as the 
ability to contact MRC volunteers and other stakeholders.  For instance, 
one local MRC coordinator reported that nearly 80 percent of residents in 
____________________________________________________________ 
27 NDMS teams assist State and local authorities in  dealing  with the medical impacts of  
major peacetime disasters.  An example of an NDMS team  includes Disaster Medical 
Assistance Teams, which deploy to  disaster sites with supplies and equipment to  sustain 
themselves for a period of 72 hours while providing  medical  care at  a fixed or  temporary  
medical care site.  HHS, National Disaster Medical System.  Accessed at  
http://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx on February 10, 
2014.  Community Emergency Response Teams assist others in their neighborhood or  
workplace following an incident when  professional responders are not immediately 
available to help.  This assistance may include providing assistance to victims, damage 
assessment information, or organizing  other volunteers to provide assistance as needed.   
FEMA,  Community Emergency Response Teams. Accessed at 
https://www.fema.gov/community-emergency-response-teams on December 15, 2014. 
28  Although we received responses from  262 MRC stakeholders, 73 of the respondents 
were not involved in the Sandy MRC volunteer response.  Therefore, our  analysis is 
based on the responses from the 189 MRC stakeholders who were involved with the  
Sandy MRC volunteer  response.   
 
 
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one county lost power, and communication with volunteers by phone or 
email became virtually impossible.  Similarly, one State MRC 
coordinator reported there was no power in affected areas, which limited 
cell phone and Internet service for several days. 
The second most frequently reported communication challenge was gaps 
in communication among MRC stakeholder groups for reasons not 
associated with infrastructure failures.  These communication gaps 
resulted from other factors, such as inadequate planning or failure to 
communicate with other stakeholders.  For instance, one local MRC 
coordinator reported that because of a lack of communication between the 
local emergency operations center and the MRC, the local center was 
unaware of MRC needs and issues in affected areas.  Similarly, another 
local MRC coordinator reported that there was no open communication 
between the MRC unit and local health department. 
The third most frequently reported communication challengereported by 
volunteerswas undefined or unclear roles for volunteers at shelters.  
MRC volunteers gave several examples of these unclear roles, such as 
volunteers who showed up but did not receive directives and shelter staff 
and leadership who seem[ed] to have no idea what volunteers should be 
doing. 
The fourth most frequently reported communication challenge was 
problems in following the chain of command or Incident Command 
System protocols.  According to the stakeholders who reported this as an 
issue, the Incident Command System was not followed in various ways.  
For instance, one MRC volunteer reported that MRC volunteers had to 
communicate shelter needs to stakeholders even though this was not 
consistent with their chain-of-command role or assignment.  Additionally, 
one local MRC coordinator reported that communication did not always 
follow Incident Command System protocols. 
Communication successes were most frequently associated 
with the methods of communication, as well as MRC 
coordinators responsiveness  
Seventy-four of one hundred eighty-nine MRC stakeholders (39 percent) 
reported communication successes associated with the Sandy response.   
The most frequently reported communication success was associated with  
methods of communication among MRC stakeholders during the Sandy 
response. For instance, one staff member from a local health department 
reported that the county had a backup electronic communication system in 
place before the storm, which enabled staff to communicate with MRC 
volunteers and other MRC stakeholders despite storm damage and power 
 
 
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outages. Several other stakeholders reported that texting worked well, 
especially during power outages.  One staff member from a local health 
department also reported using a cell phone program that allowed access 
for health care responders despite extensive damage to the cellular 
network. Another respondent, a local MRC coordinator, reported that 
amateur (ham) radio supported communication with emergency 
management officials.   
The second most frequently reported communication success was that 
MRC coordinators were available and responsive to requests.  For 
example, one volunteer reported that the MRC coordinator was readily 
available to discuss needs or issues and was very responsive to requests.  
Similarly, two staff members from a local health department reported that 
the State MRC coordinator was always available during the entire 
response. 
Challenges in staffing shelters were most frequently  
associated with volunteers who were unable to deploy; 
however, some stakeholders reported sufficient numbers of 
volunteers 
Ninety-two of one hundred eighty-nine MRC stakeholders (49 percent) 
reported a variety of challenges during the Sandy response that affected 
MRC volunteers ability to adequately staff shelters in New York and 
New Jersey.   
The most frequently reported challenge in staffing shelters was that MRC 
volunteers were often unable to deploy.  According to these stakeholders, 
this occurred for several reasons, such as road closures, power outages, 
flooding, and limited transportation options because of the storm.  For 
instance, one MRC coordinator reported that some MRC volunteers who 
were driving to a shelter were asked to turn back because of falling trees 
and blocked roads. MRC volunteers also reported that poor road 
conditions affected their ability to deploy to shelters (See Figure 3). 
 
