Coffee with COR-Featured Hot Shot :Mark Reiswig
Hurricane Irma intensified into a Category 5 storm on September 4th, 2017. One of the largest hurricanes on record, it found its way through the Atlantic Ocean leaving a path of destruction in 14 different geographic regions and taking over 100 lives. Evacuations out of Florida were unprecedented and Georgia itself declared a state of emergency in preparation for our own coastal evacuations (including multiple healthcare facilities) as well as the response phase. None of this should come as a surprise since the news covers hurricane devastation very thoroughly….but what happens after a hurricane? How do government agencies learn from their successes and challenges, and look to improve their preparedness and response efforts after disasters?
There were so many lessons learned from Irma. Over the past 22 months COR has been in collaboration with the Gwinnett, Newton, and Rockdale County Health Departments, (GNR) and Georgia’s state Department of Public Health (DPH), working through mass sheltering clinical operation processes.
Our hot shot of the month is Mark Reiswig. Mr. Reiswig graduated from Baylor University Hankamer School of Business and has served in many advisory roles for all forms of disaster response. He began work with the GNR County Health Departments over 12 years ago. In his current role, as the Director of Emergency Preparedness, he is responsible for directing all emergency preparedness efforts including budgeting, staffing, training, exercising, and responding for the three-county public health district that serves over 1.2 million people in metro Atlanta. Additionally GNR is often provides mass shelter support for evacuees of coastal areas of Georgia, either locally or by sending support teams to other regions to support shelter efforts there.
COR: We believe you have an overwhelming task in front of you, ensuring that the GNR district staff feel both competent and empowered to serve in a disaster. What has been your approach to this?
My every day job (as well as that of my 6-member team) is to anticipate potential disasters and to prepare for them. However, although also expected to respond during emergencies, this is not the day-to-day job of the other 300 GNR employees. It is my team’s task to analyze our hazard vulnerabilities, develop plans to address them, train all staff in plan implementation, and conduct exercises that test the viability of those plans. After every exercise or real-world event, it is then critical to conduct something called an After Action Review. This simply analyzes the strengths and challenges of the exercise or event, identifies planning or resource gaps, and develops an Improvement Plan to address areas of weakness. This is all part of the planning cycle. I guess my approach to all this boils down to three key things:
1. Make sure my own Emergency Preparedness team is strong and knows that they are empowered to make suggestions and decisions without me having to vet everything. A big task requires a great team; one individual will accomplish far less. Furthermore, Public Health response is never in a vacuum, and we are part of a larger community-wide team, and it important that we know key players in our first responding agencies, healthcare organizations, etc.
2. Train people in the organization in the roles that they are likely to play in a disaster response, and then conduct regular drills so they can develop these skills. Brain capacity drops significantly in a high-stress situation, so it is critical that people have some degree of “muscle memory” and a general comfort level in terms of what is expected of them to reduce that stress level.
3. No response will ever be perfect. Learn something from every single event or exercise, and seek ways to improve your response the next time, whether it means revising your plans, improving your training program, obtaining new resources, etc.
COR: Many people may not understand how the Department of Public Health and volunteer agencies work together to ensure that medical needs are met in an emergency or disaster. Can you explain how multiple entities collaborate?
Volunteers are a critical component of what we do. As I said before, our health department has about 300 total employees, and only about 10% of these are nurses. Depending on the type of disaster, we may be required to dispense life-saving medication to as many as 1.2 million people in less than 48 hours. Not possible with just our staff. We need collaboration with trained volunteers as well as our many partner agencies if we are to have any chance of succeeding. Another example is sheltering. While Public Health is the agency charged with coordinating the health and medical needs in an evacuation shelter, that does not mean that it can fill all the roles. The chart above shows some of the partner agencies we would need just to help us with only the medical needs in an evacuation shelter. This does not even count people such as Red Cross shelter managers, DFCS personnel filling other positions, security personnel, inspectors, etc. that fill the non-health needs in a shelter.
