Sirens wail as ambulances deliver more patients to the makeshift decontamination site set up outside the hospital's emergency department entrance. Medics and hospital staffers race to triage the new patients. It's a nightmare scenario that everyone prays never happens, but you have to be prepared to face. And, that's exactly what these medics, nurses, doctors and other specialists are doing: Training at FEMA's Center for Domestic Preparedness (CDP) for a scenario they hope they never have to face.

In March 2012, the CDP, located in Anniston, Ala., conducted its first Integrated Capstone Event (ICE). The ICE is a unique training approach that allows the CDP to combine multiple courses in a single end-of-course exercise. ICE events may include students from ten different disciplines ranging from law enforcement to healthcare to interact, communicate, and respond to a full-impact mass casualty incident.

Over the past few years, the CDP has identified professional groups from single organizations and/or regions that want specific training to meet organizational shortfalls, meet certification requirements, or spike improvements. To further enhance the learning environment, the CDP has crafted smaller versions of ICE, mini ICEs, that are tailored to the needs of a cohort, but include students from only one or two courses. The most recent mini ICE trained students from two healthcare courses-Healthcare Leadership (HCL) and Hospital Emergency Response Training (HERT) for Mass Casualty Incidents. Students from the HERT course integrated with the HCL course during the exercise.

"I attended with three other coworkers. When organizations send multiple employees to courses that include the ICE component, staffs are immersed in a dynamic multi-disciplinary learning environment that is typically not achieved by exercises at our home institutions," said J.T. Flick, emergency manager for Westchester Medical Center in Valhalla, N.Y. "Not only does it provide consistent training environments and material, but it also is a great team building opportunity for staff that typically has little interaction."

"The CDP will conduct full-scale ICE events quarterly and offer mini ICE scenarios throughout the year," said Denis Campeau, the CDP's Director of Training and Education. "Both ICE versions provide a training experience unlike a typical exercise and allow emergency responders to mix with colleagues from other agencies."

This ICE utilized the CDP's Noble Training Facility (NTF). More than 17,000 healthcare professionals have received NTF training since the hospital joined CDP training in early 2007. The NTF is the nation's only hospital facility dedicated solely to preparing the healthcare, public health, and environmental health communities for mass casualty events.

"The Integrated Capstone Event [ICE] combines multiple courses in a final culminating exercise that promotes an interdisciplinary response to a mass casualty incident," said Mallory Lowe, ICE development lead at the CDP. "The mini ICE provides opportunities for jurisdictions and organizations to exercise multiple elements together. Additionally, we can adapt the mini ICE to the jurisdiction's training needs and desired exercise objectives."

"The mini ICE was very beneficial. I'm walking away from this experience with a tremendous awareness of how -response agencies and their emergency responders come together," said Richard Hilton, administrator and CEO at OCH Regional Medical Center, in Starkeville, Miss. "The ICE training demonstrates the need to work jointly, having the ability to communicate with all branches of response and meet the community's emergency safety needs. Healthcare plays a critical role in mass casualty response. Understanding what resources and assets are available and the speed in which these are received only improves the ability for delivery of life saving quality care."

ICE, regardless of size, challenges responders in a complex all-hazards environment to include initial call-out, scene size up, rescue, decontamination, pre-hospital treatment, crime scene management, evidence collection, and hospital response. ICE scenarios focus on the foundations of CDP training?incident management, mass casualty response, and emergency response to a catastrophic natural disaster or terrorist act. CDP training for state, local, and tribal responders is fully funded by the Federal Emergency Management Agency (FEMA), a component of the U.S. Department of Homeland Security.