Dr. Jarrett makes the point that integration among all medical assets in the community is a necessary step toward increasing response capacity and capability. We fully support this concept. Too often, disparate local health care organizations are not planning collaboratively for a coordinated, community-wide emergency response. Health care and response organizations expect to work together during an emergency but do not necessarily share plans or have a commonly understood framework for coordination under the urgency and uncertainty of a rapidly evolving incident, and major problems result. For example, during Hurricane Wilma, several hospitals had transportation agreements with the same ambulance companies, which became overwhelmed with requests for services (1).

As Dr. Jarrett suggests, physicians in private practice have a vital role in maintaining local access to care and preventing unnecessary influx of patients to hospitals. Accomplishing collaborative planning and drills, such as those undertaken by the Richmond County Medical Society, is important to prepare for an effective response. This planning group is similar to the emerging model of the "health care coalition" for emergency preparedness planning and response. The health care coalition is composed of health care facilities and other health and medical assets that form a single functional entity to maximize medical surge capacity and capability in a defined geographic area. It coordinates the mitigation, preparedness, response, and recovery actions of medical and health providers; facilitates mutual aid support; and serves as a unified platform for medical input to jurisdictional authorities (2).

The health care coalition is part of a tiered response-management system for integrating medical and health resources during large-scale emergencies. The federal Health Resources and Services Administration recently incorporated this tiered model into its Guidance for the National Bioterrorism Hospital Preparedness Program (3). This management framework describes a process for interfacing medical and health resources with widening levels of responders from the individual health care organization (tier 1) through the health care coalition (tier 2) to local (tier 3), state (tier 4), interstate (tier 5), and federal (tier 6) levels.

Dr. Jarrett suggests that physician leadership should drive this type of integration of resources. We disagree that common physician credentials make physicians the only uniquely qualified leaders for the initiative. Interested physicians should move beyond currently disjointed "disaster medicine" concepts to understand "medical emergency management" (4), with the scientific and professional qualifications for developing and managing complex systems. Understanding these concepts and principles will become even more important as the National Incident Management System (5) standardizes terminology and concepts across response disciplines and across the United States.