organization to detail its barriers to and goals for participation to the taskforce. Mitchell credits this participant buy-in with the taskforce’s success.

Effectively removing cross-jurisdictional barriers, participants worked via conference call and in person to organize 15 vaccination sites, ensuring a broad mechanism to respond to a pandemic crisis or biological event. The CDC’s Strategic National Stockpile was used, and the unified incident command post setup followed National Incident Management System’s ICS structure. Texas A&M University photo-documented the exercise and recorded all of the metrics. Volunteers were critical, Mitchell said, including people from the school boards, community faith-based organizations, Navajo veterans associations, Rotary, Kiwanis, Medical Corps Reserve, and others.

On the day of the exercise, using seasonal flu vaccine as the proxy, 22,611 Navajo citizens (over 10 percent of the reservation) were immunized in less than 5 hours. The DHHS secretary’s office took part via a direct video feed to the unified command post. Approximately 500 patients per hour were processed at each of the points of dispensing. There were no adverse events, and 86 percent of the patients rated their satisfaction with the event as a 4 or 5, on a 5-point scale.

Though deemed a success, communications and improved access for special needs residents were identified as areas for future progress. This project demonstrated that despite long-held community divisions, effective cooperation is an attainable goal.

As a trauma surgeon, Winchell concurred with others that the single best approach to ensuring a good mass casualty response is to have a very good day-to-day response. There is no surge capacity if the system is already beyond capacity, and people cannot be expected to respond quickly and under extreme pressure, if they don’t have the capacity to respond routinely.

The efforts of EMS are wasted if they don’t have access to an appropriate destination for the patient, Winchell said. The majority of patients, even in an MCI, will not require the resources of the highest-level trauma center. Most could be treated quite well without being transported out of the region (and such transport comes at potentially significant cost to their social support systems and to the EMS transportation systems). Those patients that do urgently need the highest-level trauma care are not likely to survive if they are more than an hour away from the trauma center.

The key, Winchell said, is maintaining local hospital-based or clinic-based resources in rural areas. Whether it is a single car accident or a