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Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events. Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary. Washington (DC): National Academies Press (US); 2011.

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Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary.

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BWorkshop Agenda

Day 1

Tuesday, August 3, 2010

Keck Center, Room 100

National Academy of Sciences

500 Fifth Street, NW

Washington, DC

Workshop Objectives

The workshop discussions will provide participants an opportunity to examine the current capabilities and future opportunities to improve integrated mass casualty response in rural settings (note “rural” will be used to capture both rural and frontier settings). Specifically, the workshop will feature invited presentations and discussions that will

  • Review the findings from the NTSB report (NTSB/HAR-09/01) of the 2008 Mexican Hat incident and discuss near- and long-term opportunities to improve response capabilities in rural settings.
  • Explore existing standards, guidance, and innovative models and approaches in place for state and local jurisdictions.
  • Examine integrated systems approaches to improve the capability of the emergency medical services (EMS) system to respond to large-scale rural incidents.
  • Discuss opportunities to improve the integration and coordination with public health systems to address challenges to national public health security, particularly in rural settings.
8:00 a.m.Welcome, Introductions, and Workshop Objectives

Robert Bass, Workshop Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
8:10 a.m.Charge to Workshop Speakers and Participants
Drew Dawson
Director
Office of Emergency Medical Services
National Highway Traffic Safety Administration

SESSION I. WORKSHOP CONTEXT: 2008 MEXICAN HAT INCIDENT

Session Objective: Provide a brief overview of the 2008 Mexican Hat, Utah, incident. Consider unique and common barriers to rural response that were highlighted by the 2008 Mexican Hat incident. Review the findings from the NTSB report (NTSB/HAR-09/01).

8:25 a.m.Session Objectives and Introduction

Jolene Whitney, Session Chair
Deputy Director
Emergency Medical Services and Preparedness
Utah Department of Health
8:35 a.m.Findings from the NTSB Report (NTSB/HAR-09/01) and Other Relevant Investigations

Christopher Hart
Vice Chairman
National Transportation Safety Board
8:50 a.m.Overview of the 2008 Mexican Hat, Utah, Incident and Response: Local Perspective

Linda Larson
Director
EMS
San Juan County, Utah
9:05 a.m.Overview of the 2008 Mexican Hat, Utah, Incident and Response: State and Regional Perspective

Paul Patrick
Director
Bureau of EMS and Preparedness
State of Utah Department of Health
9:20 a.m.Overview of Incident Response and Associated Challenges During the 2010 Caddo and Little Missouri Rivers, Arkansas, Flooding

Floyd Dunson
Deputy Emergency Manager
Howard County Emergency Management Agency
Mineral Springs Fire and Rescue
9:30 a.m.Discussion with Attendees

Jolene Whitney, Session Chair
Deputy Director
Emergency Medical Services and Preparedness
Utah Department of Health
10:00 a.m.BREAK

SESSION II. DEFINING THE CHALLENGES OF RESPONSE IN RURAL AREAS; EXPLORING STRATEGIES FOR IMPROVING RESPONSE

Session Objective: Examine the specific challenges of responding to mass casualty incidents that occur in rural areas. Discuss specific challenges as they relate to 9-1-1 access and communications, the prehospital system, the healthcare system, and integration and coordination across response platforms. Examine local, state, and regional model systems that have been used to improve response to rural incidents. Explore strategies that have been tested in exercises as well as lessons learned from responding to real incidents.

10:15 a.m.Panel Discussion: 9-1-1 Access and Communications, the Challenges
  • Explore the impact limited 9-1-1 access has on emergency response in rural settings. Examine systematic strategies to overcome limited 9-1-1 access and improve rural response coordination. Identify and discuss opportunities to improve emergency response through improved integrated emergency communication.
John Chiaramonte, Panel Chair
Lead Associate
Booz Allen Hamilton

Paul Patrick
Director
Bureau of EMS and Preparedness
State of Utah Department of Health

Aarron Reinert
Executive Director
Lakes Region EMS

John Isfort
Director
Business Development & Physician Services
Marcum & Wallace Memorial Hospital
Paramedic
Madison County Emergency Medical Services
10:50 a.m.Discussion with Panelists and Attendees

John Chiaramonte, Panel Chair
Lead Associate
Booz Allen Hamilton
11:20 a.m.Panel Discussion: 9-1-1 Access and Communications, Innovative Models and Approaches to Improve Response

John Chiaramonte, Panel Chair
Lead Associate
Booz Allen Hamilton

Jenny Hansen
CEO
Strategic Partnerships

Rick Jones
Operations Issues Director
National Emergency Number Associations

Dorothy Spears-Dean
Public Safety Communications Coordinator
Integrated Services Program
11:50 a.m.Discussion with Panelists and Attendees

