response strategies. Traditional response efforts have relied upon local, state, and federal resources. In addition to strengthening coordination at all levels of government, workshop participants advocated expanding preparation, mitigation, and response efforts to include hospitals, health care professionals from all fields of social and traditional medicine, non-governmental organizations, mass media, private businesses, academia, and the engineering and scientific communities.

Recognizing the need for a unified approach to preparedness, the Department of Homeland Security (DHS) has recently developed the National Response Plan to improve coordination between government agencies and local first responders, noted Lew Stringer, of the Department of Homeland Security. Although not fully implemented as of the time of the workshop, this all-hazards plan addresses prevention, preparedness, response, and recovery for all levels of domestic incident management. Under the National Response Plan, local jurisdictions will retain primary responsibility for response efforts, using locally available resources; however, in the event of a large-scale catastrophe, local and state resources are likely to be overwhelmed. The Catastrophic Incident Plan, a supplement to the National Response Plan, has also been drafted to be immediately implemented during crisis by the DHS Secretary. The major goal of the plan is to provide accelerated deployment of federal assets to disaster zones. Pharmaceuticals and medical supplies from the Strategic National Stockpile and personnel from the U.S. Public Health Service Commissioned Corps Readiness Force, the Department of Veterans Affairs, the Department of Defense, and the National Disaster Medical System can reach disaster zones within twelve hours following a decision to deploy. While those assets will certainly help to augment the local response, noted Stringer, there is a need for another 20,000 trained and credentialed response personnel, in addition to the existing VA, USPHS, Department of Defense, and National Disaster Medical System (NDMS) staffs, to stage an effective mass-casualty response.

Enhancing local response capabilities through federal assets is only one example of creating a multi-level response. The Department of Health and Human Services has taken this a step further by incorporating both hospital and public health preparedness standards into their emergency preparedness grants, thereby emphasizing the importance of integrating health care systems’ response plans with local jurisdictions’ plans. According to William Raub, of the Department of Health and Human Services, the goals of the preparedness grants are to improve the nation’s response capabilities in bioterrorism and other disasters, while correcting decades of neglect in the public health infrastructure.

In order to bring the full range of the nation’s preparedness capabilities to bear, Jack Azar, of the Xerox Corporation, advocated the value of including the private sector in emergency response planning. In the event that a disaster occurs during regular business hours, business and industry executives must have updated and well-exercised plans, including evacuation and shelter-in-place



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