EIIP Virtual Forum Presentation — January 10, 2007

The National Alliance for Training Health Care
for Emergency Response (NATHCER)

James L. Paturas, EMTP, CHS-IV, SEM
System Manager
Yale New Haven Center for Emergency Preparedness and Disaster Response

Avagene Moore
EIIP Moderator

The following version of the transcript has been edited for easier reading and comprehension. A raw, unedited transcript is available from our archives. See our home page at http://www.emforum.org

[Welcome / Introduction]

Avagene Moore: Welcome to the EIIP Virtual Forum and Happy New Year to all! We are pleased to see each of you here today! Our topic today is the "National Alliance for Training Health Care for Emergency Response (NATHCER)." This effort is led by the Yale New Haven Center for Emergency Preparedness and Disaster Response, part of the Yale New Haven Health System (YNHHS).

As background for our topic, the Yale New Haven Health Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has been awarded more than $2 million in federal funding for two significant national initiatives. The two initiatives are the National Alliance for Training Health Care for Emergency Response (NATHCER) and the National Center for Integrated Civilian-Military Medical Response and Homeland Defense.

It is my pleasure to introduce our guest speaker today, James L. Paturas, System Manager for the Yale New Haven Center for Emergency Preparedness and Disaster Response. Jim has thirty years of experience in hospitals and health care, and has served as author, editor and contributor on twenty-six medical texts and publications with a primary focus on emergency medicine and disaster preparedness.

He is also a member of the International Association of Emergency Managers (IAEM) and has successfully completed Certification in Homeland Security IV from the American Board for Certification in Homeland Security. The Yale New Haven Health System is an EIIP Partner so we have known Jim for some time and greatly appreciate his time and effort today. If you have not read the background page, I urge you to do so after our session today to learn more about our speaker's expertise and experience.

We welcome you to the EIIP Virtual Forum, Jim. I now turn the floor to you for your formal remarks.


Jim Paturas: On behalf of the Yale New Haven Center for Emergency Preparedness and Disaster Response and the Emergency Information Infrastructure Partnership I would like to thank you for taking the time be with us today on the EM Forum.

The YNH-CEPDR National Alliance for Training HealthCare for Emergency Response (NATHCER) (pronounced nâ' chür) will utilize the successful elements of its HRSA-funded New England Partnership for Healthcare Emergency Response Education and Training program (NEPHERET) and leverage its national partnerships and collaborations in order to develop, pilot and evaluate a nationwide education and training program for the healthcare delivery workforce.

The goal of the NATHCER national education model and pilot project is to demonstrate the ability to utilize and adapt the Yale New Haven Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) regional approach to emergency preparedness education and training for healthcare delivery professionals as a nationwide strategy.

The NATHCER project will develop, pilot test and evaluate a training program available for community-based healthcare providers in the nation to better prepare them for responding to a large-scale public health emergency or mass casualty event.

The project will also develop an implementation plan to deliver the program nationally after the pilot year. This model is based on the YNH-CEPDR BTCDP-funded New England Partnership for Healthcare Emergency Response Education and Training (NEPHERET), which has successfully delivered emergency preparedness and response education and training to more than 22,000 healthcare workers.

The NATHCER project will demonstrate that the innovative NEPHERET model employed in New England is scalable, portable, replicable, adaptable and modifiable as a nationwide delivery strategy, can be customized for regional uniqueness and addresses multiple healthcare delivery disciplines and types of organizations.

Key to successful implementation in New England has been the development and utilization of a strong network of local, state and regional partners who have engaged target audiences and provided insight into local/regional uniqueness. YNH-CEPDR is using this same networking strategy for this national model.


As mentioned previously, the NATHCER project will be scalable, adaptable, modifiable, replicable and implementable. It will draw on lessons learned from the New England program and YNH-CEPDR national education and training programs and focus on the delivery and distribution of courses rather than on course development.

The target audiences will be healthcare delivery workers in any healthcare delivery setting, including community-based providers and organizations. As it does in New England and elsewhere, YNH-CEPDR will provide courses based on (1) the competencies needed for critical tasks in the Target Capabilities List (TCL) and the clinical competencies defined by national groups and organizations such as the Columbia University School of Nursing and Association of Teachers of Preventive Medicine and (2) local and regional requirements derived from needs assessments and local and regional uniqueness.

