The CDP often receives feedback from students who have put their training to the test following a disaster. First-time CDP student, Leslie Irwin, didn't wait for a disaster to hit to give the CDP feedback on how taking a CDP course was a significant experience for her.

Irwin, the vice president of Fort Sanders Regional Medical Center and the administrator of Patricia Neal Rehabilitation Hospital in Knoxville, Tenn., took the Healthcare Leadership for Mass Casualty Incidents and participated in the Integrated Capstone Event in September.

Irwin's hospital is part of Covenant Health, a healthcare system that includes nine acute-care hospitals and more than 10,000 employees that provides healthcare for more than 20 counties across Tennessee. She, along with nine others from Covenant Health, spent Monday through Thursday in the HCL class, a course that exposes healthcare professionals to the dynamics involved in the decision-making processes during an all-hazards disaster involving mass casualties. The course uses a combination of lecture and exercises to provide responders and receivers foundational information on which to base critical decisions during the fast-paced final exercise.

Then, on Friday, the HCL students teamed up with students from the Hospital Emergency Response for Mass Casualty Incidents to participate in the ICE, a student-led exercise that puts the students' newly learned skills to the test in response to a mass casualty incident that is exacerbated by some sort of hazardous material contamination.

"I believe that a disaster affecting a community is not an 'if it happens' but 'when it happens,' said Irwin, a key leader in a 500-plus bed hospital. "I am a firm believer that regular and ongoing disaster response drills are critical to maintaining continuous readiness for these types of situations. And treat the drill like the real thing! The key to an effective response is a team of individuals who are trained, confident and who have full trust in the other members of the team to execute the plan in the most effective way possible."

Irwin was able to continue to build those trusting relationships during her training. In addition to her colleagues from Covenant, she was also joined by 20 other members of the Knox/East Tennessee Healthcare Coalition who attended CDP training that week.

Irwin said her instructors emphasized the need to continuously drill and to train all staff, not just senior leaders on mass casualty response. She also experienced first-hand the importance of team building during the ICE.

"My role in treating the drill like the real thing is a huge change for me. My clinical team were so 'in the moment' for the ICE event, that I forgot it was a drill!" she said. "We came together as a team, one that completely trusted each other.

"Clear and concise communication can be taught, but trusted communication is the key! A team that works together and trusts each other fully is not to be taken lightly," Irwin said. "Senior leaders must be aware of this as we are moving staff around every day, every shift, in fact, to make our numbers work. We must consider the lost efficiencies when we disrupt a team that has developed this high level of trust among its members."

Irwin learned about CDP training from her hospital's safety officer, Robert Laney. Laney had taken CDP training some years before and was returning to the CDP for a refresher.

"I have participated on many occasions in the Command Center during disaster drills at my hospital and I was interested in learning more about hospital leadership in these disaster situations," Irwin said. "When the opportunity arose, I jumped at the chance to travel to the CDP for the hospital leadership training."

The Fort Sanders Regional Medical Center in Knoxville is located next to the University of Tennessee campus, home to nearly 30,000 students. On Saturdays in the fall, the football stadium on campus holds over 102,000 paying attendees. There are nearby chemical factories, railroad lines, interstate highways and - of course - the beautiful Tennessee River with its commercial and recreational traffic. Multiple nuclear power plants and the Oak Ridge National Laboratory are located nearby, she said.

"There are some significant similarities between my hospital location and the ICE event [we participated in]," Irwin said.

Irwin left the CDP with a different perspective on Incident Command operations than she had when she first arrived at the CDP.

"I am changed as a result of this experience. The educational/technical benefits to me were significant, and the instructors are without equal in my opinion," she said. "[Instructor] Rick [Bearden] has convinced me that, as senior leaders, we do bring value to the Incident Command Center, but that there are others in the organization better suited to leading the incident command. I believe this, now, as I know there are others in my organization better suited and trained than I am.

"I respect so much your decision to place me as a member of the clinical leadership team during the exercises," Irwin said. "I have come away with an incredibly elevated level of respect for my floor staff and I am making a concerted effort to let them know that!"

Continued training in mass casualty response and other emergency response is not only important, it is critical for healthcare leaders, Irwin said.

"When a mass casualty or other disaster event occurs, responses by healthcare and other emergency personnel must be finely tuned and nearly automatic," she said. "I believe all personnel involved in the emergency do need to think through and execute the response, but there is little time to pull the policy and procedure manuals off the shelf and search through the policies for what actions to take.

"Hospital leaders will definitely benefit from the comprehensive training at the CDP, but don't stop at the executive- or even leadership-levels. Front-line staff need and will certainly benefit from at least some training in emergency response. After all, they are involved in the disaster response, as well as the leaders of the organization," Irwin said.