Public Health Preparedness: Information on the Use of Medical Reserve Corps Volunteers during Emergencies

What GAO Found

Almost all states have a network of health care volunteers—the Medical Reserve Corps—who can augment federal, state, and local capabilities in response to public health emergencies, such as those arising from wildfires and hurricanes, and infectious disease outbreaks. Having sufficient, trained personnel, such as these volunteers, is critical to a state’s capability to respond and recover from public health emergencies. According to federal data, 48 states and the District of Columbia reported 102,767 health care volunteers in 838 Medical Reserve Corps units as of September 2019, with nurses making up 43 percent.

Number of Medical Reserve Corps Volunteers by Type, as of September 2019

Note: These data illustrate 90 percent of total health care volunteers. The remaining five types volunteers each make up less than 5 percent of the total. Other Public Health Medical volunteers may include cardiovascular technicians, sonographers, and phlebotomists.

Medical Reserve Corps volunteers in states included in GAO’s review—Alabama, California, North Carolina, and New Mexico—were deployed in response to natural disasters in 2018 and 2019, migrants at the southern border in 2019, and COVID-19 in 2020. Department of Health and Human Services (HHS) documentation shows these volunteers performed a variety of health care activities, such as providing medical services, setting up and providing support at shelters, and distributing medical supplies. Volunteers from these four states and others also participated in the response to COVID-19 by supporting testing sites, collecting specimens, and performing administrative tasks, such as data entry. For example, one unit deployed four volunteers a day for 3 days to work alongside nurses at a drive-through testing site. In addition to responding to public health emergencies, volunteers participated in preparedness activities, such as an initiative to train the public on how to respond to emergencies.

HHS oversees the Medical Reserve Corps program and has assisted units in developing their volunteer capabilities. For example, HHS

  • funded the development of a checklist of activities that should occur during volunteer deployment such as re-verifying medical credentials;
  • provided training to new unit leaders on developing, managing, and sustaining Medical Reserve Corps units; and
  • issued generally accepted practices, such as periodically re-evaluating volunteer recruitment procedures.

Why GAO Did This Study

The Medical Reserve Corps consists of health care volunteers—medical and public health professionals—who donate their time to help strengthen a response to public health emergencies and build community resilience. These volunteers prepare for and respond to public health emergencies, which may include natural disasters—such as hurricanes and wildfires—as well as disease outbreaks, whether intentional or natural.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 included a provision for GAO to review states’ use of health care volunteers during public health emergencies. This report describes (1) the number and type of Medical Reserve Corps volunteers; (2) the types of public health emergencies volunteers have participated in; and (3) how HHS has assisted in developing volunteer capabilities.

To conduct this work, GAO analyzed data reported to HHS as of September 2019; reviewed HHS documentation on four states’ use of volunteers, which GAO selected based on population, number of volunteers, and event; and interviewed officials from HHS who oversee the Medical Reserve Corps program.

GAO plans to further examine how states have used health care volunteers to respond to public health emergencies, including COVID-19, and any associated challenges to doing so in a future report.

GAO provided a draft of this report to HHS. In response, HHS provided technical comments, which were incorporated as appropriate.

For more information, contact Mary Denigan-Macauley at (202) 512-7114 or deniganmacauleym@gao.gov.

