of such a force. If that proved a reasonable option, the next issue to address is from where to pull the surgical resources. In an urban environment it is relatively easy to find surgeons in emergency medicine, but in rural America it is much harder. Regionalization of resources may be the solution such that an event in a given location mandates a response from the 100-mile surrounding area. But how can rural emergency planners deal with the issue of training these surgical specialists to respond on very short notice?

Weireter suggested that unlike in the comparison of prepositioned surgical resources, perhaps the issue of training a rapid-response surgical force might benefit from a military model. When military units change over, the arriving and departing units patrol together, the veteran unit walks point and the incoming unit follows to learn and understand the environment and its challenges. Then they transition, and the new unit walks point as the veteran unit follows. The surgical world needs to learn how to walk point in a rural incident from fire departments and EMS, Weireter said, to bring our surgical resources to the rural environment. Demonstration projects are needed to examine difference models to test strategies and establish best practices.


Leadership Through Transition

While the merits of consistent and updated education were a theme across the presentations, several participants noted the importance that trained individuals ensure their leadership can be replicated when they are no longer actively engaged (due to retirement or relocation). Roy Alson, medical director of Forsyth County EMS and medical director of Disaster Services for the North Carolina Office of EMS, again turned to the military model for potential solutions. In the military, subordinates are specifically trained to lead should the situation arise. Gaines drew attention to the fact that the Incident Command System (ICS), the National Incident Management System, and other command and control operations are built on delegation of authority and defining specific roles within a hierarchical organizational plan, and therefore are a natural aid of succession planning. He agreed with Alson that it is the responsibility of a leader to incorporate continuous leadership training into any preparedness strategy. Dan Hanfling posited the need for ways to incentivize this type of planning.

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