must work together. It’s “all the people all the time—no boundaries. Doctors Without Borders won the Nobel Prize,” he pointed out. “Can we win the Nobel Prize for our health system of preparedness? Probably not today,” he said, “but we can get there with the kind of creativity that everybody has shown.”

He introduced the panelists and said that they bring a range of perspectives to the issue of disaster preparedness, ranging from the White House to the Department of Homeland Security (DHS) to the states.


David Marcozzi, emergency physician and director of public health policy for the White House National Security Staff, began by highlighting the fundamental question, “What is regionalization?” He pointed out that the H1N1 virus does not respect state or international borders. He argued that this provides us an opportunity to think about regionalization and system coordination in a way that cuts across geopolitical boundaries. This “makes the lift even heavier,” he said “but I think it’s the right thing to do.”

He recalled being on shift in an emergency department during a relatively small mass-casualty event. A system had been put in place that was supposed to be able to handle the distribution of patients during a disaster. He reported that the personnel on scene did not use the phone number that was provided to them during disaster preparedness planning; instead, responders called the number they used to transport patients on an everyday basis. “That number was posted on everybody’s wall, corkboard, and computer, and was how we do things on a daily basis,” Marcozzi said. Under a dual-use approach, he said, processes would be linked and could be adapted as situations arise.

Second, in defining regionalization, we have to incorporate not only STEMI, stroke, trauma, and pediatric care—and potentially sepsis and other specialty care areas—but also disaster care. This could help shape how we think about disaster paradigms, Marcozzi said.

Third, whatever we put forth with regard to regionalization must be all-inclusive. We should try to get our arms around all the issues—economic, political, operational, legal, and other—that may emerge with regard to acute care and develop systems that address all issues. He noted that the Health Resources and Services Administration (HRSA) trauma program has done some fantastic work. The best practices they developed should be a starting point for the next iteration of regionalization.

The fourth point, Marcozzi said, is that we need to build on the work that has already been done. In addition to the HRSA trauma program,

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