John Chiaramonte, Panel Chair
Lead Associate
Booz Allen Hamilton
12:15 p.m.LUNCH
1:00 p.m.Panel Discussion: The Prehospital System, the Challenges
  • Examine the unique challenges facing prehospital response in rural settings. Identify and discuss strategies to improve coordinated response. Recognizing current fiscal constraints. What support can be provided to improve rural response? Explore opportunities to improve regional response in rural settings.
Jon Krohmer, Panel Chair
Office of Health Affairs
Department of Homeland Security

Gloria Tavenner Dow
Gwinnett County Department of Fire and Emergency Services
Lawrenceville, Georgia

Norm Dinerman
Medical Director
LifeFlight of Maine

Barbara Quiram
Director
USA Center for Rural Public Health Preparedness
School of Rural Public Health Texas A&M Health Sciences Center

Tim Wiedrich
Chief
Emergency Preparedness and Response
North Dakota Department of Health
1:30 p.m.Discussion with Attendees

Jon Krohmer, Panel Chair
Office of Health Affairs
Department of Homeland Security
2:00 p.m.Panel Discussion: The Prehospital System, Innovative Models and Approaches to Improve Response

Nels Sanddal, Panel Chair
President
Critical Illness and Trauma Foundation

Gary Wingrove
Director
Government Relations & Strategic Affairs
Mayo Clinic Medical Transport

Myra Wood
Director
Vital Link Ambulance in Arkansas

Aimee Binning
CVC Training
Director, Region III
NAEMT
2:30 p.m.Discussion with Panelists and Attendees

Nels Sanddal, Panel Chair
President
Critical Illness and Trauma Foundation
3:00 p.m.BREAK
3:15 p.m.Panel Discussion: The Rural Healthcare Systems: Challenges Due to Resource Realities and the Need for Regionalization

Jerry Johnston, Panel Chair
Immediate Past President, NAEMT
EMS Director
Henry County Health Center, Mt. Pleasant, Iowa

Timothy Bohlender
Medical Director
St. Anthony Granby Medical Center

Debbie Von Seggern-Johnson
EMS/Trauma Coordinator
University of Nebraska Medical Center
Henry County Health Center, Mt. Pleasant, Iowa

Randy Easter
EMS Director and Safety Officer
McPherson EMS
3:45 p.m.Discussion with Panelists and Attendees

Jerry Johnston, Panel Chair
Immediate Past President, NAEMT
EMS Director
Henry County Health Center, Mt. Pleasant, Iowa
4:15 p.m.Panel Discussion: The Rural Healthcare System, Innovative Models and Approaches to Improve Response

Dia Gainor, Panel Chair
Director
Idaho State Emergency Medical Services

Robert Winchell
Director
Division of Trauma
Maine Medical Center

Ken Knipper
Director
State National Volunteer Fire Council, Kentucky

Rifat Latifi
Professor of Surgery
Director Southern Arizona Teletrauma and Telepresence Program
Vice Chair, International Relations
Department of Surgery, University of Arizona
4:45 p.m.Discussion with Panelists and Attendees

Dia Gainor, Panel Chair
Director
Idaho State Emergency Medical Services
5:30 p.m.ADJOURN

Day 2

Wednesday, August 4, 2010

Keck Center, Room 100

National Academy of Sciences

500 Fifth Street, NW

Washington, DC

8:30 a.m.Welcome

Robert Bass, Workshop Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems

SESSION III. COORDINATION AND INTEGRATION ACROSS THE RESPONSE PLATFORMS

Session Objective: Examine the key components of an integrated health system. Explore the unique challenges associated with ensuring integration in a rural setting. Discuss benefits of establishing effective incident command structure that fully integrates the health response system.

8:40 a.m.Panel Discussion: Coordination and Integration Across Response Platforms

Dan Hanfling, Panel Chair
IOM Crisis Standards of Care Committee Vice-Chair
Special Advisor
Emergency Preparedness and Response
Inova Health System

Leonard J. Weireter, Jr.
Arthur and Marie Kirk Family Professor of Surgery
Eastern Virginia Medical School
Medical Director
Shock Trauma Center
Sentara Norfolk General Hospital

Glenn Gaines
Deputy U.S. Fire Administrator
Federal Emergency Management Agency

Jennifer Hamerlinck
Director
Emergency Management Agency
Mercer County, Illinois

Glenn Mitchell
Chief Medical Officer
Sisters of Mercy Health System

Roy Alson
Medical Director, Forsyth County EMS
Medical Director, Disaster Services
North Carolina Office of EMS

Linda Williams
Emergency Services Coordinator
Chouteau County, Montana
9:35 a.m.Discussion with Panelists and Attendees

Dan Hanfling, Panel Chair
IOM Crisis Standards of Care Committee Vice-Chair
Special Advisor
Emergency Preparedness and Response
Inova Health System

SESSION IV. ESTABLISHING METRICS TO ASSESS RISK ALONG RURAL ROADS

Session Objective: Review common elements that define public health risk along rural roads. Identify and discuss potential metrics that can be used to assess risk. Identify and discuss metrics that can be used to determine what areas are at risk. Examine how both baseline and surge capacity can be assessed in rural areas. Explore gaps that need to be addressed to establish improved metrics that can assess the capabilities of an integrated health response system.

