(6) Community Planning: Although providing the highest quality health care and patient treatment is the hospital's primary goal, hospitals should work with community emergency planners to determine its role in the community's response to mass casualty incidents. It is important that hospitals work with their communities and in particular with local and state health and radiation protection departments on community planning. However, the hospital may have to take the lead in creating a community plan for responding to such events. An important benefit of the overall planning process, however, is developing new partnerships and reaffirming long-standing ones. In time of crisis, these established relationships usually prove invaluable. (a) A hospital's responsibility in community planning and in responding to a mass casualty incident includes: (a-1) First and foremost, receiving and treating patients: To be successful, a hospital needs to develop strategies to treat a large number of patients during a mass casualty incident, including having easy access to medications. (Hospitals should consider entering into formal agreements with local hospitals and pharmacies as part of emergency planning and preparation). (a-2) Convening community partners if the health department has not already assumed this role. (a-3) Establishing adequate and redundant two-way communication with staff and partners; two-way radios can be used for this purpose. (a-4) Knowing how to avoid becoming a second-hand casualty (provide emergency power, etc). (a-5) Planning for a move if the hospital becomes dangerously contaminated. (a-6) Coordinating human resources including staff members, individual and organizational volunteers, and Good Samaritan health care professionals. The hospital should have liability and malpractice coverage that automatically covers this additional help. Furthermore, hospitals should address an emergency credentialing policy in advance (reference: May 2002 issue of the National Association of Medical Staff Services; Hospital Accreditation Standards, Joint Commission on Accreditation of Healthcare Organizations, 2002). (a-7) Controlling access to the facility. (a-8) Instituting a process to accurately record costs/expenses related to any mass casualty incident for future reference. (b) Helpful steps in developing an evidence-based Community Plan include: (b-1) Checking to see if a Community Plan already exists. If so, it should be revised if it does not include radiological incident-specific information. (b-2) Exploring evidence-based research and literature on radiation emergency response to stay abreast of new findings. (b-3) Determining who should be responsible for convening a community planning process; if there is none in place, the hospital should be the leader/convener. (b-4) Knowing the key state or regional partners. These will probably include state radiation protection and emergency response staff as well as state health inspectors. Initial players will be EMS, Police, Fire, emergency management agencies, and the health department. This group will expand quickly once the key organizations begin working together (additional partners might include public and private transportation companies, and expanding to other public and private ventures). Hospitals should include local businesses and non-profit volunteer organizations (rescue missions, churches, and food banks) as partners. (b-5) Having each partner conduct its own internal assessment and then share its findings with the partners. (b-6) Ensuring that all partners agree on and are familiar with the roles and responsibilities of each partner. (b-7) Conducting a community-wide risk assessment. (b-8) Developing an integrated training program and conducting at least one training exercise per year, as required by JCAHO. (b-9) Evaluating and reassessing the plan periodically. (c) Relationships are just as important as the plan content when it comes to ensuring successful implementation of the plan in response to a mass casualty incident. (d) Hospitals should make sure in the community planning process that there is a method in place for finding out which hospitals are still functioning, which ones need help, and which ones should not be receiving additional patients. (e) It is important to conduct post-incident debriefing and share these discoveries with hospitals in other communities. There is a need for a national institutionalized process to maximize the lessons we learn from disasters and to serve as a national clearinghouse of published and non-published research. However, hospitals may be reluctant to share information for fear of lawsuits; therefore, the research should be rendered anonymous prior to sharing. (f) The benefits of community planning go beyond joint planning to include other collaborative opportunities such as joint purchasing that will reduce costs. (g) Hospital medical personnel can use these basic guidelines in conjunction with their professional training and experience to aid in the effective and efficient treatment of victims. The purpose of the guidelines is not to address all of the possible emergency-related medical care that may be required by the hospital during such an emergency. Rather, the focus is on unique aspects of a nuclear or radiological event involving mass casualties for which the hospital's emergency department may not be adequately prepared or equipped. It should be noted, however, a successful response is dependent not only on written guidelines, but also on the communication of these guidelines along with partnerships between medical personnel and private, state, local and federal public health agencies and organizations