The NATHCER project will utilize YNH-CEPDR partners in the ten FEMA regions across the country to (1) leverage their expertise and leadership, (2) identify and engage additional local stakeholders, (3) deliver education and training that is consistent with national priorities and addresses local/regional issues and (4) develop sustainability for the program.

Based on the enthusiastic reception it has had in New England and elsewhere in the nation, YNH-CEPDR expects to deliver courses to 6,000 pilot site individuals across the ten FEMA regions. We also anticipate that an additional 2,000-3,000 individuals outside of the targeted pilot sites will hear about and take advantage of the YNH-CEPDR learning management system (LMS) and complete courses.

Previous Experience

YNH-CEPDR has extensive experience and success with delivering emergency preparedness education and training to more than 60,000 healthcare delivery workers in a variety of settings including acute care hospitals, community health centers, nursing homes, school-based health centers, community practices and emergency medical services.

All YNH-CEPDR education and training programs are aligned with the Target Capabilities List and competencies identified by national professional associations in support of the development of consistent expectations and levels of role-specific performance regardless of the organization or jurisdiction in which the training is provided.

The YNH-CEPDR approach of engaging local and regional stakeholders in modifying courses to address regional and audience uniqueness combined with the availability of its courses in multiple delivery modalities has been the key to the utilization of its courses by healthcare workers and organizations across Connecticut, New England and the nation.

YNH-CEPDR addresses the resource limitations faced by healthcare institutions today by compressing or "chunking" courses into manageable blocks of time, typically an hour or less per module, and delivering knowledge-based components using distance learning technology, allowing busy healthcare professionals to take courses at their convenience without a significant time commitment.

Where possible, federal requirements such as NIMS, regulations set by agencies such as OSHA and standards set by organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are incorporated into YNH-CEPDR courses to maximize the benefit to targeted learners. The courses that will be piloted as part of this program, EM 103 with NIMS and EM 120, are examples of how YNH-CEPDR has applied these course development strategies to address the needs of its target audiences.

During the past year, YNH-CEPDR has used this same approach to deliver emergency preparedness training to more than 22,000 healthcare delivery workers in New England through its HRSA BTCDP program. It has drawn on this experience in developing NATHCER as a national model program.


NATHCER objectives are consistent with the HRSA guidance for this supplemental grant, the YNH-CEPDR objectives for the FY 2006 application and Healthy People 2010. Based on the HRSA directive to "demonstrate the ability to develop, pilot test, and evaluate a training program for all community-based healthcare providers in the nation."

Objective 1: Develop a plan to deliver the YNH-CEPDR regional education and training program nationwide.

Objective 2: Pilot-test the feasibility of the YNH-CEPDR national model approach and demonstrate YNH-CEPDR's capability to implement the strategy.

Objective 3: Evaluate the effectiveness of the national model program and its applicability and suitability as a national strategy.

Objective 4: Develop a national implementation plan, identifying lessons learned and recommending strategies for a nationwide education and training program.

The NATHCER objectives focus on the national implementation of the education and training program being developed and delivered on an ongoing basis in New England. The New England objectives are incorporated into the national strategy and address specific aspects of program development and delivery:

(1) Staying current and consistent with the National Response Plan, the Interim National Preparedness Goal and the updated Target Capabilities List and Measures (TCL).

(2) Documenting and incorporating national competencies into YNH-CEPDR courses.

(3) Prioritizing delivery based on all-hazards needs assessments.

(4) Utilizing blended learning.

(5) Implementing distance learning strategies.

(6) Strengthening education and training partnerships.

(7) Delivering education and training that address the emergency preparedness needs and local and regional uniqueness of the healthcare delivery workforce.

(8) Delivering programs that address at-risk populations (children, the elderly, etc.).

(9) Implementing an evaluation process that assesses educational outcomes, the educational program and the evaluation process itself.

NATHCER will utilize the products and the processes of the New England program to jump-start the national delivery of emergency preparedness and response education and training and reach large numbers of target audience learners efficiently and effectively with courses that address the awareness, intermediate and advanced level needs.


