 This is ComNet. Structural collapse is most often the cause of victims being trapped. ComNet explores the National Urban Search and Rescue Recovery Program and shows how it can be utilized in the recovery effort. The mission of the Medical Reserve Corps is to serve communities by establishing local teams of volunteers to strengthen the public health system and improve emergency preparedness. Stacey Phillips continues her series on the Citizen Corps programs with a look at the Medical Reserve Corps and how they can benefit a community. The Occupational Safety and Health Administration has written a document designed to provide hospitals with practical information on receiving patients involved in the release of hazardous substances. ComNet visited OSHA and discussed this valuable information. One of the purposes of the Noble Training Center is to train emergency managers and health care professionals to manage a mass casualty event. John Eastman spoke with members of the Noble Training Center and discussed how they provide training to the response community. ComNet is sponsored by the Department of Homeland Security, Office for Domestic Preparedness and the Federal Emergency Management Agency. Coming to you from the facilities of the National Terrorism Preparedness Institute at St. Petersburg College, here are Al Rochelle and Jennifer Holloway. Hello and welcome to ComNet, the Communications, News, Equipment and Training Magazine. This program presents weapons of mass destruction related awareness information for the nation's civilian and military response communities. ComNet is being distributed over government and commercial information networks and is being streamed over the worldwide web at terrorism.spcollege.edu. We invite you to visit the NTPI website for further details on the information provided during today's program. Continuing education units can be earned for viewing ComNet programs. To register for those CEUs, go to the NTPI website and click on the Continuing Education Units link under training. This link will take you through the registration process and the login process. After you log in, you'll be able to view program videos, take the program exam and fill out an evaluation form. With an exam grade of 75% or better, you will immediately receive an online CEU certificate. After viewing ComNet, please complete a viewer evaluation of the program. Your input and comments are very important to all of us. The terrorist attacks of 9-11 and more recently, the London subway bombings have thrust certain rescue teams into the spotlight. Today, Doug Smith takes a look at FEMA's National Urban Search and Rescue Response program and shows how it can be utilized in the recovery effort. When an urban search and rescue task force arrives, it arrives ready to work. You know, we're out the door very fast. Our members are very well trained and FEMA ensures that we're very well equipped. So once we get there, we're there to assist. In an effort to address the growing need for search and rescue support, the Federal Emergency Management Agency established the National Urban Search and Rescue Response System. This system provides a framework for organizing local emergency personnel into disaster response task forces. These task forces are deployed by FEMA in times of catastrophic structural collapse. FEMA's National Urban Search and Rescue Response System is a cooperative undertaking between Department of Homeland Security and 28 sponsoring agencies for National Urban Search and Rescue Task Forces. These are predominantly large fire and rescue departments throughout the United States. This gives us the capability with all the 28 task forces. We have about 5,200 system members. Each task force is a completely standalone, multi-disciplinary response asset that can be brought to the scene of a major disaster. USAR is a very common term now, particularly in American fire service. If you look at what fire and rescue departments across the country do day to day, it can also easily be referred to as technical rescue. Each of the 28 FEMA USAR task forces are also a local resource, if you will. That is our primary focus is on our locality as well as our state and as well as our nation. Nationally, the FEMA Urban Search and Rescue Response System has evolved since the early 1990s when FEMA itself changed its mission from one of civil protection to one of response recovery. If you look at the way we were developed and designed, initially it was for earthquakes as well as hurricanes or climatic type events. So most of the early task forces were either on the west coast or on the east coast. But now we've had a tremendous amount of focus on the central US since 1995. These 28 task forces are located throughout the country and support FEMA's primary mission under emergency support function number nine. The teams are equipped to locate, remove and provide medical treatment to trapped victims. For Urban Search and Rescue, we are specially trained resources to operate and collapse structures, primarily those made of heavy reinforced concrete. So we have tools and equipment, about 25 tons of tools and equipment that we bring with us to cut the heavy concrete to cut the heavy steel to get to the approximately 20% of the people who cannot be self rescued or rescued by day to day fire department operations. Each task force can go under two different configurations. Our normal one is a large response, about 70 people, about 30 tons of equipment and that would be for heavy extrication such as removing people from like a collapse building like Oklahoma City. And our more recent capability is a smaller, faster, lighter response of a 28 person capability for weather related incidents, hurricanes, tornadoes. They go by ground and they're very mobile. The national USAR task forces include engineers, rescue specialists, search dogs and emergency medical technicians. Their duties fall roughly into four categories, search and rescue, medical, technical and logistics. It's a very, very unique group of people. Primarily it comes from the fire and rescue department, if you will, because if you look at the composition of a task force and a task force in itself is a group of very specialized people that can do multitask, thus the name Task Force. So we have a management component. We have an operations component. We have an engineering component that's part of that logistics and all the things that it needs to take to move 80 people at a time from point A to point B. In the United States. Because of that, each team is staffed with up to 210 people. That way we have a depth of three at all of our positions. And when we go out, as we said, the