We all  have common interests relating to EP planning, with the intention of optimizing the implementation of available medical resources, devices/equipment all while successfully executing the state-by-state various disaster preparedness plans. And, as you know, there are significant  gaps/contradictions (and/or selective policy directions)  between US DHS and the US DHHS with there respective grant funding guidelines.

We recognize that both entities serve different roles during an EP event (on a state level), and in most cases with good collaboration and planning. However, we have identified major lapses in critical care areas that while may be subsequently mitigated as a unforeseen event, are clearly areas that existing planning and funding should serve.

-shortage of available mechanical ventilators, which are available in a single 13 pound unit that is ICU/MRI compatible in addition to being a transport vent. Just look at every state Disaster Plan and you'll find a significant ventilator shortfall (stated recognition) during a moderate let alone a severe event. New York has developed a plan that increases the availability of vent stock by rotating its state stockpile (as opposed to storage, battery issues) within its hospital systems. Why? First, RT's become familiar with the same vent (critical in a EP event), and the vents are utilized for existing patient care. More important is NY's recognition of the importance of utilizing a easy-to-use standard vent that can treat infant, pediatrics & adults and the ongoing use of the stockpile mitigates issues relative to a stockpile storage in addition to raising the standard of RT care our patients.

While proper ventilation protocols are essential, providing protection for healthcare providers is equally important. We have a relationship with a company that provides Aerosol, Oxygen and EMS Non Rebreather masks. Yes, the n95 is the standard but falls far short of truly providing protection for providers. Superior masks are available and should be utilized especially during an influenza pandemic.

Oxygen - yes, multiple companies provide significant contributions everyday to ensure its clients have the necessary 02 for the respective facilities in addition to having EP plans to enhance supply if/when necessary. But let's face it, regardless of the disaster, oxygen MUST be considerably more included and integrated into healthcare and its secondary (back up)  locations.

Under all the listed concerns listed above, the most important issue is surge capacity and our healthcare systems ability to handle the influx of patients, and the stress this will place on care providers. Yes, we all are familiar with our respective state regional EP plans, and they do identify and in some cases have additional facilities to "handle" such an occurrence. Theoretically, the states' EP plans address these issues. But in fact, only the major populated areas have such back-ups with suitable triage, etc resources, yet they still lack resources and personnel to adequately mitigate this event.

Our Group has many suggestions to better utilize a variety of existing resources that we believe will improve upon the existing plans and significantly raise the level of patient care during a tragic event.

We look forward to future dialogue on this topic as we all can make a significant additional contribution in protecting our citizens during a mass casualty event. Thanks for the opportunity to provide input!

All one has to do is look at the various states EP plans and take a closer look at the population fatality numbers (depending on the EP event). Read them, most are duplicates of other states with few additional details regarding mitigating a EP event within their respective state. That's just the respective states' Department of Health's plan.

Now, we move to the US Department of Homeland Security, and the respective offices in each state. I'll applause the MMRS program, and we appreciate the funding provided to each state. Unfortunately (or fortunately( , the states' HMS departments have significant discretion relative to how it spends it grant dollars, and understandably so as we all realize state EP needs may vary depending upon a multitude of issues such as unlikely or likely disasters. However, in our opinion, this area, while incredibly useful in most incident responses, still lacks direction as to the true needs of the state in the event of a EP event. We also recognize that some states are in tune with its needs, while others wait to revise its plans only after an EP event. This is negligent, unresponsive, and all too prevalent in our opinion. Thanks for the opportunity to represent a educated observation