 
 
 
 
 
 
 
 
 
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  Figure 3: Poor Road Conditions After Sandy Affected Volunteer 
Availability  To Deploy to Shelters  
 
 
 
 
 
 
 
 
 
 
 
 
  Photo courtesy of Paul Scharff Photography.  Used with permission. 
MRC stakeholders also reported challenges associated with the difficulty 
in coordinating the transportation of MRC volunteers from less-affected 
areas of the State to areas with greater damage.  For instance, one MRC 
volunteer reported that it was difficult to determine a definite meeting 
location and time for MRC volunteers in western New York before they 
traveled to a shelter in a coastal area of the State, outside their MRC units 
jurisdiction.  
Further, staff from one local health department reported requesting nearly 
150 MRC volunteers to assist with their Sandy shelters.  Of this number,  
only 26 volunteers were able to deploy to shelters.  Staff attributed the 
lack of MRC volunteers to transportation issues due to flooding and 
power outages throughout the Sandy response period and stated that the 
county was understaffed during the entire response. 
Competing work or personal obligations also meant that many MRC 
volunteers were not able to deploy to shelters.  For instance, one MRC 
coordinator reported that many MRC volunteers had to work in other 
medical facilities (e.g., their places of employment) during the response 
and were thus unavailable to deploy as volunteers.  Similarly, another 
coordinator said that it was very difficult to staff shelters, primarily 
because of MRC volunteers work commitments.  Personal issues also 
affected MRC volunteers availability to deployfor example, some  
volunteers needed to repair their damaged homes and others needed to 
evacuate from their own storm-damaged neighborhoods.   
 
 
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The next most frequently reported challenge in staffing shelters was the 
low numbers of MRC volunteers with medical specialties, such as nurses.  
These staffing shortages were not specifically associated with deployment 
problems (e.g., a low turnout of volunteers as a result of road closures or 
power outages), but may have resulted from other factors, such as 
challenges in MRC units regarding recruitment and retention.  For 
instance, one MRC volunteer reported that because it was difficult to find  
additional nurses to staff shelters, the volunteer had to work shifts of  
1416 hours to compensate.  Further, another staff member in a local 
health department reported that shelters often did not receive the number 
of MRC volunteers they requested, especially volunteers with health care 
backgrounds. 
The next two most frequently reported challenges in staffing shelters were 
associated with deployment.  First, MRC stakeholders reported challenges 
related to liability and licensure concerns.  For instance, staff at one local 
health department reported that many MRC volunteers did not want to 
deploy to shelters without having a clearly defined understanding of 
liability coverage.  Additionally, one local MRC coordinator stated that  
that coordinators unit had to turn away several volunteers with medical 
specialties, such as physicians, because of liability concerns and because 
volunteers were not licensed to practice in that State.  Second, MRC 
volunteers reported that shelters had too many MRC volunteers.  For 
example, one MRC volunteer reported there were more volunteers present 
at a shelter than needed, causing the volunteer to spend a long time 
waiting for directions. As a result, the volunteer became frustrated and left 
early.  Another volunteer reported that MRC volunteers with specific 
medical specialties were not needed at an overstaffed shelter during the 
response. 
MRC stakeholders also reported communication challenges that caused 
low MRC volunteer turnout. For instance, one local MRC coordinator 
reported not being able to communicate with MRC volunteers because of 
power outages; as a result, the numbers of MRC volunteers who deployed 
to local shelters were low.   
In contrast to these challenges, 54 of 189 MRC stakeholders (29 percent) 
reported successes associated with shelter staffing in New York and 
New Jersey during the Sandy response.  The most frequently reported 
success was that shelters had sufficient numbers of MRC volunteers.  For 
instance, several MRC volunteers and local health department staff 
reported that their shelters were well-staffed, with sufficient staff to 
provide all required services. 
 
 
 
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Shelter operations challenges were most frequently  
associated with having insufficient shelter supplies 
Sixty-eight of one hundred eighty-nine MRC stakeholders (36 percent) 
reported challenges associated with shelter operations.   
The most frequently reported shelter operations challenge was that shelters 
had insufficient supplies, such as diabetic supplies, oxygen supplies, 
bedding, food, and clothing. In addition, some of the medical supplies 
(e.g., drugs) were expired. One MRC volunteer reported that a shelter had 
insufficient medical supplies and other materials because operational plans 
did not exist.  An MRC coordinator reported that the coordinators team  
arrived at a special medical needs shelter and found that it was a tent with 
nothing in it. The MRC volunteers at this shelter had to develop 
impromptu plans and procedures to gather supplies and provide patient 
care. 
The second most frequently reported shelter operations challenge 
reported by MRC stakeholderswas that MRC volunteers lacked 
shelter-specific training (e.g., how to operate or serve as a volunteer in a 
shelter). For instance, one local MRC coordinator reported that prior to 
Sandy, very few of that coordinators units MRC volunteers had 
experience in operating shelters. Another coordinator stated that MRC 
volunteers in the coordinators unit who deployed had not received any 
training in shelter operations prior to deployment.   
The next two most frequently reported areas of concern were:   
	   Volunteers reported that shelters lacked special-needs services.  For 
example, MRC volunteers reported that services to address residents 
with special needs, including mental health counselors and resources 
for those with chronic illnesses, were lacking.  One volunteer stated 
that aged nursing home residents [were] on uncomfortable cots for 
2 weeks. Another volunteer stated that the shelter where the 
volunteer served could not provide adequate sheltering resources for 
clients with multiple special needs.   
	   Volunteers also reported challenges associated with structural and 
building problems with shelters.  One volunteer noted that the shelter 
where that volunteer served was inadequate and had been designated 
as an [un]inhabitable location by the city where it was located.  
Another volunteer reported that people were sheltered in a sports arena 
with several ice rinks. However, the ice rinks were not de-iced, which 
forced evacuees to sleep on the cold floor covered in cardboard for 
warmth.  
 
