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ARIZONA
Using FEMA's Comprehensive Hazmat Emergency Response - Capability Assessment Program (CHER-CAP), Lake Havasu City, Arizona (pop. 50,000), conducted a full-scale field exercise that was supported by 40 agencies. The exercise provided weapons of mass destruction (chemical bomb) training to emergency management personnel. A follow-up tabletop exercise included newly elected city officials and assisted the school district and local hospital with their emergency plans. The CHER-CAP exercise program is used nationwide to increase response capabilities to technological hazards.
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CALIFORNIA
The Huntington Beach, California Fire Department has a volunteer program called RACES (Radio Amateur Civil Emergency Services), which provides backup communications during disasters. In 2001, the fire department trained RACES to back up its 800 MHz system. In September 2004, just two weeks after an exercise to test preparedness, the fire department's 800MHz fire radio system went down for the entire county. The fire department placed a RACES member in the police dispatch where the 911 calls came in and one in each fire engine, truck, and ambulance. RACES provided emergency communications for the city for several hours.
AmeriCorps Emergency Readiness teams in California provide opportunities for students in local community colleges to provide disaster/emergency preparedness services to vulnerable populations.
During a semiannual community-wide emergency management plan drill in California, the medical center that organized the drill discovered some holes in its emergency management response plan. The scenario was a radioactive waste spill. After scrambling to locate the appropriate personal protective equipment, staff discovered that the decontamination suits didn't fit. Several even ripped while the engineers tried to put them on. Furthermore, several "paper patients" were lost in transit. When investigating what went wrong, the organization discovered that the lost paper patients were actually transferred to an off-site location, but there was no way to indicate this on the emergency response patient transfer form.
Santa Monica, California (pop. 88,000), obtained a Federal Transit Administration grant to conduct a full-scale functional exercise in which armed terrorist role players, who claimed to have a bomb, commandeered a city bus with 20 civilians on board.
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COLORADO
The Teen SERT (School Emergency Response Training) program is an in-class curriculum-based program that helps students make informed decisions regarding emergency readiness and response. Pilot tested for the nation at Pueblo West High School in Pueblo West, Colorado in November 2003, the program is offered over a nine week period for one hour per day.
The Rocky Mountain Poison and Drug Center in Denver, Colorado worked with the state health department to create a public emergency information line. The Center had a longstanding and well-recognized public role in providing accurate and timely information. Following 9/11, its role expanded to providing information to the public on a smallpox vaccination program, providing clinical decision support for vaccines and their health care providers, and collecting reported adverse reactions to smallpox vaccinations. The demand for smallpox information was very modest, but the emergence of outbreaks of the West Nile virus in 2003 allowed the Center to adapt its capabilities to include tracking virus occurrence in the state and providing the public with consistent, accurate information about virus risks and disease management strategies. By asking people to report on dead birds in their yards, the service involved the public in the response effort, helped establish a mechanism for information exchange, and resulted in a meaningful role for the public in the process. Since then the service has been expanded to monitor and support other public health issues such as influenza, mold, hantavirus, and plague. The Center's capabilities continue to expand based upon emerging public health concerns and requests for information.
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CONNECTICUT
In Connecticut hospitals, each specific discipline, such as nursing, diagnostic imaging, respiratory therapy, and physicians, has a representative that helps to recruit and organize fellow practitioners to serve in the Medical Reserve Corps. The momentum has been considerable and the state has been selected by the Health Resources and Services Administration as one of the 10 advanced credentialing demonstration projects.
Westport, Connecticut, developed a community support and counseling team to address the mental health needs of its approximately 26,000 residents in times of crisis. The team is developing training for mental health professionals, school and community clinicians, home health care providers, child care workers, and volunteers.
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FLORIDA
For agencies and other employers in hurricane-prone areas and surrounding communities, a range of staffing-related issues requires consideration before, during, and after a major storm. For example, as part of its annual hurricane preparedness activities, Health First Health System in Melbourne, Florida, maintains and updates extensive human resources policies, procedures, and communication plans.
