Ninety six healthcare professionals from across New Hampshire made the trip south to train at the CDP the week of Nov. 16.

They divided up, taking one of three courses, based on their skill sets: the Healthcare Leadership for Mass Casualty Incidents (HCL); Hospital Emergency Response Training for Mass Casualty Incidents (HERT); and Emergency Medical Operations for CBRNE Incidents (EMO).

"This was New Hampshire Week [at the CDP], which allowed us to achieve consistency amongst all of our hospitals," said Mike Melody, the director of Safety and Emergency Preparedness for Concord Hospital in Concord, N.H. Melody, who took the HERT course that week, brought along 10 Concord Hospital colleagues to CDP training. "There are 26 hospitals in the state and a large number of them were represented down here that week. As an emergency preparedness committee, we work with the hospital association. We are trying to achieve consistency among all those hospitals so that everybody is doing everything the same way, as much as possible."

Concord Hospital is a 295-bed facility that supports 21 towns and cities in the area in and around Concord. Not only is it the only trauma center in the area, it's the only hospital in the area. He and his staff of four cover safety and fire safety for the hospital.

Some of the hazards that Melody and his colleagues face in Concord include hazardous material incidents from train or truck accidents, as well as industrial metal works. They also have to contend with nor'easters and ice storms that have wiped out power in some areas for a week or more, he said. Concord also has a NASCAR racetrack, but the crowd size is nothing compared to the Talladega Superspeedway that's located a mere 25 miles from the CDP, he said.

For Jim Alexander, the emergency management coordinator at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., the challenges he faces are somewhat different. His is the only academic medical center in the state. The center provides trauma center care and tertiary care. Alexander and his Incident Command team have been activated six times in the past year alone and not always for the "usual incidents and accidents," he said.

One activation was in response to the Oct. 5 Amtrak train wreck in Northfield, N.H., about 50 miles from Lebanon. The train carrying 98 passengers and four crew members hit rocks that had fallen onto the track, causing the train's locomotive and a passenger car to slide down an embankment and derailing three other cars.

While the Dartmouth-Hitchcock staff stood ready, only seven people were injured in the wreck. "Ultimately, they didn't send us many patients," Alexander said.

Water - or lack thereof - had a much bigger impact on the Dartmouth-Hitchcock Incident Command team. The medical center's water supply became contaminated. For two and a half days, the hospital staff had to come up with alternate water system for surgery, drinking, bathing and cleaning.

"The only thing we could use the contaminated water for was flushing the toilets and steam heating," Alexander said.

One of the major challenges for Alexander and his team was how to provide clean water or other cleaning supplies for the 50 surgeries performed at the center each day. Thanks to innovative ideas, like using other cleaning supplies, the center didn't have to reschedule any of the surgeries.

That's one of the reasons Alexander said continuous training is important.

"When we train at the CDP, we learn about emerging threats. It makes you think outside of your box," he said.

For this most recent visit to the CDP, Alexander took the HCL course and he brought along 20 members of the center's Incident Command team.

"I brought a sampling of the 35 team members: Incident Commanders, [Emergency Department] nurses and logistics chiefs," he said. "It's great team building.

"We got to deal with things we haven't dealt with before. Our people got to work with hospital members from other [N.H.] hospitals," Alexander said. "No matter what the size of your facility is, you need the other hospitals. Any time you get to work with community partners, you're stronger."

The New Hampshire students finished their respective classes on Thursday. On Friday, they put their newly minted training to the test during the Integrated Capstone Event or ICE. The ICE combines multiple courses in a final culminating exercise that promotes an interdisciplinary response to a mass casualty incident. During the ICE, the students were challenged with realistic scenarios in which role players, human patient simulators and mannequins portrayed survivors of a mass casualty incident.

The exercise was carried out in various training venues including the CDP's indoor street scene, subway and the Noble Training Facility, the only hospital in the nation dedicated to training hospital and healthcare professionals in disaster preparedness and response.

"It's just cool that we have a hospital that we can train in," Alexander said. "Very rarely can we bring someone in, decontaminate them, triage them and do the whole gamut. We can't train like that at our center. We have real emergencies. Training at the CDP is a great team-building experience. I think everyone should avail themselves of the opportunity."

Melody echoed Alexander's comments. "It's an amazing facility," he said. "[The instructors] have the ability to tailor the training for the real world that we will be able to use. They have so much experience and a great ability to present. They do a phenomenal job of keeping it lighthearted, keeping it so that we can relate. They almost make it so that we don't even know we're learning, but you learn from what they say because it's so powerful."