 
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The next most frequently reported challengereported by MRC 
volunteerswas disorganization and a general lack of planning at shelter 
locations. MRC volunteers also reported that some shelters had not 
planned for individuals long-term needs, such as power, water, and food, 
over the course of the response. 
Finally, MRC volunteers reported that shelters offered inadequate patient 
transportation to locations such as medical facilities.  For instance, one 
volunteer reported that patients could be transported to medical facilities 
only in personal vehicles because the county did not provide additional 
vehicles. Additionally, one volunteer reported that a shelter did not have  
emergency vehicles to transport patients to medical facilities and no means 
to travel to a pharmacy to obtain additional medication.  
Shelter operations successes were most frequently associated 
with MRC volunteers who had sufficient training and shelters 
that had sufficient supplies 
Although 48 stakeholders reported challenges with training and supplies, 
85 stakeholders reported successes in these areas.  Overall, 154 of 
189 MRC stakeholders (81 percent) reported successes associated with 
shelter operations, including training and supplies.   
The most frequently reported shelter operations success was associated 
with MRC volunteers who had sufficient training or previous experience 
to assist shelter operations.  For example, one volunteer reported having 
participated in drills before Sandy, which provided helpful experience.  
Additionally, another volunteer reported having gained experience by 
previously responding to Hurricane Katrina.  These respondents may have 
been in different shelters or received different training than those who 
reported training challenges. Stakeholders also reported that volunteers 
received just-in-time training that helped them while working in 
shelters.29  
The second most frequently reported shelter operations success was that 
shelters had sufficient supplies.  For instance, one volunteer reported that a 
local health department was able to obtain sufficient oxygen supplies by 
borrowing and receiving donations from  private organizations.  Another 
stakeholder reported that a shelter initially had limited medical supplies 
(i.e., a challenge) but that over the course of the response, staff acquired 
them from nearby medical providers (i.e., a success).  
____________________________________________________________ 
29 Just-in-time training is typically provided  to volunteers shortly before they deploy  or  
begin providing volunteer services.  Such training covers critical information and tasks 
for the specific incident.  
 
 
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The third most frequently reported shelter operations success was that 
shelters were well-organized.  For example, one volunteer stated that a 
shelters people, organization, and supplies were fantastically set up.  
Another volunteer reported that a shelter was very organized.  These 
stakeholders may have worked in different shelters than those who 
reported challenges in this area, or they may have had different 
perceptions of the same shelter.   
 
 
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CONCLUSION AND RECOMMENDATIONS 
During the Sandy response, MRC units in New York and New Jersey 
deployed over 2,000 MRC volunteers and reported that these volunteers 
provided over 18,000 hours of service.  MRC stakeholders reported 
challenges and successes during Sandy that were most frequently 
associated with communication, shelter staffing, and shelter operations.  
Although our review was limited to the MRC response in New York and 
New Jersey, these reported challenges highlight issues that other States 
may encounter while using MRC volunteers during future incident 
responses. Conversely, the successes that MRC stakeholders identified 
may highlight practices for States, including New York and New Jersey, to 
improve their future responses.   
Many of the challenges identified in this report resemble those identified 
in previous OIG work.  These include staffing challenges, such as 
volunteers who do not show up for scheduled shifts because of competing 
work or other commitments and other stakeholders concerns that 
volunteers might not be legally protected during an incident.  
We recommend that ASPR, in collaboration with Federal agencies (e.g., 
CDC, the Federal Emergency Management Agency) or nonprofit 
organizations (e.g., the American Red Cross), provide guidance or 
technical assistance to States and localities (including State and local 
MRC staff), as appropriate, to improve their plans, address these 
challenges, and be better prepared to respond to future incidents.  
Specifically, ASPR should continue to: 
Work with States and localities to strengthen plans for 
volunteer communication 
These plans can be strengthened by ensuring that they include the 
following: 
   Systems and backup systems for communications with MRC 
volunteers in the event of infrastructure failures before and during an 
incident. 
   Protocols for ensuring effective communication between MRC 
volunteers and other stakeholders (e.g., emergency operations centers, 
local health departments) before and during an incident, and plans for 
overcoming communication gaps if they develop. 
   Methods for clearly communicating roles to volunteers at shelters and 
for following appropriate communication chains within the shelter 
(e.g., the Incident Command System). 
 
 
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Work with States and localities to strengthen plans for shelter 
staffing 
These plans can be strengthened by ensuring that they include the 
following: 
 	  Enhanced recruiting efforts for all volunteers, including those with 
specific medical specialties (e.g., physicians, nurses), and staffing 
projections that account for absenteeism rates due to storm-related 
damage or competing work or personal obligations.  These actions will 
increase the likelihood that shelters have sufficient personnel, 
including those with specific medical specialties.  
 	  Specific volunteer liability and licensure procedures to ensure that 
concerns related to these issues do not prevent volunteers from 
deploying for future incidents. 
 	  Methods for tracking and monitoring MRC volunteer deployment to 
ensure that shelters are adequately staffed.  For example, the plan 
should contain information about when and how to relocate MRC 
volunteers from overstaffed shelters to those that are understaffed.  
The plan should also include as an assessment of the number of 
non-MRC staff (e.g., staff from the American Red Cross) deployed at 
shelters.  
 	  Multiple methods for MRC volunteer transportation to affected areas 
during an incident. This may require States or localities to develop 
agreements to use law enforcement vehicles or other local vehicles to 
transport MRC volunteers. 
Work with States and localities to strengthen plans for shelter 
operations 
These plans can be strengthened by ensuring that they include the 
following: 
 	  Methods for obtaining medical supplies and ensuring that staff 
periodically review inventory to maintain adequate supply levels and 
ensure that medical supplies have not expired. 
 	  Methods to ensure that shelter facilities are appropriate (e.g., that they 
have sufficient space and temperature controls) and have adequate 
services available for all populations (e.g., special-needs populations), 
or to ensure that localities are capable of redirecting evacuees to 
special-needs shelters, if necessary.  
 	  Strategies to address transportation to medical facilities for patients 
who require further care.  
 