main component comes from the fire and rescue department, but we also depend on emergency room physicians, canine handlers, engineers. Those types of jobs are not typical in the fire department. So we're unique also in that we are a mixed career based fire department, but also a lot of our members come from the civilian world as well. These teams have the ability to be deployed within six hours and can be self sustained for up to 72 hours. Once they arrive at an incident, a small command cell will start sizing up the location. They'll also meet with the incident commander and after a general situation briefing will set up a base of operations, including tents, equipment and a staging area. We can't rescue anybody until we can find them, but at the same time the command component of the task force is tying into the local incident command system, interacting on a number of different issues there. And then probably at least half the team is engaged in just getting the task force itself set up. We're not there to take charge. We're there to lend a hand and deliver an expertise that they may not have at that particular moment. So immediately our reconnaissance teams are comprised of specialists, including canine, that are tools, if you will, that do not need to be unpacked. Everyone who's assigned to a reconnaissance team arrives in an area ready to go to work. So we don't lose time, if you will, by having to wait for the 25 tons of equipment to be offloaded and they go out performing their assessments, particularly with the engineers. They need to get out, they need to look at the buildings, they need to target the buildings for the best way for us to make entry into those buildings. And we look at things, of doing things in phases. So our reconnaissance team is going to go out, they're going to assess those buildings, if you will, and then the detection phase begins where we use our dogs. The dogs can cover four times the area that a human can, and all of our dogs are very specially trained in air-sensing. So we don't expect the dog to lick the victim on the face, if you will, but they're going to give us a very good indication of where that person's trapped. The next phase is to come in and really pinpoint, locate exactly where that person is. And we use specialized listening devices as well as cameras to do that. And then we, those folks, our technical search folks, work hand-in-hand with the rescue component to begin the expectation phase. A lot of it is we just have a lot of rubble that has to be moved to try to gain access to voids to look for people, or if you come across a victim to remove them. We also tie in with the local trades, heavy construction, the trucks and the contractors for moving material. In fact, we have specialists on the team, the heavy rigging and equipment specialists that are focused on those type of issues in particular. But a lot of it is just hard manual labor that has to be done to do the job. One of the things that we do is what we refer to as delaying a building, where we'll take a building that's been pancaked, if you will, collapsed upon itself. We need to take that building apart. And it's like trying to take tanker toys or Lincoln Logs, you know, or pickup sticks apart, if you will. So we need to have technical expertise there to guide that job. An important part of delaying a building is knowing what type of structure you're dealing with. What kind of building was it? What was it made of? Did it have chemicals or other toxins in it? These are just some of the details the teams are trained to look for. USAR training is intensive to say the least. Each of the task force members must complete hours of training so once they reach a patient, they can quickly begin life support and remove them from the building. FEMA does not hire team members, but they do credential teams that have met the criteria and are approved by the USAR oversight board. The training within the national system is quite extensive. The majority and a tremendous amount of training is done at the local level by each of the 28 task forces. Fair amount of classroom, but much more hands-on skills type training. Cutting, breaching for the rescue specialist, the medical considerations for the doctors and paramedics. Each discipline has their own training that's done on a weekly, monthly, semi-annual basis as the case may be. Then at the national system, we have a curriculum of 12 different national training courses that our program office sponsors and conducts each year. The value of that is these are intensive week-long courses, but it allows us to bring two specialists from each of the 28 task forces together. So a number of things happen there. You get very good standardization across the system on training and issues that we bring up. But equally so, just the interaction between the students from all 28 task forces is a tremendous benefit to the system. Another part of the National Urban Search and Rescue Response program is the Incident Support Team. The IST provides federal, state and local officials with technical assistance in obtaining and managing USAR resources. No matter what agencies are involved in the response, life safety will be everyone's primary mission. Having the National Urban Search and Rescue Response teams at the scene and involved will allow lives to be saved. We tend to think of it in a very positive way of like bringing in the Calvary, the backup to help on what could truly be a very overwhelming and terrible incident. You have 70 people who are willing at the moment's notice to leave the warmth of their home and go to a locality they've never been to to be able to risk their life and do the best job that they can for American citizens. FEMA will issue an activation order once it determines that a task force needs to be deployed. This activation order contains the official activation time, the mode of transportation and a point of contact for further instructions. At the conclusion of the incident, the National Urban Search and Rescue Response task forces are expected to return to their initial state of readiness within two weeks. Stay with us. We'll be right back after this. State and local governments have direct responsibility for training and exercising their own homeland security professionals. On the next live response, we'll look at the Homeland Security Exercise and Evaluation Program and how it can be used to help all levels of government in terrorism prevention, response and recovery. Live sponsors Wednesday, September 28 at 2 p.m. Eastern. For more information on viewing, make sure to register online at terrorism.spcollege.edu. During a natural disaster or terrorist