COR: We have enjoyed our professional collaboration with both GNR and the state Department of Public Health. Why did you feel that it was important to aggressively revamp and enhance the mass sheltering protocols and processes?
Just after Hurricane Matthew hit Georgia in 2016, we sent a team of five Public Health nurses to assist in a Red Cross shelter in Savannah. To be blunt, it did not go well at all. Our nurses felt overwhelmed at extensive medical and behavioral health needs they witnessed, many of which went well beyond the scope of practice for a PH nurse. They had no logistical support whatsoever and thus spent most of their time performing tasks that could have been performed by non-medical staff. Most importantly, they did not feel safe, because security was not as strong as they would have liked. We knew we needed a new model. Therefore, we developed the concept of a Shelter Support Task Force (SSTF) to send out as a unit to a shelter (local or deployed elsewhere in the state). This SSTF consisted of nurses, epidemiologists, and logistical support staff, which would primarily be drawn from either our environmental health staff or volunteers. We were still in development of this concept, when we had the opportunity to test it out in the fall of 2017 as Irma bore down on Georgia. We were able to quickly put together a team that consisted of four PH nurses (including strong leadership skills and decision making ability), two volunteer MRC nurses with significant acute care experience, two environmental/logistical support team members (including one male, which our nurses from the prior year told us was essential), and one epidemiologist. Most of these team members did not know each other, and our training was very limited at that time. Also, unbeknownst to me, our two MRC nurses were also the principals of COR Consultants, who happened to be extremely skilled in studying processes and operations, and identifying ways to improve them. Success = Preparation + Opportunity + Luck. We sent this team to a 650-person shelter in Columbus, GA, and they made a huge impact. Despite the relative lack of training, shelter medical operations improved greatly, lives were positively impacted and I am sure in a few cases saved because of this team. Furthermore, we learned much more, and began the process to improve again. Through the feedback of this team, we worked with COR Consultants to develop new rounding processes to improve health outcomes, developed forms that improved the ability to track residents’ health needs, identified key shelter supplies to bring in a kit, and developed training curricula for PH staff and volunteers. We also put together community-wide exercise programs to demonstrate to all our partners the critical nature of collaboration among all partners. I honestly feel that we are light years ahead of where we were three years ago. I am extremely grateful to Bonnie and Nicole at COR Consultants not only for volunteering their time to help make our shelter a success, but in utilizing their skills along with information learned from the experience of actually working in a shelter to improve our process even further.
COR: We are members of the Medical Reserve Corps, a national network of volunteers, organized locally to improve the health and safety of their communities. The MRC network has worked closely with public health departments, emergency managers, and homeland security to ensure the safety of the public. Since you have expressed that many disciplines are needed to help meet the medical needs of a community in a disaster can you explain to healthcare professionals the steps they should take to volunteer for the current hurricane season?
There are over 900 local MRC units nationwide. They all need more medical and non-medical volunteers. Google it, find one in your area, and find out the process to join. Disasters are different in the various regions of the country, but they exist everywhere, and you can be part of making a great impact on peoples’ lives in a difficult time. Few things are more rewarding.
The COR Perspective: Preparation is key in readying yourself for a disaster. Although the GNR district is only one of 18, it has proven itself as one of the leading districts in the state. Mark has gone above and beyond to ensure that his district is up for the task of mass sheltering. Bringing his previous hurricane sheltering experience to the table, he has demonstrated great leadership skills by exploring both previous successes and failures.
As with all of our clients, we have been focused on two main elements during this engagement: (1) End-User Experience (is it both the best that it can be and feasible), and (2) Patient Experience (are we helping to provide safe and effective care for the community).
Mr. Reiswig has demonstrated that his priority is to ensure that DPH staff, volunteers, and community health partners are ready to serve if disaster hits Georgia or the surrounding coastlines.