 
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Additionally, ASPR should consider establishing a minimum level of 
training required on a regular basis (e.g., annually) for all volunteers.  
ASPR could work with States and localities to determine these minimum 
requirements on the basis of national competencies and local needs.  This 
would ensure that volunteers have received training in critical areas either 
before they deploy orusing a just-in-time modelas soon as they 
deploy.  These critical areas include shelter operations and other facets of 
response (including the Incident Command System) and working with 
special-needs populations. 
 
 
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AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
ASPR concurred with all three of our recommendations and stated that it is using 
the findings of this report to identify and implement actions to strengthen MRC 
competencies and coordination.  ASPR also stated that shelter staffing requires 
coordination of efforts among Federal, State, and local stakeholders as well as 
with nongovernmental organizations, such as the American Red Cross.  
Additionally, ASPR stated that  as it develops specific initiatives to address the 
challenges within this report, further resources may be required to fully achieve 
success.  
In response to our first recommendation, ASPR stated that it is drafting guidance 
for MRC units on best practices in communications during power outages. 
Additionally, ASPR is working to enhance collaboration among MRC 
coordinators and other stakeholders before, during, and after public health and 
medical emergencies.  Finally, MRC has engaged other partners to revise the 
MRC core competencies to provide more concrete information to MRC units 
about several topics for training, including the Incident Command System.      
In response to our second recommendation, ASPR stated that it has developed and 
launched an MRC toolkit that contains a set of expectations and performance 
measures that MRC unit leaders can use to enhance their units capabilities and 
operations. This toolkit also addresses many concerns and issues related to 
shelter staffing, such as assessing community needs and tracking and managing 
volunteers. 
In response to our third recommendation, ASPR stated that it will continue to 
work with stakeholders to address issues and concerns regarding shelter 
operations. In response to our statement that ASPR should consider establishing 
a minimum level of training required for all volunteers,  ASPR stated that the 
MRC toolkit it developed addresses many concerns about training needs for 
volunteers.  ASPR said that it will continue to provide additional assistancei.e., 
toolkits and guidance documentsto MRC units, but that it believes that  
increased resources will best solve the training issues identified in this report.   
We support ASPRs efforts to strengthen competencies and coordination 
throughout the MRC network. We believe that the actions ASPR describes will 
enhance the capabilities of MRC units to be effective partners in future incidents.  
For the full text of ASPRs comments, see Appendix E. 
 
   
 
 
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APPENDIX A 

 
Detailed Methodology 
 
Data Collection 
We collected questionnaire data between September and December 2013 from  
MRC stakeholders to describe MRC volunteers response in New York and 
New Jersey for Sandy from October 2012 to March 2013.  We also collected 
questionnaire data to determine the challenges and successes associated with the 
MRC Sandy volunteer response in New York and New Jersey.   
We sent our electronic questionnaire to 466 MRC stakeholders in New York and 
New Jersey.  These stakeholders were from one of the following five groups:  
(1) MRC volunteers, (2) local health department staff, (3) local MRC 
coordinators, (4) State MRC coordinators, and (5) the regional MRC 
coordinator.30    
We coordinated with ASPR and DCVMRC and reviewed previous OIG reports 
and existing literature to identify common challenges or successes associated with 
MRC volunteers response to incidents.31  For each issue we identified, we asked 
the MRC stakeholders to indicate whether, during their response to Sandy, that 
issue was a challenge or a success. If the MRC stakeholder indicated that 
something was a challenge or success, we asked for a description of the challenge 
or success. In addition, we asked each MRC stakeholder to describe any other 
challenges or successes unrelated to the topics we identified.   
We also asked each stakeholder to provide a description of MRC volunteers  
response activities while deployed.  Finally, we asked MRC stakeholders to 
describe any nonprofit or other response teams with whom MRC volunteers 
worked during their deployment. 
We received responses from 262 of the 466 MRC stakeholders; however, only 
189 of these stakeholders reported challenges or successes associated with Sandy.  
The other 73 stakeholders did not provide this information for several reasons 
for example, a locality might not have requested any MRC volunteers, or a local 
MRC coordinator might not have had any MRC volunteers deploy from that 
coordinators unit.  See Table A-1 for the number of MRC stakeholders that we 
surveyed and the response rate for all MRC stakeholders. 
 
 ____________________________________________________________ 
30 This MRC region includes New Jersey, New York, Puerto Rico, and the  Virgin Islands.  
31  When we initially coordinated  with  DCVMRC staff in  2013 and 2014, the DCVMRC had  not  
yet fully transitioned to ASPR.  
 
 
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Table A-1: MRC Stakeholders and Response Rates, 2013  
Number of  
MRC Stakeholder  MRC  Number of  
Response Rate  
Group  Stakeholders  Respondents 
Surveyed  
MRC Volunteers   330  126*  35%  
Local Health 
80  80  100%  
Department Staff  
Local MRC 
53  53  100%  
Coordinators 
State and 
Regional MRC  3  3  100%  
Coordinators 
     Total  466  262  54%  
                                       Source:  OIG analysis of 2013 MRC stakeholder  respondent data, 2014.  