event, the local public health system could be overwhelmed and in need of extra personnel. Stacy Phillips looks at how the Medical Reserve Corps program helps fill these needs. After 9-11 and the events that day, many individuals wanted to help out. They wanted to show their support. Unfortunately, a lot of those people couldn't be used because they weren't known to the emergency management system. They didn't know who they were, didn't know anything about their credentials. They didn't know how they would provide liability or legal protections for those individuals. So there was a lot of frustration on the part of the emergency managers who might have used those people, but then also on the frustration on a part of the individuals because they couldn't be used. And so the concept of the Medical Reserve Corps was created as a way to create a system to use those individuals, to pre-identify them, pre-credential them, know who they were in advance so they could be used. Formed in 2002, the Medical Reserve Corps has grown to over 300 units and over 40,000 volunteers across the country. MRC units are community-based and function as a way to locally organize and utilize volunteers who want to help supplement existing emergency and public health resources. Really, there's no one typical MRC unit. It really depends on the community. They determine what their needs are in the community and they'll design the Medical Reserve Corps to meet those needs. So a Medical Reserve Corps in Washington, D.C. will not look the same as in New York City or in rural Ohio. They're all going to be different based on those needs. It's a local response asset and they're basically just people. It's groups of people that supplement the existing community resources, the existing community resources in public health and emergency preparedness so that if there is a local response and the local public health and emergency manager set up a clinic or set up a triage site or a care facility, then they may need extra people to help out and call on the Medical Reserve Corps to help out. It's very good that the volunteers are local because they do have a sense of community, they have a sense of involvement, they feel that there is a sense of control. In the event of an emergency, especially a terrorism, it's all out of our hands as far as what happens. And so for the community to be able to come together and respond to help their neighbors, to help their friends, to help their schools, their faith-based organizations, it's very important for them. Because the Medical Reserve Corps units are community-based and many of the volunteers are experienced medical and health professionals, the MRC units not only fill the gaps in the public health system, but strengthen the community as well. Well, the MRC really makes the community more resilient. It builds a greater capacity of knowledge, of expertise, response capability, so each community is stronger and then has to, is less likely to need to go to the state or federal assets because they're more efficiently and effectively using all of those community assets which are now under the umbrella of the MRCs. In the event of an emergency, Medical Reserve Corps units may be activated to assist the local public health system. MRC volunteers offer a wide range of professional skills and fill a variety of needs. Most Medical Reserve Corps units though have decided to open up their volunteer recruitment to not only medical and public health providers, doctors, nurses, pharmacists, dentists, veterinarians, physicians assistants and others, but then also regular community members, folks that don't have medical training that can help with things like logistics, administration, communications, training, getting some legal advice, having chaplains or interpreters. Some of the examples of things that people do, that the volunteers would do during an emergency would be providing house greening, distributing medications, determining what the status of a patient is. Can they actually accept this Ciprofloxin or doxycycline? Is it something that would be damaging to them? So they could do all types of different roles and responsibilities. Over 30 MRC units were involved in the hurricanes of 2004. They did things like manning hotlines, telling people what they should do with the hurricanes coming. They helped with evacuations. They provided supplemental personnel for the community hospitals that were affected by the hurricanes and some of the local staff couldn't come to work because they were affected. So the Medical Reserve Corps members came in and filled in where there were critical shortages. The Medical Reserve Corps is a specialized component of Citizen Corps and is sponsored by the Office of the Surgeon General. Not only are the MRCs used during emergencies, but volunteers can supplement existing public health initiatives and help promote the Surgeon General's priorities. Admiral Carmona has three priorities. First is increasing prevention efforts, making sure that we all do what we can to prevent illness before it happens or prevent chronic diseases. We also want to eliminate health disparities, making sure that all Americans have equal access to health care and health services. And then finally, public health preparedness, improving the way that communities prepare and respond to emergencies. Medical Reserve Corps is really a gem. It's been a gift for me because what the Medical Reserve Corps does every day is provide a method to fill the gaps in any community. So where they might provide surge capacity in an emergency, on an everyday basis they can be in that community, helping with immunizations, helping with public health needs, or meeting the unmet public health needs of any community. While it's helpful to have a large number of volunteer health professionals in place, it's important that each MRC volunteer is trained in emergency preparedness and properly credentialed. One of the keys and why it was founded was as a way to pre-identify pre-credential individuals so that they're known in advance of the emergency. So at a minimum Medical Reserve Corps units will verify who their volunteers are. So do a check their driver's license or some other form of identification. And then they'll also do at least a basic level of credentialing for medical providers. What they'll do are things like verifying that their license is current and unencumbered in their state. What that does is says the person is who they say they are and they can do what they say they can do. Training we feel is very, very important to our volunteers. Some of them have never experienced disaster medicine or any of the incident command