NATHCER will pilot two of YNH-CEPDR's awareness-level courses in the ten FEMA regions to demonstrate its ability to deliver and evaluate training that meets TCL capabilities and other national standards for healthcare delivery workers, can be customized to address local/regional uniqueness and provides practical information that can be applied by learners in NIMS-compliant drills or exercises. The pilot will also demonstrate YNH-CEPDR's ability to engage partners in NATHCER and utilize their resources and leadership to conduct a nationwide education and training program.

The piloted courses include the NIMS-compliant and approved Introduction to Emergency Management 103 (EM 103 with NIMS) in eight FEMA regions and the Occupational Safety and Health Administration (OSHA) compliant Best Practices for the Protection of Hospital-Based First Receivers (EM 120) in four FEMA regions.

EM 103 with NIMS was approved by the NIC and meets the NIMS objectives for IS 100: An Introduction to ICS, IS 700: An Introduction to the National Incident Management System and parts of IS 800: Introduction to the National Response Plan for healthcare delivery organizations as described in the document NIMS: National Standard Curriculum Training Development Guidance, October 2005. It was chosen for the pilot because it is NIMS-compliant, can be broadly disseminated to a diverse learner community using the distance learning modalities described below and can be customized for local/regional uniqueness.

EM 120 meets the awareness-level training requirements of OSHA and provides information on hazardous substances and the risks associated with them as well as procedures needed to ensure the safety of healthcare workers and patients during a disaster or emergency. It was selected for the pilot because it can be broadly disseminated through distance learning modalities and can be evaluated using drills and exercises.

While the pilot focuses on EM 103 and EM 120, which address a subset of the competencies identified by the Columbia University School of Nursing and Association of Teachers of Preventive Medicine Clinician Competencies, YNH-CEPDR offers a series of courses that together address all these competencies.

Delivery Methods

Delivery methods will include use of the YNH-CEPDR LMS as well as other distance learning methods such as CD-ROM and VHS tape to support a consistent training approach and broad knowledge-based course dissemination. These methods will be supplemented by a train-the-trainer approach to develop a cadre of trainers across the nation who can deliver educational programs including skill-based training that builds hands-on capabilities needed for disaster response.

Facilitator toolkits will support ongoing delivery of educational programs, enhance local trainer performance and learners' educational experience. These toolkits contain more than 100 pages of instruction, interactive activities, session questions, a student guide, student evaluation forms, other course evaluation forms and post tests as well as CD-ROM and VHS tape narrated versions of the targeted course.


As you can all understand, initiating a project like this comes with its challenges. The challenges and resolutions described relate specifically to implementation and satisfactory completion of the proposed national model project.

Building project momentum. With only twelve months to demonstrate the viability of a national education and training delivery strategy, NATHCER has begun the implementation activities immediately. YNH-CEPDR has leveraged existing partnerships in each of the ten FEMA regions to identify organizations that are ready to start the project at once and are eager to pilot and implement the identified course. YNH-CEPDR has identified additional organizations with interest in participating at this level.

Maintaining existing and building new partnerships. NATHCER success is dependent on the active involvement of each of its partners. YNH-CEPDR has hired an Education and Training Coordinator (ETC) to manage existing partner relationships, coordinate meetings with additional stakeholders and potential participants in each region, facilitate evaluation activities and serve as a conduit for communication among NATHCER partners.

Moving NATHCER from a pilot program to full implementation. Expanding a regional program, even one as successful as NEPHERET, to encompass the entire nation is a substantial undertaking. A key component of the program evaluation will be the identification of unique regional obstacles and the development of concrete, realistic interventions to overcome those obstacles by the NATHCER staff and the National Advisory Board (NAB). YNH-CEPDR was successful previously when it adapted its Connecticut approach to deliver education and training and expanded it for the entire New England region. Anticipating similar success with its national pilot, YNH-CEPDR staff and NATHCER partners will begin identifying and meeting with additional stakeholders and organizations of influence in each FEMA region to discuss the NATHCER program and approach during the pilot period. Lessons learned regionally and nationally from the pilot sites will be integrated into ongoing and future NATHCER activities.

Educating healthcare workers from a wide variety of healthcare delivery professions. NATHCER will focus on delivering programs that address the unique needs of varied disciplines in diverse work settings. Partnering with organizations representing many disciplines and using distance learning technology will be key strategies to resolving this challenge.