                                       *Note: Of  the  204 volunteers who did not respond to our request, we were not able to contact 7 volunteers because we did  

                                       not  receive accurate contact information for them from State MRC coordinators.  We  contacted the remaining 197 volunteers,  

                                       but they  did not respond to  our  request. 

MRC Volunteers.   To identify MRC volunteers who deployed in response to 
Sandy, we worked with MRC coordinators in New York, New Jersey, and 
New York City to develop a list of  all MRC volunteers who deployed in these 
areas. These coordinators initially reported a total of 1,540 MRC volunteers 
deployed, and these MRC volunteers served as our sampling population.32    
We organized the 1,540 MRC volunteers into three strata on the basis of where 
they deployed.  Stratum one included 1,028 MRC volunteers that deployed in 
New York City.  Stratum two included 239 MRC volunteers that deployed in 
New York State, outside of New York  City.  Finally, stratum three included 
273 MRC volunteers that deployed in New Jersey  
From these 1,540 MRC volunteers, we selected a stratified simple random sample 
of 330 MRC volunteers. Of these 330 volunteers, we selected 135 from stratum  
one, 95 from stratum two, and 100 from stratum three.  We sent a questionnaire to 
these selected volunteers, and we contacted them by phone and/or email up to 
three times to ask them to complete our questionnaire.  
Overall, 126 MRC volunteers completed the questionnaire, yielding a weighted 
response rate of 35 percent. Because of the low response rate of MRC volunteers, 
we cannot project the data from our MRC stakeholder respondents to the 
populations of MRC stakeholders in New York, New Jersey, or nationwide.  See 
Table A-2 for the number of sampled MRC volunteers, the number of 
respondents, and the response rates by stratum and overall. 
____________________________________________________________ 
32 Initially, MRC coordinators in  New York, New Jersey, and  New York City reported that  
1,540 MRC  volunteers deployed in response to Sandy.   After data collection, they reported that  
2,027 volunteers deployed.  Because we had already sent our data collection instruments to 
selected volunteers, 1,540 serves as the population from which we selected our sample. 
 
 
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Table A-2: MRC Volunteers and Response Rate by Stratum, 2013  
Number of   Number of  
Sampling 
Stratum  Sampled  Volunteer  Response Rate 
Population  
Volunteers   Respondents 
New York City   1,028   135  42  31%  
New York (outside 
239   95   36   38%  
New York City)  
New Jersey    273   100   48   48% 
     Total   1,540   330  126  35% 
 
           Source:  OIG analysis of  2013 MRC Volunteer Respondent Data, 2014. 
Local Health Department Staff. We worked with New York and New Jersey State 
MRC coordinators to create a list of appropriate individuals (e.g., county health 
directors, emergency response coordinators, and public health officers) in local 
health departments to complete our questionnaire.33   After identifying these 
individuals, we sent a questionnaire to local health department staff in 79 counties 
in New York and New Jersey.  We also sent one questionnaire to staff in the 
New York City local health department, which covers five additional counties in 
New York State.   
Staff in all of these 80 localities completed our questionnaire; however, we 
analyzed only the responses from the 24 local health departments that received 
MRC volunteers in their jurisdictions.  The remaining 56 localities did not receive 
MRC volunteers during the Sandy response.34   
Local MRC Coordinators. We worked with the State MRC coordinators to create 
a list of all active local MRC units and coordinators (i.e., the units and 
coordinators that were recruiting MRC volunteers at the time we began data 
collection) in New York and New Jersey during the Sandy response.  Using this 
list, we determined there were 53 active units, and we sent a questionnaire to the 
MRC coordinator associated with each of them.  Coordinators from all 53 units 
completed our questionnaire; however, we considered only the responses from the 
36 units that deployed MRC volunteers for Sandy.35 
 ____________________________________________________________ 
33  We  defined appropriate individuals as those who worked, coordinated,  or communicated with  
MRC stakeholders (e.g., MRC volunteers, local coordinators) during  the MRC response. 
34 These localities did not receive volunteers for several reasons.  For instance, some localities 
were not affected  by Sandy and  did  not need  volunteer assistance.  Other localities were affected 
by Sandy but received help from organizations other than the MRC. 
35 One MRC coordinator reported that  volunteers from a unit  deployed in  response to  Sandy, but  
this coordinator did not report any challenges or successes  associated with the response.  
Therefore, we  did not include this coordinators responses in our analysis. 
 