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    Move Over laws vary by state but generally require motorists to move over a lane or slow down, or both, when approaching emergency response vehicles with flashing lights stopped on the roadside. U.S. Department of Transportation's (DOT) National Highway Traffic Safety Administration (NHTSA) data provide limited information on whether crashes involved violations of these state laws, but the agency is taking steps to collect additional data. For instance, NHTSA's 2018 data show 112 fatalities from crashes involving emergency vehicles, representing 0.3 percent of all traffic fatalities that year, but these data cannot be used to definitively identify which crashes involved a violation of Move Over laws. NHTSA is proposing updates to the data that it encourages states to include on crash report forms to better identify crashes involving violations of Move Over laws, and plans to convene an expert panel and initiate a pilot project to study further data improvements. Selected state officials reported that they have taken actions to improve public education and enforcement of Move Over laws but still face challenges in both areas. Such actions include education through various forms of media and regional coordination among states to conduct targeted enforcement of Move Over laws within their respective borders during the same time period. State officials cited raising public awareness as the most prevalent challenge, as motorists may not know the law exists or its specific requirements. Variation in the requirements of some Move Over laws—such as for which emergency vehicles motorists are required to move over—may contribute to challenges in educating the public about these laws, according to state officials. DOT has taken actions and is planning others to help improve emergency responder roadside safety. NHTSA helps states promote public awareness of Move Over laws by developing and disseminating marketing materials states can use to develop their own traffic safety campaigns. NHTSA also administers funding that states can use for public awareness activities or enforcement initiatives related to emergency responder safety. FHWA has coordinated with a network of stakeholders across the country to train emergency responders on traffic incident management best practices. Finally, in response to congressional direction, NHTSA officials are planning several research efforts intended to enhance emergency responder safety, including studies on motorist behaviors that contribute to roadside incidents and technologies that protect law enforcement officials, first responders, roadside crews and other responders. General Requirements of Move Over Laws for Motorists on a Multiple Lane Roadway     Police, fire, medical, towing, and other responders risk being killed or injured by passing vehicles when responding to a roadside emergency. To protect these vulnerable workers and improve highway safety, all states and the District of Columbia have enacted Move Over laws. GAO was asked to review issues related to Move Over laws and emergency responder roadside safety. This report: (1) examines data NHTSA collects on crashes involving violations of Move Over laws, (2) describes selected states' actions and challenges related to Move Over laws, and (3) describes DOT efforts to improve emergency responder roadside safety. GAO analyzed NHTSA's 2018 crash data, which were the latest data available; reviewed federal and state laws and regulations, and DOT initiatives to improve emergency responder roadside safety; reviewed state reports to DOT; and interviewed NHTSA and FHWA officials, traffic safely and law enforcement officials in seven selected states, and stakeholders from traffic safety organizations and occupational groups, such as the Emergency Responder Safety Institute and the International Association of Chiefs of Police. GAO selected states based on a variety of factors, including traffic fatality rates per vehicle mile traveled and recommendations from stakeholders. DOT provided technical comments, which we incorporated as appropriate. For more information, contact Elizabeth Repko at (202) 512-2834 or RepkoE@gao.gov.
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  • Child Welfare and Aging Programs: HHS Could Enhance Support for Grandparents and Other Relative Caregivers
    In U.S GAO News
    In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials. Most Children Living with Kin Are Not in Foster Care, 2018 Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists. The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunities to help states better support kin caregivers. Grandparents and other kin often step in to provide stability and security when parents cannot care for their children. Taking on this responsibility can lead to significant hardships, especially for older caregivers. GAO was asked to study the challenges faced by grandparents and other older kin when becoming primary caregivers. This report examines (1) what is known about the numbers of grandparents and other kin serving as primary caregivers for children, and the reasons for that care; (2) challenges kin caregivers face and how officials report addressing them in selected communities; and (3) the extent to which HHS has supported states' efforts to use relevant federal programs and initiatives. GAO analyzed U.S. Census Bureau survey and HHS administrative data; reviewed relevant literature, federal laws, regulations, guidance, and other documents; and interviewed officials from HHS, national organizations, and in four states (Mississippi, New Mexico, New York, and Ohio) and communities, selected for their relatively large numbers of grandparent caregivers and to reflect geographic and demographic diversity. GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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  • Facial Recognition Technology: Privacy and Accuracy Issues Related to Commercial Uses
    In U.S GAO News
