The concept is really kind of like the Reese’s Peanut Butter Cup. We have the chocolate of the local health care coalitions, and we have the peanut butter of the Ebola experience, and how can you build on that to build a national system based on local health coalitions? The one thing I didn’t mention is where the trauma hospitals and the trauma system fits in. I believe that, quite frankly, the foundation of any kind of disaster system has to be made on what exists already with our local and the regional trauma systems. How do we build that out? Then, bake that cake and layer it with frosting that would be these highly specialized national capabilities like with infectious diseases or potential radiation or nuclear events. How do you build that national and regional expertise that would be supportive of the local trauma systems to respond to a variety of events?

RM: I like the idea of a regionalized disaster response, because centralizing often overwhelms a small group of resources. We’ve seen that with multiple events that have occurred. What’s interesting to me is that the infrastructure’s changing. Now we have a rapid growth of population-based resources that are distributed within the community, the urgent cares, the satellite emergency departments, and the emerging smart-sized hospitals. How would you best distribute those resources in a regionalized system?

RK: I think the key is that’s part of the coalition. That is really about integrating those kind of care systems as they evolve and as they mature to make sure they’re part of the conversation and part of the equation. When I was medical director in special operations down at Fort Bragg, I had 24 para-rescue men assigned to me. I was their medical director. What was transformational in their ability was not only their collaboration with their army and navy compatriots, but really the training and the opportunity for access to expert consultative support that took them to the next level.

How do we ensure that there’s training of our local providers? Emergency physicians’ educational role is vital in this thing, but what about the primary care physicians that are in that area? What about those other people who are very dependent on our emergency physicians, like our EMS providers, nurses, and physician assistants? There’s a great opportunity to provide training in disaster medical care that could be just-in-time or foundational. Those are the kinds of things that we’re looking to do that we think could be very transformational.