 
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State and Regional MRC Coordinators. We sent a questionnaire to the State 
MRC coordinators in New York and New Jersey and the regional MRC 
coordinator.   All three of these coordinators completed our questionnaire.   
Data Analysis  
Describing MRC Volunteers Response. Using the information provided by State 
and regional MRC coordinators, we determined the extent to which MRC 
volunteers deployed in response to Sandy (i.e., the number of MRC volunteers 
who deployed in New York and New Jersey).  We also reviewed descriptions of 
MRC volunteers activities from all five MRC stakeholders groups to determine 
the type of services that MRC volunteers provided and whether they worked with 
response teams from nonprofits (e.g., the American Red Cross) or other 
organizations. 
Identifying Challenges and Successes Associated With the MRC Sandy Response. 
To describe the challenges and successes of the Sandy response, we conducted 
qualitative data analysis on the responses we received from all five stakeholder 
groups. We first organized the reported challenges and successes, separately, into 
common themes that we most frequently identified during our analysis (i.e., 
communication, shelter staffing and shelter operations).  If a challenge or success 
addressed multiple themes, we treated each of the unique concepts of the response 
as a separate challenge or success.  If a respondent cited the same challenge or 
success in response to multiple questions, we counted it as a single challenge or 
success. Additionally, respondents may have reported both challenges and  
successes that fell into the same theme.  For instance, if a volunteer reported 
challenges relating to communications infrastructure (e.g., power outages), but 
successes associated with an MRC coordinator who was responsive, we would 
count these responses as a communication challenge and success, respectively.  
We classified each concept within a response into one, and only one, category.  
We developed a theme if we identified 25 or more related challenges or successes 
across respondents. For instance, we developed the communication theme after 
identifying 25 responses that addressed communication challenges.  Because 
respondents raised challenges and successes beyond the common challenge or 
success topics we identified and included in our questionnaire, the themes we 
developed were related, but not identical, to the questions we asked MRC 
stakeholders. 
If a challenge or success could not be categorized into a theme because there were 
not at least 24 other challenges or successes dealing with the same topic, we 
categorized it into an other theme.  For instance, MRC stakeholders reported 
successes associated with volunteer resiliency during the Sandy response, but it 
was not mentioned frequently enough to constitute a theme.   
 
 
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We then categorized each challenge or success within each theme into one or 
more subthemes.  We developed subthemes if they contained five or more related 
challenges or successes.  If a challenge or success could not be categorized into a 
subtheme, we placed it in the themes other subtheme.  See Appendix D for the 
number of other challenges and successes within New York and New Jersey 
reported, by theme.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDIX B 
Sandy Challenges Reported by Medical Reserve Corps (MRC) Stakeholders Within New  York and 
New Jersey, 2013  
 Local  State and  Total**  
MRC  Health   Local MRC  Regional  (n=189)  
Challenge Themes and Subthemes   Volunteers   Department   Coordinators   MRC   
(n=126)  Staff  (n=36*)   Coordinators   (NY n=100) 
(n=24*)   (n=3)   (NJ n=89)  
Communication   33  15  28  3  79 
New York   50 
New Jersey   29  
General communication   4  14  21  1  40 
problems due to infrastructure              
failures (e.g., power outages,              
limited cell service, etc.)           
New York                    20 
 New Jersey           20  
Communication gaps among   6   1   8   1   16 
stakeholder groups unrelated to    
power outages, etc.   
New York  11 
 New Jersey   5  
Undefined or unclear MRC   11   0   0   0   11 
volunteer role   
New York  8 
 New Jersey   3  
Chain of command or Incident  2   1   2   0   5 
Command System not   
followed   
New York  2 
 New Jersey   3  
Shelter Staffing   53  17  19  3  92 
New York  58 
 New Jersey   34  
27  14  11  3  55 
MRC volunteers unable to deploy  
 
 New York 
39 
 New Jersey  
16  
Low number of MRC volunteers with  8  2  1  1  12 
medical specialties   
New York  3 
 New Jersey   9  
Liability and licensure concerns   0  4  7  1  12 
New York  5 
 New Jersey   7  
Too many MRC  volunteers  10  0  0  0  10 
New York  10 
 New Jersey   0  
Communication problems caused  3  1  3  0  7 
low MRC volunteer turnout   
 New York  3 
 New Jersey   4  
continued on next page  
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   28 
(OEI-04-13-00350)   
   
Sandy Challenges Reported by Medical Reserve Corps (MRC) Stakeholders Within New  York and 
New Jersey, 2013, Continued  
 
 Local  State and  Total**  
MRC  Health   Local MRC  Regional  (n=189)  
Challenge Themes and Subthemes   Volunteers   Department   Coordinators   MRC   
(n=126)  Staff  (n=36*)   Coordinators   (NY n=100) 
(n=24*)   (n=3)   (NJ n=89)  
Shelter Operations  51  10  7  0  68 
 New York  38 
 New Jersey   30  
Insufficient shelter supplies   29  7  0  0  36 
New York  20 
 New Jersey   16  
Lack of shelter-specific training  6  2  6  0  14 
 New York  4 
 New Jersey   10  
Special-needs services lacking   8  0  0  0  8 
New York  6 
 New Jersey   2  
Structure and building problems   8  0  0  0  8 
New York  4 
 New Jersey   4  
Disorganization and a general lack   7  0  0  0  7 
of planning   
New York  5 
New Jersey   2  
Inadequate patient transportation          6  0  0  0  6 
 New York  3 
 New Jersey   3  
*Sample size reflects respondents in jurisdictions or units with deployed MRC volunteers rather than all respondents for  stakeholder group.   

Note: Some MRC stakeholders reported more than one  challenge.  The shaded rows  represent all challenges reported by MRC stakeholders within a  

theme, including other challenges.  See Appendix D for  more details on  the other challenges reported by MRC stakeholders. 

**Challenges reported by MRC stakeholders in New York include those from the MRC regional coordinator, New York State, and New  York City. 

Source:  OIG analysis of Sandy MRC questionnaire data, 2014. 