The hurricanes of 2004 hit hard in portions of DeSoto County, Florida, where migrant farm workers lived and worked in the area's citrus groves. The local hospital, health department, and the CDC were concerned about the community-wide risks posed by standing and contaminated water and other health hazards. In the past, migrant workers typically used the local hospital to meet their health care and information needs. However, leery of contact with government officials on the scene, many workers chose to stay in the citrus groves rather than seek hospital care. The hospital sent mobile care units staffed by bilingual individuals into the citrus groves to identify and treat injuries, provide information on safe water use, and try to re-establish contact and trust.
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GEORGIA
To decrease the possibility of contamination of treatment areas, the Medical Center of Central Georgia in Macon designed a physically separate space for decontamination. If an individual is or may be contaminated, staff posted at the EMS entrance ramp ensures that the person is directed from the private vehicle or ambulance into a decontamination room prior to entering the emergency department.
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IDAHO
The Mayoral Institute for WMD (Weapons of Mass Destruction) and Terrorism Incident Preparedness, provided through the Idaho Institute of Emergency Management, provides the nation's mayors a "mayors only" forum to discuss strategic and executive-level issues and challenges, and share proven strategies and practices related to WMD/terrorism preparedness.
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ILLINOIS
In Illinois, the West Central Municipal Conference has created a regional Homeland Security Coordinating Committee, which includes the mayors of 38 communities, some large and some small. Among other activities, this committee monitors allocations and expenditures by local, state, federal, and private entities for homeland security, and develops and influences policies, protocols, and coordinated efforts.
Caterpillar, one of the largest employers in the Peoria, Illinois, area, was invited to the regionwide planning table. Caterpillar participated extensively in plan development and offered specific response help in the form of heavy construction equipment that might be needed in the event of a disaster. In a collaborative spirit, the area's public works office indicated that its staff members would assume responsibility for driving the equipment.
The Peoria County Emergency Services and Disaster Agency coordinates all phases of comprehensive emergency management, defined by the agency as mitigation, preparedness, response, and recovery for Peoria County. It functions collaboratively within a five-county region to integrate planning and response across multiple jurisdictions.
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MAINE
Saco, Maine (pop. 16,000), held a disaster recovery workshop and simulation exercise focused on its information technology infrastructure. The city tested its plan to safeguard data and systems in the event of a natural disaster, or even a man-made technological disaster, such as computer hacking. Representatives from all city agencies and some local businesses participated in the simulation. Backup computer storage, telecommunications, and backup power generation were among the systems tested.
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MARYLAND
The Maryland Institute for Emergency Medical Services Systems maintains a Web-based Facility Resource Emergency Database to expedite the flow of resources (including emergency department and pediatric bed availability, medications, blood, medic unit availability, and emergency response personnel and apparatus) to the scene of an incident or to an emergency operations center. Hospitals, public health, 911 centers, specialty referral centers, law enforcement agencies, and other components of the EMS system monitor this Web page.
The public health bio-defense team in Montgomery County, Maryland, conducted a tabletop training exercise to test the system for accessing the Strategic National Stockpile (SNS) and disseminating the SNS supplies to public and private points of distribution. The exercise involved 18 public and private agencies. An after-action, "lessons learned" report summarized problems encountered and potential solutions.
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MASSACHUSETTS
Arlington, Massachusetts (population 43,000), formed a subcommittee of the Local Emergency Planning Committee to enhance the community's ability to respond to the threat of terrorism. Subcommittee initiatives included targeted hardening of critical infrastructure; specialized police training for incident command; updating of mutual aid agreements; acquisition of protective equipment and emergency operations planning software; enhancement of the town's emergency management plan; development of emergency plans for specific locations, such as schools; and emergency operations exercises at a high-profile institution.
