least three members at each hospital, which would triple the team number.

The Training Ladder

The team response hierarchy is broken down into four levels. Each level is associated with a team member name or role, has a set of requirements and builds on the previous level's requirements. In addition, as a team member moves up to the next level, he or she becomes a trainer for the previous level.

Using training previously developed and widely accepted by regulatory agencies, such as the Federal Emergency Management Agency (FEMA) and The Joint Commission on the Accreditation of Health Care Organizations, we can build a team using widely accepted concepts. It also ensures almost certain compliance with federal, state and local regulations.

The only acceptable online training is FEMA's Emergency Management Institute's Professional Development Series. All other classes, including ICS 100-200 and IS-700, are required in the classroom to ensure comprehensive understanding of the curricula.

Training is advertised through the team e-mail group and offered every other month - the most recent training opportunity was a Level 4 exercise design class delivered by the South Dakota Office of Emergency Management. The average participant can complete all levels of coursework within one year, though some take longer. Some of the monthly training sessions are three-day classes. Other course subjects include team activation, exercise planning, upcoming federal requirements and cross-state border issues.

Most, if not all, members look forward to the regularly scheduled meetings and training. The development of this team concept is a key element of its success. Members are there because they see the ultimate value of this project. They also know that they are the reason for its success and that their continued participation is what makes it a tangible asset.

When to Activate?

Powering up the system command center won't be necessary for every event across the health system. The assumption was that activation would be automatic for any event requiring decontamination support or that is expected to exceed a single operational period - a specific, predetermined amount of time used to complete objectives.

In a recent event, we ran into an awareness and training problem: Many staff members involved in the hypothetical incident - an ammonia leak at a local business resulting in about two dozen injuries, which involved two of our hospitals - either knew little about the process or thought about it but didn't activate the command center.

The after-action discussion resulted in the development of an activation checklist that's part of the disaster packet distributed to every facility. The checklist asks simple questions with "yes" or "no" answers. The affected hospital command center and call team leader is activated with any "yes" response. This will take the guesswork out of activation on the end-user level.

Activation doesn't call out the entire cavalry immediately; it sets up an instant consultation between the affected facility and one of two on-call, Level 4 team members. The activation algorithm explains the process

Once the decision is made to power up the System Command Center, the on-call team member who provided the initial consultation responds to the System Command Center and becomes the liaison. The second on-call team leader deploys to the affected facility and also notifies team members at the closest unaffected facilities. This begins to power up the "close support" concept. A team member, usually Level 3, is deployed from the closest unaffected facility to the affected facility to meet the team leader.

There are team members at each facility, which quickly puts no less than three incident management team members in the command center at an affected facility. One team member immediately takes the liaison position and ensures hard communication with the system command center. Communication is then extended to the

Greg Santa Maria  |  Contributing Writer