utions proposed by RMBT to address surge needs was to equip a medical cache or armory that could be mobilized. As discussed in the section on supply options, three levels of supply caches were recommended (hospital augmentation cache, regional alternative care site cache and a comprehensive cache). These caches of medical supplies can be stored in various locations and mobilized to urban or rural areas and across State lines.
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The exercise was an "orientation exercise" (i.e., scoping type exercise) since many of the roles, issues, and caches are still being defined and tested. An outside expert exercise coordinator from the Denver Office of Emergency Management was invited to develop and facilitate the exercise for the Working Group.
The five primary objectives of this exercise were to:
- Determine the appropriate command and control procedures for deploying a mobile medical cache across State lines.
- Using the 3 different levels of supply caches, determine which cache should be deployed and the factors considered.
- Identify the legal limitations to deploying staff and supplies across State lines and potential solutions.
- Determine the level of staffing that will be required and how and from where they will be mobilized.
- Identify the additional supplies and equipment that will be needed, where they will come from, and how they will be mobilized.
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The RMBT Working Group based this exercise on a simple scenario of a biological event occurring in a rural area of this region. Aid was requested from a neighboring State with available caches.
"On August 8, 2003 at 10:15 am, Colorado OEM has received a request from a neighboring State to possibly lend assistance under the EMAC agreement to a small community in their State. The 50-bed Medical Center in the community has become overwhelmed with an outbreak of an unknown diarrhea agent in a large group of motorcycle enthusiasts on their way to Sturgis, South Dakota. Public Health is investigating the possibility of a contaminated water 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 consen