Rural communities often integrate across fire, police, EMS, emergency management, and public health services. They understand that disaster response is the “ultimate team sport,” remarked Roy Alson. The challenge is coordinating response at all levels. For example, it can be difficult to get hospitals that are competing for market share to collaborate.

Alson noted that although rural areas may have limited resources, manpower, and equipment deficit, they do not always request help from the states. Therefore state agencies should be particularly cognizant of ways in which they can support the mission of local EMS by providing training, planning, or establishing communications. For example, Alson pointed out that the state of North Carolina established the North Carolina State Medical Response System to develop an all-hazards medical response to disasters.

Like Utah’s Bureau of EMS and Preparedness, whose role in coordinating regional response to the Mexican Hat incident was discussed in Chapter 2, North Carolina is one of many states that requires each county to have an EMS system plan that covers MCIs. Each system is also required to have a medical director and a trauma triage plan that designates a trauma center to which they will transport patients whose injuries exceed the capability of the community hospital. As part of that, ambulance strike teams, which Mexican Hat responders considered crucial in retrospect to both their incident response as well as the provision of EMS to nonrelated emergencies, have been established across the state of North Carolina in three regions to provide not only additional units to respond to the scene, but also units to backfill community EMS so they can continue regular operations.

For North Carolina, the state office of EMS is the lead in the regional medical plan, with public health agencies as key partners. The approach has been to support disaster preparedness at a regional level. The state is developing a regional disaster medical plan for each trauma region. One of the tools the state maintains for emergency management is the State Medical Asset Resource Tracking Tool (SMARTT), an online system in which hospitals update their bed status on a daily basis, and agencies update their equipment and supplies status on a regular basis. In disaster situations the system can operate in real time, providing resource updates to the incident commander.

However Alson emphasized that the state role is not to directly administer MCI response, but to support the community and the region by mobilizing and deploying resources and coordinating outside help. Other programs the state is working on include a mass fatalities response system and a regional burn plan. The state supports several interoperable com-

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