director at St. Anthony Granby Medical Center in Grand County. The RETAC has been critical in coordinating preparedness and response in five adjacent Colorado counties. It does this by formalizing relationships between medical centers and EMS, and between trauma centers, including children’s hospitals. The RETAC has also helped coordinate air transport and specialty ambulance providers.

However Aimee Binning, a member of the board of directors of the National Association of Emergency Medical Technicians (NAEMT) and owner of CVC Training, Inc., cautioned that broadening the scope of MCI response relationships through regionalization should not compete with strengthening local, nontraditional relationships. Using her own experience, Binning explained that while regionalization can provide greater response capacity over the course of an MCI, long distances between neighboring resources increases the time it will take these additional resources, however well-prepared, to arrive at the scene. Therefore it is crucial to engage local corporations and their personnel in response planning to ensure all available community resources are quickly mobilized to provide coverage in the gap before regional resources can be recruited.

Communications Challenges

When establishing regional coalitions, boundaries must be defined based on tangible barriers that may not always correlate to county or state boundaries. For example, local industries and available resources all impact potential partnerships and should be considered when establishing coalitions, commented Bohlender. To maximize the value of rural regional coalitions, as well as waylay fears of centralization, the issues of communication must be addressed when establishing and maintaining coalitions.

Robust communication systems that integrate and facilitate information sharing between EMS and local providers are critical when developing and maintaining coalitions as well as during incident response. As already described, unreliability of cell towers, or the lack thereof, pose a significant obstacle. The establishment of a central phone number for communication and agreements to notify each other early in the course of an incident have been successful improvements in the Kansas Major Emergency Response Group (MERGe) described by Randy Easter, EMS director for McPherson EMS and Safety Office for Memorial Hospital. Jerry Johnston, the immediate past president of the National Association of Emergency Medical Technicians (NAEMT) and EMS director of Henry County Health Center in Iowa, offered another successful strategy used in Henry County. With one dispatch tone, everyone who carries a pager in the county receives all of the dispatch information simultaneously. Johnston and Easter both said that their local hospitals and other facilities have county alphanumeric



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