Key Focus Areas: CDC's recommendations are based on the following six focus areas: (1) Notification and Communication A. The key to a hospital's capacity to serve the critically ill is to recognize that a hospital is part of a community. It is important that hospitals work with their communities and in particular with local and state health and radiation protection departments on developing plans for notification and communication. The local hospital is an integral part of the community-wide system for emergency response and any existing community emergency response plans are a good place to begin. In this regard, hospitals should: (a) Understand community plans and resources and specifically: (a-1) Determine if there is an existing state or community plan. Consider how the hospital fits into this existing plan. Note that states with nuclear power plants have well-defined plans and an established hierarchy for notification and plan activation. (a-2) If there is no existing community plan, participate in the development of one. Include the state radiation protection or radiation control program (this program is usually housed within a state's public health, environmental control, or professional licensing agency) in the development of any community plans. (a-3) Utilize the resources available from FEMA as a means of locating both planning information and state emergency management agencies (www.fema.gov). Also take into consideration the many other organizations and entities that deal with emergency-related services during disasters, such as the National Disaster Medical System (www.oep-ndms.dhhs.gov/), the American Burn Association (www.ameriburn.org), Emergency Nurses Association, American College of Emergency Physicians, Society for Emergency Physician Assistants, and American Psychological Association's Disaster Response Network. (a-4) Use the community's Poison Control Centers as a resource (to find your local Poison Control Center. See: www.aapcc.org/findyour.htm). (a-5) Know that the radiological community has many recognized experts who can assist in response to plan activation. A good resource for expertise in radiation dose estimation would be a hospital medical physicist or health physicist. One might also find expertise in this area at the following internet sites: www.crcpd.org/contact.asp and www.hps1.org/aahp/members/members.htm. (a-6) Determine whether the hospital needs an Incident Command Center (ICC). One useful ICC model is the Hospital Emergency Incident Command Structure (HEICS) system used in California (www.emsa.ca.gov). (a-7) Assign and prepare staff in advance by: (b) Ensuring that roles and responsibilities are clearly defined. (c) Assigning a staff person, who is available all hours, responsible for making the proper notifications (externally and internally) regarding the hospital's response to the incident and ensuring they have an accurate and updated list of experts that the staff can contact for guidance. (d) Having back-ups for key officers, in case they are not available. Use existing resources to: (e) Regularly revise and update existing plans for radiological incidents. (f) Ensure that hospital personnel are familiar with the community's ICC and, specifically, who is responsible for what and how it will be established. Activate a plan that: (g) Uses a confirmed incident, suspicious incident, or expected incident as a trigger for the plan. (h) Is cautious about triggering emergency response. There may be graded responses, not just an all or none response. Putting unneeded "All Hazards" contingencies in place may result in slowing down delivery of everyday patient care. The HEICS system (referred to above) is designed for modular activation. (i) Considers adopting the concept of modular activation, so that parts of the disaster plan may be activated without activating the entire plan and causing major disruption, especially early on when it may be unclear how much of a disaster exists. (j) Establishes a strong link with the ICC during the disaster to determine exactly what is taking place. Know who is in charge of your community's ICC ahead of time