    Market research and other data suggest that the market for facial recognition technology has increased in the number and types of businesses that use it since GAO's 2015 report on the topic (GAO-15-621 ). For example, newer functions of the technology identified by stakeholders and literature included authorizing payments and tracking and monitoring attendance of students, employees, or those attending events. Functions of Facial Recognition Technology Accuracy. Although the accuracy of facial recognition technology has increased dramatically in recent years, differences in performance exist for certain demographic groups. National Institute of Standards and Technology tests found that facial recognition technology generally performs better on lighter-skin men and worse on darker-skin women, and does not perform as well on children and elderly adults. These differences could result in more frequent misidentification for certain demographics, such as misidentifying a shopper as a shoplifter when comparing the individual's image against a data set of known shoplifters. There is no consensus on what causes performance differences, including physical factors (such as lighting) or factors related to the creation or operation of the technology. However, stakeholders and literature identified various methods that could help mitigate differences in performance among demographic groups. Privacy. Stakeholders and literature identified concerns related to privacy, such as the inability of individuals to remain anonymous in public or the use of the technology without individuals' consent. Facial recognition technology may collect or store facial images, posing varying levels of risk. Some federal and state laws and the European Union's General Data Protection Regulation impose requirements on U.S. companies related to facial recognition technology. However, as we reported in 2015, there is no comprehensive federal privacy law governing the collection, use, and sale of personal information by private-sector companies. Some stakeholders, including privacy and industry groups, have developed voluntary frameworks that seek to address privacy concerns. Most of these frameworks were consistent with internationally recognized principles for protecting the privacy and security of personal information. However, U.S. companies are not required to follow these voluntary frameworks. Facial recognition technology can verify or identify an individual from a facial image. Advocacy groups and others have raised privacy concerns related to private companies' use of the technology, as well as concerns that higher error rates among some demographic groups could lead to disparate treatment. GAO was asked to review the commercial use of facial recognition technology and related accuracy and privacy issues. Among other issues, this report examines how companies use the technology, its accuracy and how accuracy differs across demographic groups, and how privacy issues are addressed in laws and industry practices. GAO analyzed laws; reviewed literature and company documentation; interviewed federal agency officials; and interviewed representatives from companies, industry groups, and privacy groups. GAO also reviewed selected privacy frameworks, chosen based on expert recommendations and research. GAO reiterates its previous suggestion from a 2013 report ( GAO-13-663 ) that Congress consider strengthening the consumer privacy framework to reflect changes in technology and the marketplace. For more information, contact Alicia Puente Cackley at (202) 512-8678 or cackleya@gao.gov.
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  • Retirement Security: Other Countries’ Experiences with Caregiver Policies
    In U.S GAO News
    For over a decade, Australia, Germany, and the United Kingdom (UK) have developed and implemented national approaches—including strategies, laws, and policies—to support family caregivers, according to experts GAO interviewed. Specifically, experts noted that these efforts could help caregivers maintain workforce attachment, supplement lost income, and save for retirement. As a result, their retirement security could improve. For example, experts said: Care leave allows employees to take time away from work for caregiving responsibilities. Australia's and Germany's policies allow for paid leave (10 days per year of work or instance of caregiving need, respectively), and all three countries allow for unpaid leave though the duration varies. Caregivers can receive income for time spent caregiving. Australia and the UK provide direct payments to those who qualify. Germany provides indirect payments, whereby the care recipient receives an allowance, which they can pass on to their caregiver. Other Countries' Policies to Support Caregivers Experts in all three countries cited some challenges with caregiver support policies. For example, paid leave is not available to all workers in Germany, such as those who work for small firms. In Australia and the UK, experts said eligibility requirements for direct payments (e.g., limits on hours worked or earnings) can make it difficult for someone to work outside their caregiving role. Experts in all three countries said caregivers may be unaware of available supports. For example, identifying caregivers is a challenge in Australia and the UK. As required under the RAISE Family Caregivers Act, the Department of Health and Human Services (HHS) convened the Family Caregiving Advisory Council (FCAC)—a stakeholder group that is to jointly develop a national family caregiving strategy. As of July 2020, HHS and the FCAC reported limited information on other countries' approaches, and neither entity had concrete plans to collect more. In September 2020, HHS officials provided sources they recently reviewed on selected policies in other countries, and they further noted that HHS staff, FCAC members, and collaborating partners have subject-matter expertise and bring perspectives about other countries' efforts into their discussions. Family caregivers play a critical role in supporting the elderly population, which is growing at a rapid rate worldwide. However, those who provide eldercare may risk their own long-term financial security. Other countries have implemented policies to support caregivers. In recognition of challenges caregivers face in the United States, Congress directed HHS, in consultation with other federal entities, to develop a national family caregiving strategy. GAO was asked to provide information about other countries' efforts that could improve the retirement security of parental and spousal caregivers. This