Preparedness and Response to a Rural Mass Casualty Incident Workshop Summary (2011) / Chapter Skim
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5 Coordination and Integration Across Response Platforms
5 Coordination and Integration Across Response Platforms
Pages 45-64
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From page 45... ...
. REGIONALIZATION Regionalization, as used in this summary, refers to the establishment of healthcare coalitions that extend beyond immediate local responders and providers to include those of neighboring localities, regional public health entities, and other private and public organizations that may contribute to MCI preparedness and response (Courtney et al., 2009)
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From page 46... ...
Planning and response hurdles · evel of staffing does not allow personnel to take time away from day-to-day L responsibilities · Costs associated with training, lack of funding for travel to training · mphasis on cost containment in health care affects surge capacity (e.g., lack E of beds) · eople working in rural healthcare and EMS wear multiple hats, cover multiple P responsibilities · Lack of integration with emergency management and public health · pervasive attitude in communities that "it is not going to happen to us" nega A tively impacts the ability to gather all of the stakeholders for proactive planning · Defensive medicine" (costs associated with conduct of unnecessary advanced " imaging or other expensive procedures on patients with minimal or vague complaints)
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From page 47... ...
· Develop regional guidelines to aid facility decision making on patient transfer. · stablish regional communication and triage centers (where triage and patient E destination decisions are made by an impartial third party)
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From page 48... ...
· Assign staff whose jobs are nonessential in a disaster to other supportive roles. · xplore integrating trauma surgeons into the larger system (e.g., a pre E registered, pre-credentialed, rapidly mobilized force of surgeons bringing sur gery to the scene)
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From page 49... ...
The establishment of a central phone number for communication and agreements to notify each other early in the course of an incident have been successful improvements in the Kansas Major Emergency Response Group (MERGe) described by Randy Easter, EMS director for McPherson EMS and Safety Office for Memorial Hospital.
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From page 50... ...
Whether informal or formal, bolstering communication systems can help to assuage individual fears that regionalization equates to inefficient centralization. INTEGRATING TRAUMA SURGEONS Leonard Weireter, Jr., is the Arthur and Marie Kirk Family Professor of Surgery at Eastern Virginia Medical School, medical director of the Shock Trauma Center at Sentara Norfolk General Hospital, and current chair of the Disaster Preparation Committee for the American College of Surgeons, Committee on Trauma.
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From page 51... ...
. Roy Alson, medical director of Forsyth County EMS and medical director of Disaster Services for the North Carolina Office of EMS, again turned to the military model for potential solutions.
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From page 52... ...
The key is education, and Gaines suggested rural fire services seek grants such as those from the Assistance to Firefighters Grant program, the Rural Fire Assistance Program, the Fireman's Fund, state and regional EMS or medical councils, and local community and state colleges. For volunteer fire departments especially, Allstate and other insurance companies offer specific grants to assist in obtaining equipment.
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From page 53... ...
Randy Easter, EMS director for McPherson EMS and safety officer for Memorial Hospital in McPherson, Kansas, provided an overview of MERGe, the Major Emergency Response Group in Kansas EMS Region III. Easter explained that responders around the region had developed informal agreements over the years to provide assistance to each other, but EMS directors within Region III saw the need to "develop, facilitate, and maintain a system of preparation, response, and recovery for major emergency medical events effecting licensed ambulance service in EMS Region III." Easter described how they started meeting informally, as a group of friends, to define the issues that were important to their services and counties.
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From page 54... ...
Each system is also required to have a medical director and a trauma triage plan that designates a trauma center to which they will transport patients whose injuries exceed the capability of the community hospital. As part of that, ambulance strike teams, which Mexican Hat responders considered crucial in retrospect to both their incident response as well as the provision of EMS to nonrelated emergencies, have been established across the state of North Carolina in three regions to provide not only additional units to respond to the scene, but also units to backfill community EMS so they can continue regular operations.
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From page 55... ...
SPURRING REGIONAL COLLABORATION AND PLANNING Jennifer Hamerlinck, a public health nurse and director of the Emergency Management Agency in Mercer County, Illinois, observed that there are two scenarios that create a demand for integration: prospectively in the form of regionally funded disaster planning sessions or retrospectively from "lessons learned" during an emergency response. Regional Preplanning Sessions Conducted by the Centers for Disease Control and Prevention (CDC)
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From page 56... ...
resulted in Mercer County being designated a federal disaster area. Hamerlinck noted that from a host of other disaster responses, like those necessitated by ice storms, tornadoes, and extended power outages, the county developed integrated plans for shelter preparedness, culminating in MOUs with nine county shelters.
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From page 57... ...
seeks to develop universally adaptable guidance and toolkits based on the expertise and experience of regional coalitions. Workshop chair Robert Bass, Executive Director of the Maryland Institute for Emergency Medical Services Systems, explained that the ongoing work of this joint CDC-ORISE effort engages a wide range of stakeholders at all levels of response, including clinical EMS staff, local public health departments, pharmacists, school districts, long-term nursing care facilities, faith-based organizations, and other private and public organizations.
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From page 58... ...
Yet despite these considerable hurdles, Mitchell related how the planning and execution of a mass vaccination/pandemic emergency preparedness exercise employed integration to meet its metrics of success. An intergovernmental, multiagency taskforce convened in Window Rock with the goal of developing a broad mechanism to respond to a pandemic crisis across the 27,000 square miles of the Navaho Nation and adjoining lands in Arizona and New Mexico.
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From page 59... ...
Effectively removing cross-jurisdictional barriers, participants worked via conference call and in person to organize 15 vaccination sites, ensuring a broad mechanism to respond to a pandemic crisis or biological event. The CDC's Strategic National Stockpile was used, and the unified incident command post setup followed National Incident Management System's ICS structure.
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From page 60... ...
For those that still resist accepting trauma patients, a stronger approach is making acceptance of trauma patients a condition of licensure or funding for all accredited healthcare facilities in the region. North Dakota and other states have rules, regulations, or statutes that require healthcare facilities to participate in trauma care at a facility-appropriate level.
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From page 61... ...
The Arizona Example To illustrate the potential of telemedicine for rural health systems, Rifat Latifi, director of the Southern Arizona Teletrauma and Telepresence Program, and vice chair of International Relations in the Department of Surgery at the University of Arizona, presented the case of an 18-monthold female who arrived at Southeast Arizona Medical Center in Douglass, Arizona, 3 hours after a motor vehicle crash. Complicating the treatment of her severe injuries, including severe head trauma, was the fact that it was a new ER physician's first day on the job.
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From page 62... ...
Several participants expressed the hope that telemedicine will be a requirement for all level I and level II trauma centers, perhaps becoming as basic as having a phone. In the future, improved technologies will enable wireless transmission of data, and secure Internet connections may allow access from anywhere.
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From page 63... ...
A participant noted that not everyone needs to be sent to the top-level trauma center. Establishing connections and building personal relationships prior to a disaster fosters collaboration during an MCI.
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From page 64... ...
Grants and incentives can be directed toward education, training, planning, or establishing communications. States can also support the community and the region by mobilizing and deploying resources and coordinating outside help during an MCI.
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