care is limited, while in rural America, responders must sustain patient management for miles and hours, and may need to address complex medical issues that require specialized training they may not have.

Behavioral paradigms add to these challenges, Dinerman said. Altruism is a great motivating factor for prehospital care providers in all of rural America, as are the values of community service and heroism. Rural America also has a strong sense of independence and is proud of its resourcefulness. The incorporation of this mindset into strategies to improve preparedness is discussed in the following sections.

Applying What Works: Identifying Best Practices

Dinerman recognized the importance of identifying “best practices” through experience, but he drew participant attention to the equally important task of adapting best practices from other industries, such as vehicle tracking, crash notification, weather reporting, or “preferred corridors” for tour buses (comparable to a ground-based “flight plan”). He similarly emphasized nimbleness and agility, both politically and operationally, in sharing identified metrics for contemporary risk management methodology and contemporary scaled disaster response, in the form of available strike forces. There are a myriad of disaster preparedness models and approaches to contemporary preparedness education, Dinerman explained, such as those used by the Federal Emergency Management Agency (FEMA), the National Aeronautics and Space Agency (NASA), and the military, that can prove valuable as guides. EMS statutes should be principled, reciprocal, and situationally flexible, Dinerman said. He added that to optimize air medical capability and safety, night vision goggles and local air traffic control should be used. Sophistication must exist at all levels of response, and there must be a focus on local provider needs.

Many strategies were discussed that leverage creativity and inclusive planning to address these challenges. Myra Wood, director of Vital Link Ambulance in Arkansas, related how Vital Link avoided an interruption in service despite the destruction of its dispatch headquarters on February 6, 2008, by an EF-4 tornado that touched down in Atkins, Arkansas. Wood explained that the ability to survive an unexpected event, that itself killed 23 people along its 123-mile trajectory, was a direct result of preplanned surge capacity. Vital Link is an active participant in regional preparedness planning and practices and continuously updates its mass casualty incident (MCI) plans. Vital Link maintains extra ambulances and employs almost as many part-time staff as full-time staff, from which it draws crucial increases in personnel during an MCI, as full-time staff.

While Vital Link was able to creatively integrate surge capacity with its traditional organizational infrastructure, panelist Aimee Binning, a member

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