structure protocols or programs from the state perspective or the local perspective. So we provide them an initial training which teaches them about liability protection, what some of their core functions may be, their roles and responsibilities. Then we take them to another level of training which is actual hands-on training. We provide exercises and actual hands-on experiences for them so that they feel more comfortable when they get to the scene that they've done something similar before. What we've done with the Medical Reserve Corps and NIMS is to recommend to them and actually provide training in the trainings that we give on the National Incident Management System. We have the expectation that they would be able to plop into, if you will, a local jurisdiction and just work in the incident command structure that exists. And so for them to do that, they really have to understand what the incident command structure is. We feel very confident that our volunteers will understand the scene, how to work in the scene and the core concepts of NIMS, which is very important for them, and to reduce their stress as they engage in these situations. They're going to be receiving some medical training, very rudimentary medical training. We will have as volunteers some very professional folks who are retired, such as retired doctors and retired nurses. But the majority of the people that we're asking to volunteer are going to be laypersons who can act in administrative type positions, things to do support logistics and things of that nature. So they don't have to have a medical background. If you work with the computers and data processing, data entry or whatever, you can do things like that if you don't want to work directly with a patient or whatever, or you could work with sign-in when people come in or a greeter. Some people are good at that. Whatever you think you're better at doing, then they let you feel comfortable at whatever job that you can do. And that's what I like about the program. Anybody can be a part of it. By training and organizing medical and public health professionals, along with other community members, the Medical Reserve Corps is now functioning and available for the community to access and emergencies and ongoing efforts in public health. One of the most exciting questions we received about using volunteers in an everyday crisis was in the Carroll County Health Department. They want to provide flu mist, which is a vaccination or a preventive measure against the flu to all the children in the Carroll County Schools. So we're working right now to provide volunteers for that distribution of flu mist. And it's a very exciting program because now we're meeting, our volunteers are actually meeting not only the local health department, but the school administrators and some of the law enforcement community, and they're really getting to know how they would be used to provide this vaccination to children, which is an important thing before the flu season kicks off next year. Our Corps has been deployed three times for events that, because of the nature of what security means here in the nation's capital, we do it and we're involved in it at a level that in other areas might not be the case. For example, we've been involved in President Reagan's funeral. We've been involved in the World War II Memorial dedication. And lastly, we've been involved in the presidential inauguration here back in January. It's always inspirational to me to see the response we get from our volunteers. It's truly one of the most encouraging portions of this work, that we have so many people who are really excited about helping out in an emergency and they go. They actually go. During the inauguration, for example, we sent a cache of volunteers to the D.C. Health Department because we were very concerned that there may actually be some type of an event in D.C. Thankfully nothing happened during the inauguration, but we were ready and now our volunteers know how the system works. They're more well equipped. They have good contacts in our national capital region and we're ready for the next thing, if and when it happens. Really I just want to encourage your viewers to think about the Medical Reserve Corps, to think about either volunteering with the Medical Reserve Corps or supporting it in their community, doing things that can help promote the Medical Reserve Corps concept. What we have found is that a few excited people in the community can really get the Medical Reserve Corps unit started and getting it really embraced in the community. Getting all the community partners, public health, medical, emergency preparedness, leaders, business, getting them all at the table to think about this concept of strengthening public health and improving the preparedness. They can either contact our local health department to find out if there's a local Medical Reserve Corps or probably even easier they can go to our website which is www.medicalreservecore.gov and they can find if there's a nearby Medical Reserve Corps unit. I would encourage them to contact that unit, the unit leader, and find out how they can get involved. If there's not a Medical Reserve Corps unit nearby them, I would encourage them to start one. They can download our technical assistance series off the website which gives a step-by-step really checklist on how to get a Medical Reserve Corps unit started. I'd like to see an MRC in every major metropolitan area and even in smaller communities where we can do it. It's really a wonderful asset that allows people to express their need to participate. One of the things we saw at 9-11, there was an outpouring of people who wanted to do something to help the country yet we had no organizational structure to do that and we had to deal with each case on an individual basis. Now we have an MRC with its organization, people understand their roles, there's training, there's education and there's a continuing mission that goes along every single day. So I would hope that they grow and continue to grow because it really is a wonderful asset for the United States. With Medical Reserve Corps units in place, these volunteers will help improve not only the health, but the safety and security of the nation. Be sure to watch the next edition of COMnet as we look at another important Citizen Corps program. That is the Fire Corps. Now it's time to take a look at the latest responder news. The National Terrorism Preparedness Institute in partnership with Response Technologies recently conducted a three-day course on air monitoring equipment at St. Petersburg College. The syllabus was geared toward emergency response personnel who