ter supply. Despite the Medical Center's full status, patients complaining of chills, fever, and diarrhea are still seeking admission to the facility, with many existing patients becoming angry at the long delays and staff shortage. The State's Department of Public Health decides to set up an alternative care site in town to triage and treat suspected cases. The State does not have the resources readily available to quickly supply/staff this alternative medical facility and requests regional assistance. At 11:15 am, Colorado OEM solicits medical assistance from the Denver OEM. Denver OEM has suggested the possible use of one of Colorado's medical caches such as Denver Health's due to proximity of the surge event."
One of the resources used for this exercise was the Colorado Gubernatorial Executive Orders developed by the State of Colorado. These orders address the issue of licensure requirements for physicians, nursing and emergency medical technicians. This exercise also utilized the Emergency Management Assistance Compact (EMAC), an agreement that can be utilized between States to share resources in disaster response. Of the 50 States, only California and Hawaii do not participate. This resource can be used by States in regional disaster response and coordinates with the Federal Response Plan (FRP).
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1. Determine appropriate command and control procedures for deploying a mobile medical cache across State lines
Issue 1: Who will ask and who will give permission to deploy the asset?
The group agreed that in the case of a State-owned asset, the request and permission should be governor to governor through the EMAC or with mutual aid agreements between County Managers within each State for Border States. If it is a locally owned asset, mutual aid agreements should be developed in advance. If it is a privately owned asset, the receiving State's governor and the private entity should undertake negotiations.
Issue 2: Which entity "breaks down" and distributes the deployed cache?
The RMBT Group consensus was that this is a local responsibility. The asset should be sent to a centralized point and then it is up to the receiving State and local government to distribute. Local receiving authorities should decide what they want and need, where the people should go and what they should do.
Issue 3: What is the hierarchical structure for cache utilization?
This should be locally determined, but would likely mirror concepts put forward in Hospital Emergency Incident Command (HEICS).
2. Using the three different levels of supply caches, determine which cache should be deployed and the factors considered
Issue 1: Which factors should be considered in requesting a level of cache?
There are three possible levels of cache developed by the RMBT Working Group. These assets may be owned by State or private entities. The requesting State could request the asset from either type of institution depending on what they need to address their surge requirements. Factors that should be considered include: Communicable or non-communicable event, access to medical supply resources at site, variation in deployment for each of the three caches, and acuity and number of patients.
Issue 2: Who will transport the cache?
The Working Group consensus was to contract with a local trucking company that can dispatch at anytime, or the local law enforcement. Caches should be in pre-positioned locations. Vehicles that pull the cache may be multi-use for efficiency purposes and availability issues.
3. Identify the legal limitations to deploying staff and supplies across State lines and potential solutions
Issue 1: Licensing for health care providers from another State?
- Investigate and potentially utilize National Reserve Corps concept.
- Create enabling legislation re: licensing.
- Develop gubernatorial orders.
- Utilize Disaster Medical Assistance Teams (DMATs); they are federally credentialed.
Issue 2: When can the resources be deployed?
The Working Group debated whether resources should be deployed when the formal contract is signed or when th