port, the use of Incident Command, teamwork, innovation, and access to communications are factors that appear to improve the response to MCIs.

Communications technologies and the lack of interoperability within those systems were a central theme throughout this workshop. Technology plays several roles in rural emergency and disaster response and consequently serves as both an opportunity and a challenge. Better communications and patient tracking can be a tremendous asset to everyone involved in a disaster response. Interoperability with all responders, including across state lines, would be the ultimate resolution. Standardization for patient tracking systems would be another desirable outcome. Leveraging existing federal programs (e.g., NG-911, HHS, and DHS preparedness grants, National Broadband Plan) will also provide an opportunity to improve access to broadband technologies (public safety communications, telemedicine, and patient tracking) in rural and frontier areas of the United States.

Moving forward, many participants emphasized that grant guidance will need to be updated to facilitate the development of regionalization and the necessary partnerships—within government, local military bases, and the private sector—and establish the metrics necessary to assess capabilities. While some participants expressed concern about regionalization decreasing “local” control, as will be highlighted later in this report, regionalization facilitates partnerships and sharing of increased resources that result in greater flexibility to plan and respond at the local level. Workshop chair Robert Bass suggested that mechanisms to identify and share best practices in planning for and responding to MCIs will help federal, state, and local governments.


The report that follows summarizes the presentations by the expert panelists and the open panel discussions that took place during the workshop. An overview of two rural MCIs, the 2008 Mexican Hat incident and the 2010 Albert Pike flood, are provided in Chapter 2.

Chapters 3 through 5 examine some of the specific challenges of responding to mass casualty incidents that occur in rural areas, as well as strategies and innovative approaches to improving response. Chapter 3 discusses the impact of limited 9-1-1 access and other communications challenges; Chapter 4 examines the unique challenges of rural prehospital response; and Chapter 5 considers the lack of resources and other issues facing rural healthcare systems. It also discusses strategies to address the challenges posed by coordination and integration across response platforms.

Metrics for assessing capabilities and guiding resource allocation are discussed in Chapter 6. Chapter 7 discusses opportunities for improving rural mass casualty response, including the roles of federal, state, and lo-

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