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MINNESOTA
To answer questions about how residents can prepare for all types of emergencies and how their city and county was preparing for emergencies, Roseville, Minnesota (population 34,000), hosted a community emergency readiness night. The presentation and discussion were open to all residents. Topics included how to prepare for all types of severe weather and preparing for Y2K problems, which was an issue of concern at that time.
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MISSOURI
Civilians that could address special needs populations should also be considered; recommendations from state task forces could assist in identifying knowledgeable planning partners. For example, Missouri has a state Special Needs Population Task Force that has brought together more than 17 organizations, agencies, and consumers to address this area.
Missouri's Department of Health and Senior Services has a close working relationship with the Missouri Hospital Association (MHA). Three MHA planners work with the 144 member hospitals and coordinate hospital planning efforts, assuring that hospital representatives are at the local, regional, and state planning table and linked to each plan.
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NEW HAMPSHIRE
The Substance Abuse and Mental Health Services Administration (SAMHSA) issued an RFP to increase state behavioral health response capacity. New Hampshire was one of 35 states to receive a $200,000 grant from SAMHSA for this purpose. The majority of these funds have been used to identify behavioral health professionals, encourage them to volunteer and train them in the unique aspects of disaster behavioral health response. In addition, training has been provided to emergency medical, public health, and public safety organizations to familiarize them with the psychosocial impact of disasters and the existence of behavioral health response in New Hampshire.
The New Hampshire Department of Safety, Bureau of Emergency Management (BEM) has developed organized teams of behavioral health providers to respond to the mental health needs of New Hampshire residents following disasters. Five regional disaster behavioral health response teams totaling over 500 professionals have been created and can be deployed immediately anywhere in the state.
In December 2004, the Northern New England MMRS, in coordination with Dartmouth Hitchcock Medical Center and community emergency planners, offered a successful flu vaccination clinic in an indoor sports arena at Dartmouth College. More than 1,900 primarily high-risk patients were vaccinated. Involvement of multiple agencies and organizations in this type of "routine" care reinforced the concept of working together, but also provided valuable experience and insight into what may occur within that community during an actual emergency.
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NORTH CAROLINA
Iredell County in North Carolina (pop. 130,000) applied and obtained a $10,000 grant through the state Citizen Corps to offer three CERT training programs during 2003.
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OHIO
Following 9/11, a small community of 5,500 in Ohio formed an auxiliary force modeled on the former civil defense system for the community. The goal was to meet community needs during the first 72 hours after a disaster. The force, which now includes 31 individuals, is working with the county in order to dovetail with county efforts and obtain needed funding.
The emergency planning team of a small suburban community approximately 30 miles outside of Cleveland, Ohio recognized that the community was totally dependent on its volunteer firefighters and volunteer paramedics as first responders. Most of these individuals had full-time jobs in other communities, so any sense of comfort that the individuals would be available to the community as first responders during an area-wide disaster was a false sense of comfort. The team's preparation and response efforts focused on how to prepare the community to respond without the full benefit of its all-volunteer first responder force. This involved consideration of appropriate training programs for community residents.
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PENNSYLVANIA
A nuclear plant sited on the Susquehanna River in Pennsylvania has a large emergency response network consisting of 27 municipalities, county and state governments, school districts, hospitals, fire companies, ambulance and emergency medical services, and federal agencies. The level of response to an event depends on the potential threat to public health and safety.
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TEXAS
In Texas, hospital leaders across the state brought together emergency management, law enforcement, and other community stakeholders to conduct emergency preparedness planning at the local level.
In various communities in Texas, selected mental health workers, social workers, school counselors, drug abuse counselors, faith-based counselors, and others can attend a 16-hour training program in emergency response. If the community or a neighboring community requires mental health support, these individuals are activated to provide mental health services through the emergency operation center.
Tyler, Texas (pop. 84,000), recently purchased several hundred low-cost ventilators and the training program to use these ventilators. Emergency personnel are teaching disaster life support very broadly among possible first responders, health care personnel, and other citizens in the community.
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