either currently are or would like to be hazardous material technicians. The course provides them a basic understanding of the instruments that they're being asked to use for the recognition, identification and measurement or quantification of toxic gases and vapors. Students participated in traditional classroom instruction in addition to lab exercises where they received vital hands-on training. The only way you're going to get familiar and get proficient with this equipment is to get into a setting where you can use it, push the buttons, make it do what you want to do and get confident with the ability to make that instrument do what you need it to do. Hazardous materials technicians from all disciplines are being challenged with new detection and monitoring equipment. It's not as simple as the four gas unit anymore that we used on a routine daily basis in the past. We're dealing with things like photo and flame ionization detection units, ion mobility spectroscopy, infrared spectroscopy, gas chromatography and mass spectrometry. Tremendous sets of new types of technology that are coming in and challenging technicians to become confident with that equipment so they can make appropriate decisions in the field. The Washington Metropolitan Area Transit Authority hopes their new chemical sensors will help save lives. The sensors operate like smoke detectors by sending an alarm to station manager booths as well as to the Transit Authority's operation control center whenever a chemical release is detected. Initially, just two stations had these sensors installed in January of 2002 as a direct result of the September attacks on the Pentagon and the World Trade Centers. Now there are units in half of DC's metro stations. Additional funds are needed to complete this ongoing project, but the increased threat level caused by the London Tube bombings makes this a top priority. By quickly alerting metro police, the sensors will allow more passengers and employees to evacuate trains and get out of harm's way. Disasters, no matter what the cause, can paralyze business operations. Michael Chertoff, Secretary of the Department of Homeland Security, launched Listo Negosios to help Spanish-speaking business owners and managers develop emergency plans. Listo Negosios, co-sponsored by the Advertising Council, is the Spanish version of the Ready Business Campaign, which provides strategies for emergency preparation. It is designed to aid Spanish-speaking owners of small to medium-sized businesses prepared for emergencies. The guide includes practical steps and user-friendly templates, all in Spanish, to help them communicate with their employees, protect their investment, and ultimately stay in business. The annual Firehouse Expo was held in Maryland recently at the Baltimore Convention Center. As the largest fire and emergency services event on the East Coast, the Firehouse Expo spanned five days that included exhibits, more than 80 classroom sessions, and hands-on training. Hands-on training is key to the industry right now. Firefighters don't get the type of on-the-job training that they're used to. They just don't fight as many fires. Mostly what they're doing is running EMS calls. So there's a great need out there for what we call hands-on training. We want to give the students the feeling of what it's going to be like when they respond to that first call. This year's Expo schedule entertained and educated those in attendance. Attendees were treated to half-price admission to an Orioles baseball game and an end-of-the-week parade. Really at any level of the service that you're in, any type of department is going to find lifesaving techniques, products, and education here at Firehouse Expo. The National Fallen Firefighters Foundation is taking further steps to prevent line-of-duty deaths and injuries. Their new website, EveryoneGoesHome.com, is a collection of resources firehouses can use to bolster their training. The site is a continuation of the effort begun at the 2004 Firefighter Life Safety Summit held in Tampa, Florida. That conference produced the 16 life safety initiatives that are essential to reducing fatalities and injuries. Their goals include reducing firefighter fatalities by 25% within five years and 50% within the next 10 years. The Foundation hopes this webpage will increase visibility of its national initiative to bring prevention to the forefront. This September, America will again join together as one for National Preparedness Month. The second annual event will include more than 125 organizations and all 50 states and will officially launch at Union Station in Washington, D.C. on September 1st, 2005. Those in attendance will learn about training opportunities and receive preparedness materials. All of the National Preparedness Month activities are designed to encourage Americans to get an emergency supply kit, make family emergency plans, and get involved in preparing their communities. The Department of Homeland Security and the American Red Cross also plan to distribute emergency preparedness information and host public awareness events throughout the country. And that's a look at this month's Responder News. In the event of a terrorist incident, victims will eventually need to be treated for their injuries. As these patients enter their local health care facilities, it is possible that they will be bringing contamination with them. So how can hospitals prepare for and protect themselves against this danger? David Klu takes a look at a document that addresses those concerns. Over the past few years, the need for hospitals to be ready to receive contaminated victims has been obvious. Recently, the Occupational Safety and Health Administration completed an effort that combined a wealth of expertise into a Best Practices document. This document is named Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents involving the release of hazardous substances. The key goal of the document is to offer personal protective equipment and work practice guidelines that could be used by first receivers. Actually, the impetus from this document came out of a summit that was held here in Washington, D.C. that focused on emergency preparedness. This conference was actually cosponsored with OSHA and FEMA. And it was at that conference that we heard a message loud and clear about the First Receivers community. They felt that there needed to be some guidance that protected their workers in the event of a WMD event. From their perspective, there was a great deal that had been written to protect first responders and address personal protective equipment issues for first responders, but very little in the area of first