Our greatest strength and assets are the excellent partnerships we have developed over these past five years. As previously mentioned, YNH-CEPDR will deliver its national model program through its network of partners and collaborators organized around the ten FEMA regions. A pilot will be conducted in each region. NATHCER partners represent diverse healthcare delivery organizations including hospitals, healthcare systems, community health centers, emergency medical services, community medical providers and a mental health institute. They also include state departments of health and academic institutions.

Many partners focus on the delivery of community healthcare and at-risk populations. NATHCER programs will be provided to all of these organization types with an emphasis on community health centers, clinics and hospitals. The disciplines that will be trained through NATHCER include community and hospital-based physicians, nurses, allied health professionals, security and other administrative and support staff, mental health professionals including psychologists and social workers and emergency medical services providers.


With the strong emphasis on being able to validate what we do does help to make a difference, the evaluation component of this project is critically important. NATHCER evaluation practices will adhere to the parameters of instructional systems design representing an enhanced Kirkpatrick’s Model by (1) asking learners and subject matter experts about their reaction to courses and materials including overall quality, appropriateness and relevance (2) verifying that all programs have attainable learning objectives that result in measurable outcomes (3) using drills and exercises to verify that desired behavior (skills, knowledge and attitudes) has been learned through courses and other related materials and can be transferred from the classroom into the workplace and (4) providing ongoing evaluation after drills and exercises to critique results and link performance to education and training programs.

Using this model, training provided nationally will be evaluated across five key program components that encompass all aspects of NATHCER including: course content, delivery method and knowledge acquisition, retention and application. The evaluation tools themselves will also be assessed.

It is anticipated that evaluation outcomes will demonstrate significant improvement in training-related learning and performance, indicating the healthcare delivery workforce is more prepared to respond to public health threats and other emergencies related to the Columbia/ATPM competencies and the healthcare-related capabilities identified by the TCL. These results will be shared as a successful program that can be replicated elsewhere throughout the nation.


An essential element for developing an integrated preparation and response system is to build an education and training program that provides consistent, coordinated, cross-disciplinary training for the "target audiences" and the leaders of the public and private organizations that deploy them. Key is to identify, educate and train them regarding their job-specific roles as they relate to one another in providing an integrated medical surge response aligned with national criteria. Through this NATHCER project, YNH-CEPDR and its partners will deliver pragmatic, consistent, scalable and adaptable medical training to the target audiences and foster the integration required for a systematic approach to building medical capability based on national criteria.

Contact Information

If anyone wishes to contact me directly, here is the information required to do so:

Jim Paturas
System Manager
Yale New Haven Center for Emergency Preparedness and Disaster Response

(203) 688-3224
[email protected]

One Church Street, New Haven, CT 06510


That concludes my formal remarks. I await any questions and now turn you back to our Moderator.

Avagene Moore: Thanks for your overview of NATHCER, Jim. We will now turn to questions from our audience.

[Audience Questions & Answers]

Joe Adams: How much will this cost per offering?

Jim Paturas: We calculated our costs based on the number of learners and it will average to about$100/learner. [Subsequently clarified via email, this is an estimated development cost - there are no student fees for participating partner institutions.]

Robert Crutchfield: You speak of "partners." Can you tell us more about how partners become a part of your effort?

Jim Paturas: When we began to identify the key partners for this project we first reviewed the types of organizations (e.g., hospital, community health center, EMS, etc.). We then looked at the various FEMA regions and tried to gauge who we already had developed some form of relationship with. Next came the partner’s ability to complete the various deliverables. Some of the partners came from existing personal relationships that members of the YNH-CEPDR had developed in our current or past lives. We are always looking to develop new partnerships. As I mentioned in the previous discussion, part of our success comes directly from these relationships. I think we all know that none of us can go it alone.

Amy Sebring: Jim, for those that complete training, will you offer continuing education credits and/or a certificate?

Jim Paturas: Yes, continuing education credits are included. At times that requires that we work with the state or local CME agency depending on the medical credential.

Robert Crutchfield: Where are you in the "pilot year" of this project?

Jim Paturas: We have completed the first round of face-to-face meetings with the partners. In fact, we are off to Arkansas next week for another meeting. Part of the team is in MN today. The next step is to begin the introduction of the courses and development of the web portals for those partners. This allows them to use a web-based approach that looks and feels like their own organization.