   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   29 
(OEI-04-13-00350)   
   
APPENDIX C 
Sandy  Successes Reported by Medical Reserve Corps (MRC) Stakeholders Within New  York and 
New Jersey, 2013  
 Local  State and  Total**  
MRC  Health   Local MRC  Regional  (n=189)  
Success Themes and Subthemes  Volunteers   Department   Coordinators   MRC   
(n=126)  Staff  (n=36*)   Coordinators   (NY n=100) 
(n=24*)   (n=3)   (NJ n=89)  
Communication   37  14  20  3  74 
New York  29 
 New Jersey   45  
18   12   16   2   48 
Methods of communication among 
 
stakeholders 
 
New York 
13 
 New Jersey  
35  
MRC coordinators were   18   5   4   2   29 
available and responsive to   
requests   
New York  9 
New Jersey   20  
Shelter Staffing   25  14  12  3  54 
New York  27 
 New Jersey   27  
Sufficient number of   21  7  2  1  31 
MRC volunteers   
 New York  18 
New Jersey   13  
Shelter Operations  114  20  19  1  154 
 New York  84 
 New Jersey   70  
MRC volunteers had      44  11  18  1  74 
sufficient training    
 New York  31 
New Jersey   43  
Sufficient shelter supplies  17  2  1  0  20 
New York  8 
 New Jersey    12  
Well-organized facility/shelter  9  0  0  0  9 
New York  4 
 New Jersey   5  
*Sample size reflects respondents in jurisdictions or units with deployed MRC volunteers rather than all respondents for  stakeholder group.  Note: 

Some MRC stakeholders reported more than one success.  The shaded rows represent all successes reported by MRC stakeholders within a theme, 
 
including other  successes.  See Appendix D for more details on  the other successes reported by MRC stakeholders.  
 
**Successes reported by MRC stakeholders in New York include those from the MRC regional  coordinator, New York State, and New York City. 

Source:  OIG analysis of Sandy MRC questionnaire data, 2014. 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   30 
(OEI-04-13-00350)   
   
APPENDIX D 
Other Sandy Challenges Reported by  Medical Reserve Corps (MRC) Stakeholders Within New  
York and New  Jersey, 2013  
 Local  State and  Total**  
MRC  Health   Local MRC  Regional  (n=189)  
Challenge Themes   Volunteers   Department   Coordinators   MRC   
(n=126)  Staff  (n=36*)   Coordinators   (NY n=100) 
(n=24*)   (n=3)   (NJ n=89)  
Communication (e.g., MRC  14  2  5  1  22 
volunteers not having contact   
information for shelter managers)   
 New York  19 
 New Jersey   3  
Shelter Staffing (e.g., lack of MRC  18   5   4   2  29 
volunteer tracking and reporting   
systems)   
New York  17 
 New Jersey   12  
Shelter Operations (e.g., not having  17   4   1   0   22 
adequate sanitation stations for   
medical MRC volunteers or residents)   
New York  16 
 New Jersey   6  
Other  (e.g., MRC volunteers were  not  30  0  7  2  39 
working within their scope of practice)   
New York  28 
 New Jersey   11  
*Sample size reflects respondents in jurisdictions or units with deployed MRC volunteers rather than all respondents for  stakeholder group.   

**Challenges reported by MRC stakeholders in New York State include  those from the MRC regional coordinator.  

Note: Some MRC stakeholders reported more than one challenge.  

Source:  OIG analysis of Sandy MRC questionnaire data, 2014. 
  
Other Sandy Successes Reported by  MRC Stakeholders Within New  York and New  Jersey, 2013  
 Local  State and  Total**  
MRC  Health   Local MRC  Regional  (n=189)  
Success Themes   Volunteers   Department   Coordinators   MRC   
(n=126)  Staff  (n=36*)   Coordinators   (NY n=100) 
(n=24*)   (n=3)   (NJ n=89)  
Communication (e.g., effective  19  4  13  2  38 
communication with American Red   
Cross)   
 New York  19 
 New Jersey   19 
Shelter Staffing (e.g., MRC volunteers  4  9  12  3  28  
arriving at assigned shelters on-time)     
 New York    10 
 New Jersey   18  
Shelter Operations (e.g., local health  111  18  1  0  130 
departments were able to feed   
volunteers and had sufficient space for   
MRC volunteers)   
 New York  75 
 New Jersey   55 
Other  (e.g., MRC volunteers displayed  65  10  17  3  95 
resilience during Sandy)   
 New York  51 
 New Jersey   44 
*Sample size reflects respondents in jurisdictions or units with deployed MRC volunteers rather than all respondents for  stakeholder group.  

**Successes reported by MRC stakeholders in New York State include  those from the MRC regional coordinator.  

Note: Some MRC stakeholders reported more than one success.  

Source:  OIG analysis of Sandy MRC questionnaire data, 2014. 
  
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   31 
(OEI-04-13-00350)  APPENDIX E 
Agency Comments 
~=-..-	- """'4
~
.. OE I'.-\IHiVI E:"'T OF II EALTII & ll l':\1:\1\ SERVIC ES 
 Offi ce of lhe Secre lary
::::-z~ -
Assis tarl l Secretary lor 
Preparednt="c;s & ResponsP 
Wa<;~~.ngt on D C 	 20201 
TO: 	 Suzarme Murrin 