10:05 a.m.Session Objectives and Introduction

Dia Gainor, Panel Chair
Director
Idaho State Emergency Medical Services
10:15 a.m.Panel Discussion: Common Elements and Associated Metrics

Charles Mains
Trauma Director
St. Anthony Central Hospital, Denver, Colorado

Craig Thomas
Chief, Outcome Monitoring and Evaluation Branch
Division of State and Local Readiness
Centers for Disease Control and Prevention

Gregory Mears
Associate Professor of Emergency Medicine
University of North Carolina Medical School
Medical Director
North Carolina Office of EMS

Kelly Hardy
Safety Program Manager
American Association of State Highway and Transportation Officials

Sally Phillips
Director
Public Health Emergency Preparedness Program, AHRQ

James Groves
Interagency and First Responder Programs
Office of Science and Technology
Department of Homeland Security
11:15 a.m.Discussion with Panelists and Attendees
  • What are some common guiding principles that will guide the users of resources and assets?
Dia Gainor, Panel Chair
Director
Idaho State Emergency Medical Services
11:45 a.m.LUNCH

SESSION V. IMPROVING RURAL MASS CASUALITY RESPONSE IN THE UNITED STATES—THE WAY AHEAD

Session Objective: Review current security plans and examine the resources available, as well as those that are needed, to ensure appropriate safety and security of assets and individuals during the dispensing of medical countermeasures.

12:15 p.m.Session Objectives and Introduction

Jon Krohmer, Session Chair
Office of Health Affairs
Department of Homeland Security
12:25 p.m.Panel Discussion: The Way Forward

Bethany Cummings
Physician/EMS Physician
Immediate Past Chair
Rural Domestic Preparedness Consortium and Emergency

Mercedes Benitez-McCrary
Director of the Division of Emergency Preparedness
Centers for Medicare & Medicaid Services

Eileen Holloran
Public Health Analyst
Office of Rural Health Policy
Health Resources and Services Administration

Rick Jones
Operations Issues Director
National Emergency Number Association

Mike Zanker
Associate Chief Medical Officer (Acting)
Office of Health Affairs
Department of Homeland Security

James DeTienne
Supervisor
EMS & Trauma Systems
Montana Department of Public Health & Human Services

Drew Dawson
Director
Office of Emergency Medical Services
National Highway Traffic Safety Administration
1:30 p.m.Discussion with Panelists and Attendees
  • Given the limited financial resources, what can and should be done by the relevant stakeholders to improve preparedness and response in rural settings?
Jon Krohmer, Session Chair
Office of Health Affairs
Department of Homeland Security

SESSION VI. GENERAL DISCUSSION WITH WORKSHOP PARTICIPANTS AND ATTENDEES

Session Objective: Discuss what opportunities and constraints exist to improving medical surge capacity in rural settings. Review opportunities and challenges identified during the workshop. Identify and discuss the most promising near-term opportunities for improving integration of emergency care in rural settings.

2:15 p.m.Panel Discussion: Synopsis of Workshop Discussions

Robert Bass, Panel Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems

Jolene Whitney
Deputy Director
Emergency Medical Services and Preparedness
Utah Department of Health

John Chiaramonte
Lead Associate
Booz Allen Hamilton

Jon Krohmer
Office of Health Affairs
Department of Homeland Security

Dia Gainor
Director
Idaho State Emergency Medical Services

Nels Sanddal
President
Critical Illness and Trauma Foundation

Jerry Johnston
Immediate Past President, NAEMT
EMS Director
Henry County Health Center, Mt. Pleasant, Iowa

Dan Hanfling
IOM Crisis Standards of Care Committee Vice-Chair
Special Advisor
Emergency Preparedness and Response
Inova Health System
2:45 p.m.Discussion with Panelists and Attendees
  • What new ideas have surfaced in this workshop that should be explored further?
  • What action steps are required to integrate these strategies into the current public health system?
  • What resources and further infrastructure investments will be necessary in the short and long term?
3:00 p.m.Closing Remarks: The Path Forward

Robert Bass, Workshop Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
3:15 p.m.ADJOURN
Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK62387

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