Health and Human Services needs to take multiple steps to ensure that a surge of responders will be available and adequately trained in the event of disasters and public health emergencies, the Government Accountability Office found in its review of the department’s approach to staffing the National Disaster Medical System (NDMS).
The NDMS is a partnership between HHS, the Department of Homeland Security, the Defense Department and Veterans Affairs, designed to augment the response during events in which state, local and tribal response capabilities could be overwhelmed. Responders are divided into the Disaster Medical Assistance Team, the Trauma and Critical Care Team, the Disaster Mortuary Operational Response Team, the Victim Information Center Team, and the National Veterinary Response Team.
HHS’ Office of the Assistant Secretary for Preparedness and Response enrolls and deploys responders, and as of December had 3,667 on hand — 2,703 of those on the Disaster Medical Assistance Team and 212 on the Trauma and Critical Care Team.
However, during the 2017 hurricanes that hit Texas, Puerto Rico, Florida, and the U.S. Virgin Islands, there was a shortage of NDMS responders that had to be augmented with personnel from federal partners such as DoD.
As of the end of March, about 1,200 NDMS public health and medical responders had been deployed to help fight the COVID-19 pandemic in missions such as working to safely transfer cruise ship passengers to inland quarantine sites.
GAO reviewed NDMS because of a provision in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 for the office to review the medical surge capacity in the event of a public health emergency. The watchdog looked at ASPR’s workforce planning and evaluation of the training it provides to its team of responders.
“In 2018, HHS developed an enrollment target for NDMS of 6,290 responders, but GAO found HHS did not follow key principles of effective strategic workforce planning in developing this target. For example, HHS did not identify the critical skills and competencies needed of its NDMS workforce to meet current and future programmatic results,” GAO wrote. “Specifically, HHS’s target does not take into consideration three key areas: a workforce capable of responding to (1) a nationwide event or multiple concurrent events, (2) the needs of at-risk individuals, and (3) the availability of other medical responders. Consequently, HHS cannot be sure its target, if achieved, will provide an adequate number of responders with the skill sets needed to effectively respond.”
NDMS responders have to take online training before deployment — including psychological first aid once every three years and a course on “pathogens of concern” once in their career — and have the option to add in-person training. But GAO said that the agency’s “process to evaluate its training does not align with key practices.”
“As a result, HHS does not have assurance that it is effectively preparing responders for deployment, including keeping them and others safe during an emergency, such as COVID19,” the report states. “For example, HHS requires a web-based course on donning and doffing personal protective equipment to protect against infectious disease, biological, and chemical threats. However, HHS does not know the training’s effectiveness until responders have deployed; at which point, if ineffective, responders could potentially expose themselves to hazards.”
“Further, HHS officials state their in person training is most beneficial but more costly to provide, limiting its provision. A more effective training evaluation process would help the agency determine which in-person courses are most beneficial and should be prioritized, or even made mandatory, for effective and safe responder deployment.”
ASPR told GAO that it “wants to develop and launch a program to actively recruit medical professionals into NDMS,” but GAO said “there are no specifics included in the plan on how this will be achieved.”
“It will be important for ASPR to develop specific plans,” the report continued. “Without strategies to fill gaps to achieve an NDMS workforce target, ASPR continues to risk being unable to provide adequate numbers and types of NDMS responders to effectively respond to public health emergencies. It also risks not being able to take full advantage of the direct-hire authority that expires in September 2021.”
GAO recommended that ASPR “develop an NDMS responder workforce target that aligns with the goals and objectives in ASPR’s forthcoming strategic plan” and accounts for the critical skills and competencies that are needed to meet challenges such as multiple concurrent events, develop strategies to fill workforce gaps, develop a process to evaluate the results of its training courses, and “develop a process or approach to prioritize various in-person training needs for its NDMS responders while taking into account budget constraints.”
HHS concurred with GAO’s recommendations, but expressed concern about the report’s references to the COVID-19 pandemic because “a pandemic response is outside the primary scope of NDMS” and assessment of staff currently deployed would be premature. GAO said that its review “did not assess NDMS’s response to COVID-19, rather we assessed ASPR’s workforce planning more generally for all-hazards events.”