By Bill V. Powers, MPA

Related Article: Six areas for better collaboration: The 2009 UASI Conference

The tone for the 2009 National Metropolitan Medical Response System Conference was set by the Office of Management and Budget, when it released preliminary language for the direction of the Administration’s FY 2010 budget:

‘State and Regional Preparedness Programs: $2,045,000,000 - $40,000,000 Medical Surge Grant Program (MSGP) – replacing the MMRS program, $41,000,000 in FY 2009. This [MSGP] supports integration of emergency management health, and medical systems into coordinated response to mass casualty incidents by any hazard(s). Building on gains made by MMRS program and works in conjunction with the MMRS cities (according to budget justification), will serve as a pilot for application of version 3.0 Target Capabilities List.”

Requests for clarification filled the room as National Program Managers from FEMA tried to explain the genesis of this OMB language and its potential effect on existing MMRS programs and jurisdictions.

The conference was held in Charlotte, N.C., on June 12, immediately following the 2009 National Urban Areas Security Initiative Conference.

W. Ross Ashley, assistant administrator with the Grant Programs Directorate, and Dr. Jon Krohmer, acting assistant secretary of the DHS Office of Health Affairs, offered inputs and evaluations regarding the importance of surge capacity following the recent H1N1 swine flu outbreak and the World Health Organization’s decision to raise the pandemic threat level. Ashley and Krohmer urged participants to build on their existing plans to prepare for and respond to this emerging public health challenge. Further, each vowed to prepare guidance that would continue to help MMRS jurisdictions maintain scalable flexibility in their planning efforts.

Dr. Sebastian Heath, MMRS National Program Manager, gave an enlightening overview of the goal to apply defensible metrics to current MMRS jurisdictions, citing the policy directives from P.L. 109-295, the Post Katrina Emergency Management Reform Act of 2006, or PKEMRA. Heath primarily outlined steps to achieve “capability-based preparedness” that aligns with the emerging v.3 Target Capabilities List incorporating defensible measurements. A vigorous discussion on how to segue the MMRS program to a risk-based program followed.

It’s recognized that current MMRS allocations are based on antiquated methodologies that follow no logical or defensible allocation matrix, with the program funding the same jurisdictions for several years, each sharing an equal sum, despite differences in risk, impact and vulnerability.

Heath suggested that converting to a risk-based funding allocation process has the potential to alter the funding streams, while also providing defensible funding mechanisms, allocating funds to areas with the highest risks (populations) and becoming consistent with other DHS grant programs that currently make award funds using a risk-based methodology.

Heath then gave an overview of the necessary steps to convert all programs, most specifically MMRS, to a risk-based allocation platform. This conversion realizes the value of a regionalized approach, while expanding the MMRS program from its current 124 jurisdictions, which cover roughly 75 percent of U.S. states and territories, to an equitable program that covers all 56 states and territories.

Heath summarized the complex risk-based formulas currently used in the Urban Area Security Initiative and State Homeland Security Grant Programs. These programs employ a risk, threat and vulnerability formula linked with the Metropolitan Statistical Area (MSA). MSA analysis is applied to the risk methodology matrix and considers economic impact, threats on an urban area and other factors, such as population density.

This sparked interest from the capacity crowd, generating an obvious and much-asked question, “Will MMRS be folded into the UASI program?” While Congress has not directed FEMA and the Grant Programs Directorate to alter its current management and administration of the MMRS program, Heath said that there were no plans to either dissolve MMRS or incorporate it into the UASI. TK

He did, however, emphasize that population is an appropriate risk consideration when debating whether and how to expand the MMRS program and modify the allocation process(es). Converting to such a proactive methodology will ensure program continuity, and jurisdictions under this proposal would not receive less funding; future approaches would incorporate a minimum allocation while risk-based processes are gradually introduced.

Citing the heralded successes of other risk-based approaches currently incorporated into the suite of DHS grant programs, Heath did a stellar job of highlighting the need to convert to a risk-based program, emphasizing the expansion to a national program with increased protection for medical surge in populous cities, while increasing regional efficiency.

Moving on, Heath gave participants an overview of the collaborative discussion from the MMRS community as related to defensible metrics. Though the MMRS grant program has become broader and more diversified, it has lacked a defensible measurement tool to determine program impact. Building on recommendations during the 2008 National MMRS Conference, the utility of metrics is being developed to measure readiness against a comprehensive checklist that can identify progress, trends and anomalies. It is these measurements that Heath suggested will become useful tools for adjusting future MMRS priorities.

Some of the metric categories presented and under development included:
* Governance,
* Strategic planning,
* Logistics and readiness,
* Operational readiness,
* Protection of citizens,
* Mass patient care,
* Fatality management,
* Communications readiness,
* Environmental readiness, and
* Training and exercises.

While the development of these metrics continues to unfold, the MMRS Program Office remains committed to stakeholder input as a way to employ proactive approaches to measurement and defensible metrics that will support the program.

The 2009 National MMRS Conference concluded on a positive note. Participants and federal stewards enjoyed a collaborative dialogue of best practices, lessons learned and recommendations for moving forward on the array of topics discussed.

Bill V. Powers joined the Department of Homeland Security in February 2005 and serves as the Branch Chief for the Office of Health Affairs, where he manages grant coordination to promote health and medical readiness. A nationally certified Chief Fire Officer and Rescue Technician, Powers holds a bachelor of science in management and a master’s in public administration from Bellevue University, where he is also an adjunct professor in the College of Professional Studies.