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Show that have responsibilities for support during an emergency. Developing personal relationships among key players will be of great benefit in responding to the rapidly changing situations during a mass casualty event and in dealing with the inevitable gaps and omissions that will be present in the most well conceived plans. An important piece of practicing the plan is the use of an "After Action" review. On-site observers can be particularly helpful in accomplishing such critiques since the required activities of the participants may preclude their effective evaluation of the exercise. Nevertheless, the After Action review should also involve all participants so that there can be a critical review of command and control, communications and coordination as well as overall exercise management. Discussions that include what went well, what did not go well, and what are the opportunities for improvement will increase functionality. In addition to bettering the plan, each participant becomes invested in the process and over-all outcomes improve. SUMMARY Disasters and other emergency events, including terrorism, may occur without warning. The potential for large numbers of patients and concerned citizens descending on health care facilities requires planning before the event. In addition to providing the usual medical and public health support, it is essential that plans address the "4 Cs". Attention to command and control, communications, and coordination in planning and practice will enable to health organizations to make effective responses to a disaster and to respond efficiently to rapidly-changing situations as the event evolves. REFERENCES Baker, A (2002). In crisis, New York's emergency office was thwarted by its past. New York Times, 9 September 2002. Bardi, J.(1999). Aftermath of a hypothetical smallpox disaster. Emerging Infectious Diseases, 5, 547-551. Centers for Disease Control and Prevention (CDC). (2000). Biological and chemical terrorism: Strategic plan for preparedness and response B recommendations of the CDC Strategic Planning Workgroup. Morbidity and Mortality Weekly Report, 49, (No. RR4) 1-14. Flynn K. & Dwyer, J (2002). Fire department lapses on 9.11 are cited. New York Times, 3 August 2002. Garrett, L.C., Magruder, C. & Molgaard, C.A. (2000). Taking the terror out of terrorism: Planning for a bioterrorist event from a local perspective. Journal of Public Health Management Practice, (5(4), 1-7. Gebbie K.M. (2002). Bioterronsm and emergency readiness competencies for all public health workers. Columbia University School of Nursing Center for Health Policy. Retrieved 5 February 2003 from www.nursing.hs. Columbia, edu/institutecen ters/chphsr/btcomps.html. Inglesby, T., Grossman, R. & O'Toole, T. (2000). A plague on your city: Observations from TOPOFF. Biodefense Quarterly, 2(2), 1-10. Macintyre AG, Christopher GW, Eitzen E Jr, et al. (2000). Weapons of mass destruction events with contaminated casualties: Effective planning for health care facilities. Journal of the Ameri can Medical Association, 283,242-249. Miller C.W. (CDC). (2003). Potential threats and the public health response: Radiation. Presentation at the American College of Preventive Medicine Pre-Conference Institute on Emergency Response and Preparedness. San Diego, CA. Moser, R. Jr., White, G.L., Lewis-Younger, C.R. & Garrett, L.C. (2001). Preparing for expected bioterrorism attacks. Military Medicine, 766,369-374. ABOUT THE AUTHORS Royce Moser, Jr., M.D., MPH. Professor and Director, Rocky Mountain Center for Occupational and Environmental Health. nnoser@rrncoeh.utah.edu George L. White, Jr., Ph.D., MSPH. Professor and Director, Public Health Programs. Department of Family and Preventive Medicine, University of Utah School of Medicine. gwhit 6(5; dfpm, xttah, edu Colleen Connelly, BSN, R.N. Emergency Preparedness Man- ager, University of Utah Hospital. Coles Con v > , edu Linda K. Amos, Ed.D., R.N. Associate Vice President for Health Sciences, Ida May "Dotty" Barnes. R.N. & Keith Barnes, M.D., Presidential Endowed Chair, Professor of Nursing, Ilnda.amos^hsc .utah.edu Utah's Health: An Annual Review Volume DC 23 |