Avagene Moore: Jim, how is the pilot promoted in the regions and across the country? Who does the promotion?

Jim Paturas: Most of the promotion to the primary partner organization is done through our office. The partner organization, if they choose, can then promote it regionally.

Amy Sebring: I would think this program could be very beneficial for health and medical volunteers in particular. Have you established any partnership or relationship with the Medical Reserve Corps program at the national level, or through the regions?

Jim Paturas: Yes, in fact we initiated the first Connecticut based MRC four years ago and now host the MRC statewide planning group, which includes six additional MRC throughout the state that are independent.

Robert Crutchfield: Are you going to use only courses you develop, or are you going to leverage some material that’s already out there? I'm thinking of some of the things I have taken at the CDC, emedicine.com, the NTPI, etc.

Jim Paturas: We will be using both approaches. When we first began the YNH-CEPDR project five years ago, we never intended to develop curriculum. What happened was that many of the excellent programs that were being developed were not able to be tailored to meet the needs, delivery approaches, and time constraints of busy healthcare workers. That led us to evaluate most of the programs that did exist, and to develop curriculum that was more scalable and able to be tailored to the needs of the various health care workers in the various types of health care organizations.

Debbie Kim: We have had questions regarding accreditation or certification of courses. Many individuals have taken courses at state levels, where there may be variation in content. Is there anyone "out there" who is addressing this?

Jim Paturas: One of the other projects that we have recently undertaken is a grant from the National Library of Medicine. Our intent is to develop a demonstration project around building a database of competencies that can be measured for effectiveness. As you all know this has, and continues to be an issue that affects all of us. The sense that we have is that many organizations are shying away from the word "certification." This requires very stringent criteria that can be validated and the science and research is not there yet.

Avagene Moore: Does NATHCER require or encourage all staff from various type health care facilities to train together or can they train by department or individually?

Jim Paturas: We do not encourage one way or the other. It is organization specific. On a personal note, I think that having a varied group can be beneficial.

Amy Sebring: I expect you are aware that EMI has recently released a NIMS awareness course for hospital staff. Have you had a chance yet to compare to your EM 103?

Jim Paturas: Yes we have. While the IS series are well done and I have taken many of them, our initial review indicates that they took the original 100 series course and added some terminology around HC. It also does not allow for any modification.

Cindy Eckert: Can you be paid with funds from HS grants?

Jim Paturas: We believe so. Based on how things are done here in CT, it would require the support of the state DHS representative.

Amy Sebring: I was particularly interested in the course "Mental Health Aspects of Emergencies and Disasters for Non-Mental Health Professionals" you have available through your Website. Is this one that the Center developed? I have not seen anything like it offered anywhere else.

Jim Paturas: The Mental Health course is a "primer" for those health care folks who need an update on some of the key elements around dealing with staff and patients who are experiencing mental health signs and syptoms. It was developed by members of our clinical faculty who are from the Yale School of Medicine. It is not a required program.


Avagene Moore: Thank you, Jim! We greatly appreciate your effort and time on our behalf. We wish you well as you continue your work with NATHCER and we will be watching your progress.

Jim Paturas: Thank you all for your participation.

Avagene Moore: Please stand by a moment while we make some quick announcements. If you are not currently on our mailing list, and would like to get program announcements and notices of transcript availability, please see the Subscribe link on our home page.

We are proud to announce our first new EIIP Partner of 2007. We welcome Homeland Security HQ. Please check out the Web site at http://www.homelandsecurityhq.us/. The official Point of Contact is Robert A. Crutchfield, President / Editor, of Homeland Security H. who is with us here today! If you are interested in becoming an EIIP Partner, please see the "Partnership for You" link on the EIIP Virtual Forum homepage http://www.emforum.org .

Again, the transcript of today's session will be posted later this afternoon and you will be able to access it from our home page. An announcement will also be sent to our Mail Lists when the transcript is available.

Thanks to everyone for participating today. We appreciate you, the audience!

Before you go, please help me show our appreciation to Jim for a fine job. The EIIP Virtual Forum is adjourned! Our next Virtual Forum session will be Wednesday January 24. We hope to see you back with us on a regular basis in 2007!