report examines (1) other countries' approaches to support family members who provide eldercare, (2) challenges of these approaches, and (3) the status of HHS' efforts to develop a national family caregiving strategy. GAO conducted case studies of three countries—Australia, Germany, and the United Kingdom—selected based on factors including rates of informal care (i.e., help provided to older family members or friends) and the types of policies they have that could improve caregivers' retirement security. GAO interviewed government officials and experts and reviewed relevant federal laws, research, and documents. GAO's draft report recommended that HHS collect additional information about other countries' experiences. In response, in September 2020, HHS provided an update on its efforts to do so. As a result, GAO removed the recommendation and modified the report accordingly. For more information, contact Tranchau (Kris) T. Nguyen at or nguyentt@gao.gov.
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  • Federal Tactical Teams: Characteristics, Training, Deployments, and Inventory
    In U.S GAO News
    Within the executive branch, GAO identified 25 federal tactical teams, and the characteristics of these teams varied. The 25 tactical teams were across 18 agencies, such as agencies within the Departments of Homeland Security, Justice, Energy, and the Interior. The number of reported team members per team ranged from two to 1,099. More than half (16 of 25) of the teams reported that they are composed of team members working for the team on a collateral basis. Most teams (17 of 25) had multiple units across various locations. Photos of Federal Tactical Teams in Action Tactical teams generally followed a similar training process, with initial training, specialty training, and ongoing training requirements. Nearly all teams (24 of 25) reported that new team members complete an initial tactical training course, which ranged from 1 week to 10 months. For example, potential new team members of the Federal Bureau of Investigation's Hostage Rescue Team complete a 10-month initial training that includes courses on firearms; helicopter operations; and surveillance, among others. Nearly all teams (24 of 25) reported offering specialized training to some team members, such as in sniper operations and breaching. Nearly all teams (24 of 25) also reported having ongoing training requirements, ranging from 40 hours per year to over 400 hours per year. The number and types of deployments varied across the 25 tactical teams for fiscal years 2015 through 2019. The number of reported deployments per tactical team during this time period ranged from 0 to over 5,000. Teams conducted different types of deployments, but some types were common among teams, such as: supporting operations of other law enforcement entities, such as other federal, state, and local law enforcement (16 of 25); providing protection details for high-profile individuals (15 of 25); responding to or providing security at civil disturbances, such as protests (13 of 25); and serving high-risk search and arrest warrants (11 of 25). Four teams reported that they had deployed in response to the Coronavirus 2019 (COVID-19) pandemic, and 16 teams reported deployments related to nationwide civil unrest and protests in May and June 2020. Tactical teams reported having various types of firearms, tactical equipment, and tactical vehicles in their inventories. Team members generally have a standard set of firearms (e.g., a pistol, a backup pistol, and a rifle), but some may also have specialized firearms (e.g., a shotgun designed to breach doors). Tactical teams also have a variety of tactical equipment, such as night vision devices to maintain surveillance of suspects or tactical robots that can go into locations to obtain audio and video information when team members cannot safely enter those locations. Tactical teams may also have tactical vehicles, such as manned aircraft (e.g., helicopters) and armored vehicles to patrol locations. The figure below identifies the number of tactical teams that reported having such items in their inventories. Number of Federal Tactical Teams That Reported Having Firearms, Tactical Equipment, and Tactical Vehicles in Their Inventories, as of January 2020 Appendix I of the report provides details on each of the 25 tactical teams, such as each team's mission; staffing; types and frequency of training; and number and types of deployments from fiscal years 2015 through 2019. This is a public version of a sensitive report issued in August 2020. Information deemed to be sensitive by the agencies in this review, such as the quantities of firearms, tactical equipment, and tactical vehicles in team inventories, has been omitted from this report. Many federal agencies employ law enforcement officers to carry out the agency's law enforcement mission and maintain the security of federal property, employees, and the public. Some of these agencies have specialized law enforcement teams—referred to as federal tactical teams in this report—whose members are selected, trained, equipped, and assigned to prevent and resolve critical incidents involving a public safety threat that their agency's traditional law enforcement may not otherwise have the capability to resolve. This report provides information on the (1) federal tactical teams and their characteristics; (2) training team members receive; (3) deployments of such teams from fiscal years 2015 through 2019; and (4) firearms, tactical equipment, and tactical vehicles in team inventories, as of January 2020. To identify federal tactical teams, GAO contacted executive branch agencies with at least 50 federal law enforcement officers. GAO administered a standardized questionnaire and data collection instrument to the identified teams to gather information on team missions, staffing, training, deployments, and inventories. GAO reviewed team documents, such as standard operating procedures, and interviewed agency officials. GAO collected descriptive information on reported deployments as of June 2020 in response to COVID-19 and nationwide civil unrest, which were ongoing during the review. GAO incorporated agency technical comments as appropriate. For more information, contact Gretta L. 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