city or county emergency manager to ensure that all resource needs can be met either locally or from a distance.

Having these team members in place at the Hospital Command Center (HCC) provides several major benefits, including:

· hard-wired liaisons for solid communications;

· an ICS coaching staff to assist the HCC in the incident action planning process;

· freedom to release some local facility leadership from the command center to the operational areas; and

· confidence, although this might be an underestimated asset. There is much to be said about a team that plans with confidence versus a team that plans with uncertainty.

The entire team concept is to provide a command center coaching staff. This supports leadership. I regularly use the phrase, "I can run a disaster, but I can't run your hospital." However, together, as a team, we can do anything.

Trial and Error

One of the biggest issues discovered outside the command center is the need for decontamination team support. Many of our communities have large amounts of hazardous materials, like anhydrous ammonia, and organophosphate- or carbamate-based pesticides. This, combined with the staffing available at our small facilities, leads to decontamination teams that can handle an initial surge, but need support to maintain operations. It's surprising how quickly you can run out of decontamination personnel on a hot day.

Today, hospitals are staffed with just enough personnel to handle the average daily patient load. In many cases, even a small-scale mass casualty incident could push a facility to a breaking point. This is even more apparent in Critical Access Hospitals.

It's even more surprising how quickly a health system can develop a large decontamination team if you look beyond the doors of the affected facility. With 24 hospitals in our system, decontamination training is an ongoing and continuous process. At any given time, we have approximately 160 personnel trained to the Occupational Safety and Health Administration (OSHA) 1910.120 (and .134) standards. OSHA 1910.120 is the hazardous waste operations standard for industrial facilities that dictates the standards that must be met by professional decontamination teams. The 134 level is the respiratory protection standard. Having one curriculum for training allows team members to easily integrate with one another, from one facility to another.

In addition, U.S. hospitals are working to achieve NIMS compliance. As the new NIMS five-year plan has been released, it is painfully clear that hospital leadership will have to participate in the higher-level - and drastically longer - incident command classes. Also, they will likely have to participate in the position-specific competencies being developed.

With that said, it's one thing to participate in a course, and another to practically apply - and eventually master - the skill sets delivered in these classes.

Another lesson came from a recent 10-facility ice storm exercise: Our command centers need to be more mobile.     

South Dakota saw the value in that process and provided funding for command center technology that includes laptop computers with wireless cards and an electronic incident management tool called E-Sponder Express. The health system is deploying E-Sponder Express software across the intranet, which will be available to all system facilities.

E-Sponder Express contains electronic ICS forms, resource management tools and a powerful communication tool that will automate all call trees. With the addition of this software, team leaders can log into an incident from home over a secure Web connection and monitor an incident anywhere in the system.

Moving Forward

Make no mistake, the development and design of a team like this is no easy feat. It takes the support and backing of many people, including local emergency managers, regional and state health department representatives, and many others. Most importantly, it works only when the team believes in it.

This isn't only a hospital-based process; this same concept can be used by a rural fire service, EMS and emergency management, to name a few. Keep in mind that this concept was developed to manage wildfires with great success. It's not new; it's just underused in other arenas.

The next step is to expand the project outside our health system. There are numerous stand-alone hospitals all over our service areas that would require the same assistance as our affiliated facilities. Expanding this project outside the system and to other systems expands the support structure and opens the door to necessary resources.

Maybe one day there will be an expert response team for hospitals across the nation. Maybe it will have started in South Dakota.

Greg Santa Maria  |  Contributing Writer