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U.S. Department of Health and Human Services

Integration With Other Tiers

An important function of the Tier 2 coalition is to integrate community medical assets with non-medical response organizations in the jurisdiction. This is accomplished through a Tier 2 liaison function. Having one liaison to represent the collective interests of HCOs (Tier 2) at the jurisdiction (Tier 3) level enables non-medical response assets to more easily interface with and understand the concerns of the healthcare community. If the Tier 2 coalition covers multiple local jurisdictions, a Tier 2 liaison should be assigned to each Tier 3 incident command post or EOC (as indicated) to represent the coalition's interests.

Depending on specific incident circumstances, Tier 2 coordination with the following agencies might be considered:

  • EMS—tactical and strategic issues may be addressed through formal liaison with EMS. For example, Tier 2 may provide frequent status reports to EMS with each HCO's up-to-date receiving capacity. This promotes a more equitable distribution of patients by accounting for patient walk-ins, of which EMS transport officers might otherwise be unaware. At a strategic level, the Tier 2 liaison could have important input into action planning occurring within EMS.
  • Public Health—presenting HCO concerns in a single, organized format to public health promotes a more timely response. This association is mutually beneficial because patient numbers, symptoms, or other patient-related information that is collected and formatted in a standardized manner by Tier 2 can be invaluable to public health epidemiological investigations.
  • Law Enforcement—specific police support may be requested, or law enforcement may be alerted when their activities affect HCO operations (e.g., road closures that limit staff access to HCOs).
  • Public Works—this is important in the event that loss of a specific utility affects HCO operations.
  • Others—this may include the public school system, fire service/ HAZMAT, military, national guard, or others as indicated by incident circumstances.

To promote an organized response system, the Tier 2 liaison is best assigned to the local EOC (a MACC for Tier 3) or to the jurisdictional incident command post (Tier 3), depending on the incident. In a primarily non-medical event, the Tier 2 liaison will likely integrate at the EOC; in a major medical event, integration should occur within the jurisdiction's ICS (see Figure 4-1). If a jurisdiction operates using principles outlined in the next chapter, representatives from all of the just-listed agencies would be present and available to work with the Tier 2 liaison.

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  • This page last reviewed: February 14, 2012