receivers. So who are first receivers? First receivers typically include clinicians and other hospital staff who have roles in receiving and treating contaminated victims. To understand our document, I think you need to understand who we target when we talk about first receivers. These are individuals who work remote from the side of the toxic release. They're not in the hot zone. These are individuals whose exposure to the toxic substance is limited to a mouth that's brought in on victims, on their bodies, on their clothes, or on their personal effects. In the hospital community, it would be individuals that are involved in perimeter security, individuals that actually do triage of these victims, or treatment, or certainly the decontamination team as well. A first receiver is actually a subset of traditional first responders, although their relative risk is different. What do I mean by that? Well, the amount of hazardous material associated with a victim is the key limitation to what a first receiver can be exposed to. First receiver's exposure is strictly limited by the amount of material that will come into the hospital that is associated with the victim, the victim's clothing, their personal belongings. OSHA received a number of comments on the document, incorporated many of those remarks, and sent it back out for a second review. The document also includes comments from several government partners like the Department of Health and Human Services, Centers for Disease Control and Prevention, the Department of Defense, and the Department of Homeland Security. It was actually published in December of 2003. Initially, a team was created here at OSHA, and it was made out of two different professions, healthcare professions, and then professionals from the industrial hygiene community. That group began to work, and their first stage was to review all literature that had been published in this area. They did a thorough literature review. However, the literature that they focused on was primarily the literature that was published after 9-11. After they had sought all the subject matter experts, the third stage was going out and reviewing some of the best practices. We as an agency identified seven hospitals across the nation that were known for having exemplary emergency response plans. We went and did personal visits and learned what we could from the leaders in this area. Those three areas, the literature search, the opinions of subject matter experts, and the wisdom of exemplary hospitals provided the foundation for the document and resulted in a first draft of the document being created. The document is based on the latest OSHA standards, existing hospital practices, and current respiratory protective devices. Along with PPE and training recommendations, the document contains 13 appendices and lists of tables that address such topics as decontamination procedures, chemical suit test results, and how to maintain future hospital readiness. A new user to the document, I would encourage them first and foremost to read the executive summary. That's included in the very first three or four pages of the document and gives an overview of what's to be found later on. After they read the document, there's some information that explains the logic behind the document, and then it's followed by a section of four tables that in many ways, in a concise way, indicates what our recommendations are. Table one indicates what the decontamination area needs to be like. For this document to be applicable, there are certain situations that need to occur in the decontamination zone. Tables one and two of the document prescribe conditions that a hospital must have in place prior to actually implementing or availing themselves of the personal protective equipment recommendations in table three, and what those preconditions are in tables one and two really mirror what hospitals should already have in place or beginning to get in place as associated with the requirements of the Joint Commission for Accreditation Health Care Organizations, J.Co. The PPE recommendations are actually included in table three of the document, and when we think about personal protective equipment, we look at it in two perspectives. First of all, is the respiratory protection or the protection from inhaled hazards, and then the skin protection or the protection from those that could come in contact with the skin. From an inhalational standpoint, our recommendations recommend a powered air purifying respirator with an assigned protection factor of 1,000. To protect from the dermal hazards, we recommend a chemical protective system with a chemical protective suit and double-gloving, which includes butyl over nitron gloves. The hospitals need to look at what their specific needs are because the thickness of the glove, as much as the material will determine dexterity and dexterity leads to its practical usage. Clinicians still need to perform things like field-based intubation to stabilize a patient, and if they're not able to do that, then they need to look at, well, do I really need a 14-millimeter thick glove when I can get away with a 4-millimeter thick glove? What we talk about here is we talk about powered air purifying respirators and there are two types. There's the hooded type where you don't need to perform a fit test, which is required for a tight-fitting facepiece, whether it be half-facepiece or full-facepiece. So the hooded types have their advantages in that regard. And someone like me who wears eyeglasses could just go put the hooded type respirator and perform my duties in the hospital's emergency management plan. It's true this document focuses on the unknown hazards that are associated with mass-casualty incidents and specifies the minimum level of PPE first-receivers should use. However, these best practices are meant to be recommendations. We were asked to provide some guidance to the first-receiver's community on how they might best protect their workers, and that's what this document attempts to do. With a limited number of areas, it points to actual OSHA standards, such as if individuals will wear a respirator. Certainly they're covered under our Respiratory Protection Standards, and those standards would need to be followed in those individuals. But this is not as a document. This is not a requirement. It's a recommendation. It's a best practice guideline. These recommendations are limited and certain assumptions were made when generating the document. We need to realize that this document does not address a time in which the toxic release is at the hospital itself. We are assuming that the toxic release, or the chemical release, is