Deputy Inspector General 

Department of Health and Human Services 

FROM: 	 Nicole Lurie, MD, MSPII 

Assistanl Secretary for Preparedness and Response 

SUBJECT: 	 Office of Inspector General"s Draft Report: Medical Reserve Corps Volunteers in 
New York and New Jersey During Supers/arm Sandy, OEI-04-1 3-00350 
The Office of the Assistant Secretary for Preparedness and Response (ASPR) appreciates the 
opportunity to review and comment on the Office of Inspector General's (OJG) draft report : 
Medical Reserve C01ps Volunteers in New York and New .Jersey During Superstorm Sandy (OEl
04-13-00350). Thank you tor your review of this important issue. 
The Medical Reserve Corps (MRC) program was under the authority of the Office of the 
Assistant Secretary for Health (OAS H) during the response to Superstorn1 Sandy. In an eff011 to 
build on recent experiences during the activation of the MRC during this major response, ASPR 
is utilizing the findings of thi s OJG report to identify and implement actions to strengthen MRC 
competencies and coordination throughout the network.  As the report highlights, MRC units 
struggled to appropriately staff shelters and communicate with state and local entities during the 
response. demonstrating gaps in training and operational capacity for particular MRC units. 
ASPR is actively examining methods to capture and communicate MRC units capabilities to 
state and local partners, promote consistent MRC baseline capabilities nationally. and enhance 
how MRC units are utilized during a response. As ASPR develops specific initiatives to address 
the gaps within this report-such as additional trainings, technical assistance, and identification 
and implt:mentation of best practices - additional resources may be required to fully achieve 
success. 
ASPR concurs with OIG"s general recommendation that 'ASPR, in collaboration with federal 
agencies (e.g.. CDC, the Federal Emergency Management Agency) or non-governmental 
organizations (e.g.. American Red Cross), provide guidance or technical a~sistance to states and 
localities (including MRC staff in these areas). as appropriate, to improve their plans, address 
these challenges. and be better prepared to respond to future incidents: Consistent with OIG's 
findings. there are many factors that impact communications and operations during a response to 
an incident.  It is important to note, however, that the MRC does not operate in isolation and 
many MRC functions arc dependent on the management and operations of other organizations, 
both govenm1ental and nongovernmental.  Broader coordination and integration with partners 
throughout the spectrum of response and emergency management will further improve 
communication and coordination during a response. 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy  32 
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Agency Comments (Continued) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   33 
(OEI-04-13-00350)   
   
Agency Comments (Continued) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   34 
(OEI-04-13-00350)   
   
Agency Comments (Continued) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   35 
(OEI-04-13-00350)   
   
Agency Comments (Continued) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   36 
(OEI-04-13-00350)  Agency Comments (Continued) 
OEI-04-13-00350 
Page 6 
provide training.  ASPR will continue to provide additional assistance to MRC units in a 
financially prudent way (i.e .. toolkits and guidance documents). but believes that 
increased resources will best solve the training issues found in this report. 
Thank you again tl1r carrying out this study and permitting us to review this draft report . The 
findings of this OlG report identifies gaps that could be alleviated with increased resources to 
support traimng and recru itment and retention activities.  We will continue to seck new ways to 
collaborate with our federal partners and nongovernmental organizations in preparing the nation 
for natural disasters and other public health emergencies.  Please direct any questions to Serina 
Vandegrift by telephone at 202.205.0050. or by e-mail at Serina.Vandegrift@hhs.gov. 
Nicole Lurie, MD. MSPH 
Assistant Secretary for Preparedn ess and Response 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy  37 
(OEI-04-13-00350)   
   
ACKNOWLEDGMENTS 
This report was prepared under the direction of Dwayne Grant, Regional 
Inspector General for Evaluation and Inspections in the Atlanta regional office, 
and Jaime Stewart, Deputy Regional Inspector General.   
David Samchok served as the lead analyst for this study.  Central office staff who 
contributed include Kevin Farber, Kevin Manley, and Christine Moritz.   
 
 
 
Medical Reserve Corps Volunteers in New York and New Jersey During Superstorm Sandy   38 
(OEI-04-13-00350)   
Office of Inspector General
http://oig.hhs.gov  
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is  
to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the 
health and welfare of beneficiaries served by those programs.  This statutory mission is carried out through 
a nationwide network of audits, investigations, and inspections conducted by the following operating 
components:  
Office of Audit Services 
The Office of Audit Services (OAS) provides auditing services for HHS, either by conducting audits with 
its own audit resources or by overseeing audit work done by others.  Audits examine the performance of  
HHS programs and/or its grantees and contractors in  carrying out their respective responsibilities and are  
intended to provide independent assessments of HHS programs and operations.  These assessments help 
reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS. 
Office of Evaluation and Inspections  
The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide HHS, Congress, 
and the public with timely, useful, and reliable information on significant issues.  These evaluations focus 
on preventing fraud, waste, or abuse and promoting economy, efficiency, and effectiveness of  
departmental programs.  To promote impact, OEI reports also present practical recommendations for 
improving program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative investigations of fraud and 
misconduct related to HHS programs, operations, and beneficiaries.  With investigators working in all 
50 States and the District of Columbia, OI utilizes its resources by actively coordinating with the  
Department of Justice and other Federal, State, and local law enforcement authorities.  The investigative 
efforts of OI often lead to criminal convictions, administrative sanctions, and/or civil monetary penalties. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, rendering 
advice and opinions on HHS programs and operations and providing all legal support for OIGs internal  
operations.  OCIG represents OIG in all civil and administrative fraud and abuse cases involving HHS 
programs, including False Claims Act, program exclusion, and civil monetary penalty cases.  In  
connection with these cases, OCIG also negotiates and monitors corporate integrity agreements.  OCIG 
renders advisory opinions, issues compliance program guidance, publishes fraud alerts, and provides other 
guidance to the health care industry concerning the anti-kickback statute and other OIG enforcement 
authorities.