Rapidly growing communities often outpace their medical treatment capacity; for patients requiring specialized care such as decontamination from biological or chemical materials exposure, delays in treatment place the patient and future medical providers at increase risk. Addressing this challenge, Center for Homeland Defense and Security (CHDS) Emergence 1901 alumna, Courtney Mayard, the Disaster Program Manager for Medical City Plano, Texas, applied the skills learned within the classroom to establish local decontamination teams scaled to fit the capabilities of north Texas medical providers. An April 2019 graduate of Emergence, Mayard utilized the lessons of the classroom, her previous experience as an Emergency Medical Technician (EMT), and a little help from a Facebook group discussion to identify this significant gap in emergency decontamination response within Medical City Plano (MCP) and the surrounding medical facilities.
In her role as Disaster Program Manager, Mayard oversees a 600 bed, Level I trauma center, two surgical centers, and a small, stand-alone emergency center. Early in her tenure, MCP faced two significant decontamination emergencies.
However, it was not until Mayard read through comments on a Facebook page for medical professionals discussing the topic of decontamination that she recognized both the lack of any scaled service availability and, more importantly, the resignation from most members that such services are untenable with small, local facilities. Through her personal experience and the collective responses from peers in the field, Mayard zeroed in on her Emergence project. Addressing current decontamination protocols, Mayard stated, “CDP [Center for Domestic Preparedness] provides excellent guidance for a Level I trauma center, however, things that apply for the Level I trauma center do not apply to the smaller hospitals or clinics.” Additionally, she commented, “For most small hospitals or facilities, the guidelines seemed too daunting and they often defer to the larger facilities or fire departments…however, in a mass casualty event, even these services may be overwhelmed.” Focused on finding a solution to her project, Mayard availed herself to the opportunity provided by Emergence and in the stories and testimonials of her classmates. “During that first week, I listened to the ideas of those in my cohort…and as I started to formulate an action plan, I utilized many of their [cohort members] lessons learned to develop my strategy for going forward,” Mayard stated.
The narrowed and focused Emergence project, combined with the skills developed in the classroom, allowed Mayard to brief the MCP Asst. Chief Operating Officer, MMs. Christina Roscoe, between in-residence program sessions. In reflecting upon the briefing, Mayard noted, “I think, to a certain extent, my limited experience (two-years with MCP) helped me in the brief…I used what I learned at Emergence without any preconceived notions of the project being doomed for failure…call it youthful optimism.” With overwhelming agency support, Mayard pursued additional information and expertise, coordinating with the five Level I trauma centers in the area, corporate assets from across the nation, as well as local fire departments. Collecting and synthesizing all the proposed guidelines, Mayard developed a scaled approach to decontamination procedures with utilizing available personnel and beds at each facility as the primary drivers. However, simply developing the processes and procedures proved to be only part of the challenge; implementing what Mayard heard termed “an unfunded mandate” provided the next series of challenges.
Discussing the implementation challenges, Mayard touched upon several themes common in organizational change initiatives, such as reluctance to adopt new processes and the limited sense of urgency for addressing the problem within some of the smaller facilities. She stated, “Although I was met with some expected skepticism and hesitancy, I had incorporate support for implementing the scaled operations over time to provide for an easier transition…for every individual that was somewhat negative, I probably had three that thought the plan was doable.” Increased acceptance and incorporation of the training and decontamination procedures are producing increased positive feedback including some real-world success stories with effective, local decontamination efforts. Additionally, and a secondary effect of her project, improved communication between organizations and facilities produced other benefits external to decontamination. Mayard commented, “We are much more open to sharing information and asking questions…where we would never ask such questions in the past.”
Throughout Emergence, Mayard absorbed the lessons of the instructors as well as her classmates. “I truly appreciated the broad, cross-discipline approach within the classroom…the different perspectives and stories really helped advance my project,” Mayard stated. As such, her ability to capitalize on the experiential diversity within the classroom continues to epitomize the participants within every CHDS program.