remote from the hospital and that the period of time from the release to victims arriving at the hospital, the transit time, would be at least 10 minutes. There's a certain amount of decontamination that would occur during that period of time, and those are some of the presuppositions we worked with. The OSHA Best Practices document states that hospitals have to provide all the resources in an emergency. But it does say the hospital should identify where those resources will come from. The real benefit of this document is that it shows that hospital preparedness is much more than just wearing the right protective suit. It's having the right emergency management system in place. It is a good starting point for a hospital who really has not begun to think about how they're going to protect their first receivers during a mass casualty incident. And again, in addition to understanding OSHA's thought process as it made its recommendations, there's also Appendix A. Appendix A is key in the document because it summarizes the solutions that hospitals already in existence who have already taken steps to meet the challenges of implementing an EMP have gone through. And it's key to understanding what their colleagues and what their peers have already accomplished. I think a hospital that has not approached the area of emergency management, particularly in the area of WMD events, sometimes they're overwhelmed with the thought of what could potentially happen and how their hospital could be ready. I encourage them to read the document because I think it gives them very specific goal-oriented activities or steps that they can take to ultimately reach the goal of getting ready for a mass casualty event should it occur. The Occupational Safety and Health Administration recommends that hospitals use this best practices document in conjunction with other available emergency preparedness information sources. For more information or to get a copy of the document, just visit the ComNet website. And now we turn from news to a look at various events happening around the country. On September 7th through 10th, the Crime Mapping Research Conference will be held at the western Savannah Harbor in Savannah, Georgia. The Environmental Systems Research Institute is sponsoring the Homeland Security Summit, the key to intelligent collaboration on September 12th through 14th at the Adams-Marc Hotel in Denver, Colorado. Then on September 15th and 16th, the Homeland Defense Training Workshop is sponsoring the Physical Security for Government Facilities Conference at the Adams-Marc Hotel in Dallas, Texas. And on September 20th through 21st, the US Maritime Security Expo will be held at the Jacob Javits Convention Center in New York City. The 112th Annual International Association of Chiefs of Police Conference will be held at the Miami Beach Convention Center on September 24th through 28th in Miami, Florida. On October 4th through 8th, the Fire Department Instructors Conference East will be held at the Atlantic City Convention Center in Atlantic City, New Jersey. The National Conference for Hospital-Based First Receivers will be held in New York City in Washington, D.C. Also on October 11th and 12th, the Emergency Preparedness Media Relations seminar will be held in Norfolk, Virginia at the Sheridan Norfolk Waterside Hotel. The 2005 Homeland Security Summit will be held at the Holiday Inn Rosslyn at Key Bridge on October 12th through 14th in Arlington, Virginia. Then on October 16th through 18th, the Advanced Personal Protective Equipment Challenges in Protecting First Responders Conference will be held in Blacksburg, Virginia and Skeleton Conference Center. And on October 18th through 20th, the Third Annual International Counterterrorism Officers Association Conference will be held at Disney's Coronado Springs Resort in Orlando, Florida. The Noble Training Center in Fort McClellan, Alabama is a state-of-the-art medical training facility. Now operated under the Department of Homeland Security Preparedness Directorate, this facility is complete with classrooms, exercise in simulation areas and a realistic hospital environment. John Eastman brings us this report on the Noble Training Center's Hospital Emergency Response Training. I think Noble Training Center is very unique especially for my program, the master exercise practitioner program in that we can apply these facilities to the healthcare environment for the very first time. The Hospital Emergency Response Training Mass Casualty Incidents is designed to provide guidance to give instruction to hospitals, healthcare facilities, health departments, emergency management and EMS also of how to deal with a mass casualty incident that may arrive at a local hospital. And this training helps them to go back, develop, design and staff their own hospital emergency response team. Being a former army hospital the Noble Training Center offers an authentic setting for medical training. The hospital emergency response team curriculum provides training for response to hazardous materials or weapons of mass destruction incidents. Through the use of advanced training and technology, patient simulation and scenarios, hospital personnel now have a huge advantage in preparing for the influx of patients during a mass casualty or mass contamination event. Ron, what are the goals of the courses that you teach? What we try to give them is what you can expect to see in a mass casualty incident. Some hospitals never face that. They don't have a clue. Some have, but those that have not we try to put them in a situation where they need to experience what a major incident would be. And our drills and our exercises allow them to experience that in a real hospital environment. Portions of the Noble Training Center still maintain a hospital likeness. We're able to kind of focus in on health care training. So we do a lot of exercise based training for the health care audience down at Noble along with a bunch of our other training. The Noble Training Center offers a great facility for training. We have aspects of the hospital left in place to provide a realistic setting for medical emergency training. We have the real life experience of having a facility that is open with certain hospital characteristics that are enable the participants to carry out their functional duties. I believe that we are the only hospital that is dedicated to WMD training. We're not a functioning hospital and therefore the participants can use the facility to carry out their emergency management plans without interfering with patient care or visitors or any routine daily business going along in their hospitals. And certainly having the