The nation's ability to respond to natural disasters and pandemics is currently being strained. The Department of Health and Human Services (HHS) is responsible for leading the public health and medical response to such emergencies.

During the push to battle COVID-19, HHS deployed caregivers enrolled in the National Disaster Medical System (NDMS), who are individuals, including doctors and nurses, that usually work outside the federal government and are used intermittently.

However, according to the Government Accountability Office (GAO), HHS developed an enrollment target for NDMS-response individuals of 6,290 responders in 2018. GAO found HHS didn’t follow the critical principles of competent strategic workforce planning in developing this target.

Per the report, HHS didn’t identify the critical skills and competencies needed of this specific workforce to meet current and future programmatic results. For example, the HHS target doesn’t consider three crucial areas, including the workforce being able to respond to nationwide events or multiple concurrent events; the needs of at-risk individuals; and the availability of other medical responders.

The GAO says it has found that HHS can’t guarantee whether it can meet these targets, nor if it can provide for “an adequate number of responders with the skill sets needed to effectively respond.”

HHS requires responders to take web-based training before deployment to review characteristics of infectious diseases and offers optional in-person training that supports care delivery in a severe environment.

Even so, the GAO said HHS' process to evaluate its training doesn't align with critical practices, so HHS can’t guarantee if its programs are sufficient to prepare its response teams for deployment or keep these people safe during an emergency. Its training programs can’t be determined effective until responders are deployed. In this scenario, HHS can’t determine until caregivers are on the frontlines if the training programs are ineffective.

HHS officials say in-person training is most beneficial. In-person requires more funds to cover. The solution, says HHS, is 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.”

NDMS responders jump into action during storms and other natural disasters. The current COVID-19 pandemic is another example of when they are called to action. In response to hurricanes in 2017, NDMS had a shortage of responders, resulting in HHS relying on other departments to provide medical care.

As of December 2019, HHS had only 3,667 NDMS responders, well short of its 6,290 targets.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 provided a GAO provision to review HHS's responder surge capacity. This report examines 1) the workforce planning for NDMS responders to assist with public health emergencies, and 2) training provided to these responders.

To conduct this work, GAO reviewed agency NDMS planning documentation, including NDMS staffing decisions, team structures, and training materials; compared HHS actions to critical workforce planning practices; and interviewed HHS officials.