Chapter 8: Implementation, Training,and System Evaluation

Contents

Key Points of the Chapter

The concepts presented in the MSCC Management System are designed to complement ongoing initiatives to establish individual components of medical surge, such as identifying pools of qualified healthcare personnel. This handbook provides the management processes necessary to enhance coordination and integration of these components. Implementation of these concepts should take full advantage of the assets and processes already in place to address medical surge. Important areas of focus for implementation strategies include:

Management of Individual Healthcare Assets (Tier 1): Develop processes in the healthcare organization (HCO) Emergency Operations Plan (EOP) that promote effective internal management of the HCO response and information management. This will significantly enhance the ability of HCOs to coordinate with one another and to integrate into the larger community response.
Management of the Healthcare Coalition (Tier 2): Establish processes for cooperative planning and information sharing among HCOs that can be used in times of crisis, as well as during day-to-day operations. To the extent possible, standardize requirements so that HCOs know what to report, when to report, in what format, and to whom. Establish or revise mutual aid agreements that formally describe processes for requesting, receiving, and managing mutual aid support.
Jurisdiction Incident Management (Tier 3): Bring together representatives of the various emergency response entities, including acute-care medicine and public health, to participate in joint planning. Determine how event notification, unified incident command, and information management will occur across the response system. Ensure that processes are in place so public health and medical input can be provided into unified incident command. The Hospital Preparedness Program and MMRS Program guidance may be of assistance.
Management of the State Response (Tier 4): Determine critical information requirements for coordinating intrastate jurisdictions and specify how State primary incident command will occur when necessary. Conduct an inventory and assessment of existing mutual aid agreements and determine how they can be enhanced to specifically address public health and medical issues.
Interstate Regional Management Coordination (Tier 5): Establish interstate mutual aid arrangements that address medical and public health needs. Determine critical information requirements and how information will be shared across State borders. Identify points of contact in neighboring States and formally establish processes for requesting, receiving, and managing support. Where possible, integrate these arrangements into the regulations and processes that maintain the State's Emergency Management Assistance Compact. The MMRS Program guidance may be of assistance in coordinating interstate regional preparedness response in a major metropolitan area.
Federal Support to State, Tribal, and Jurisdiction Management (Tier 6): Establish processes to gather Statewide information, evaluate response capabilities, and to determine the need for Federal public health and medical assistance. Understand how Federal public health and medical resources are organized, how they are activated and where they come from, and establish processes to facilitate integration of Federal assets at the State and local levels.

Once the concepts of the MSCC Management System are implemented, responder training should examine how they are applied within tiers and across tiers to shape the overall response system. Training sessions should include representatives from each of the major organizations involved in mass casualty or mass effect incident response. The training may be structured in stages of varying complexity and difficulty so that participants of similar knowledge level and experience can learn together. Both didactic instruction and drills might be used to maximize comprehension and retention of key concepts. Trainers should have significant experience and demonstrated expertise in large-scale incident response, and they should be able to motivate people from diverse professions to work together.

The lack of system change after thorough incident review has been a major challenge for all response entities from the local to the Federal levels. To achieve and maintain effectiveness, the response system must continually evolve to incorporate best-demonstrated practices identified through exercises or after-action report processes. A mechanism should be built into the system to provide feedback on ways to address deficiencies. In all after-action analyses, input from medical and public health disciplines should be sought and incorporated with the recommendations of other disciplines. Findings must then be translated into organizational learning, where improvement in processes, procedures, training, equipment and supplies, EOP guidance, or other areas will create lasting organizational learning rather than the less permanent "lessons learned."

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