equivalent hospital facilities on the first and second floors really allow us to do some very unique things in the overall emergency management arena especially in that area related to training because we can involve the health care providers in that kind of training and provide the environment that looks and feels like the real thing because frankly it is the real thing. The courses at Noble incorporate hospital hazmat plans into the training. Hospital emergency response team students receive instruction not only on procedures for the triage of large numbers of patients but also on decontamination and use of personal protective equipment. By integrating realistic exercises, students at the Noble Training Center get to practice these techniques as if they were in a true WMD hazardous materials incident. This allows them to experience a real rush of patients they may see during such an event. Now because of terrorist events and the likelihood that it could occur and there could be a rush on the emergency department from patients who perceive they've been contaminated or patients who really have been contaminated the hospitals now must think of being first responders. Our programs are medical centered but yet they have to integrate hazardous materials. They have to integrate wearing chemical protective clothing and they have to integrate the EMS triage method in front of the hospital rather than on the scene. What makes Noble unique in emergency management training? This is a practice session a way for them to exercise that particular response instead of just a clinical emergency type setting. There is a tendency to go into a triage that is different from the usual triage system. In a mass casualty event you may have to reverse your triage system in which the most serious are not the first patients to be treated. You have to be able to wear chemical protective clothing at least a level C ensemble which consists of a power air purifying respirator or an air purifying respirator and chemical protective clothing. Now I want to clearly point out this is not a hazmat course but they have to think outside of the hospital environment where the cap and gown and safety glasses and gloves was fine protection against blood borne pathogens but for hazardous materials and chemicals that could impact the skin and the respiratory system more protection and that's what this course has been designed to do is to help them operate outside of the emergency department to clean up patients that may be contaminated. So when they come into the emergency department they're not contaminating the staff nor are they contaminating the facility. Because of the broad scope of a WMD incident emergency responders will most likely face many unique circumstances that must be addressed. The WMD Mobile Training Center is designed to prepare students across a broad range of disciplines and bridge interagency gaps. Typically all emergency management disciplines which would include the healthcare audience which is hospital public health emergency medical services along with all of the other emergency management disciplines public works along with utilities emergency management community services, Red Cross volunteer agencies law enforcement personnel and so on. In the past unfortunately hospitals and public health agencies have not had a good communication system in place and now when they come to the course they see the importance of each other and I think that we're fostering a better communication between those agencies. There are advantages to having this training here at Noblen if so what are they? All the students all learning how to go back home and do tabletop functional and full scale exercises within their own organizations as well as interface with the agencies and organizations that might be coming to help them. What the healthcare series will allow us to do is focus on those organizations and agencies which provide healthcare within a community be it the state or local or the federal community for that matter and allow us to train them up in terms of how to design, develop, conduct and evaluate exercises that are applicable to their environments. The training itself the units are not different and I say that because that's really important it's really important because we want the hospital to easily integrate into these to fire agencies to EMS and into hazmat so our programs got to be the same as theirs we got to teach the same information. Responding to a WMD or Mass Contamination Incident is likely to be both physically and mentally draining. At the Noblen Training Center many of the courses were developed to recognize the psychological and physical limits responders may face at a mass casualty event. With emphasis on exercises and real world simulations especially as it relates to a WMD event students at Noblen are exposed to the physical and mental challenges these kinds of responses will bring. Are there physical challenges with these exercises? Students are asked to use all their abilities dressed for the occasion let's say it is a demanding exercise and the exercise can last three or more hours. It's physical first of all and it's emotional for the staff but for responding to chemical events biological suspected biological events radiological events they now have to put on chemical protective clothing which most hospitals are not used to doing and this is taxing on the body. When you take them out of their own facilities and away from their own jobs and put them in a unique situation such as this you can regulate their stress and stress is important in decision making in a mass casualty type of event. The Noblen Training Center has set the standard for state-of-the-art medical emergency training especially in the preparation for a WMD event with mass casualties. The addition continues to be the improvement of the country's health care professionals in response to natural and man-made disasters. If you'd like some more information on any of the agencies featured in this program you can visit our website or write to comnet that's PO Box 13489 St. Petersburg, Florida the zip code is 33733 and while you're on the NTPI website be sure and sign up and take the online test for CEUs. Also, you can help ensure that we are meeting your learning needs by completing the evaluation form. Just a reminder our next comnet will air Wednesday October the 26th at 2 p.m. Eastern Time and be sure to join us for live response on September the 28th at 2 p.m. Eastern Time where we will discuss weapons of mass destruction and their sizes, their design and execution. Alright everybody, thanks a lot for viewing and we'll see you next time on comnet.