BORDERS Alert and Ready presents a national model for health emergency training

Marma Wilkie (second from right) and mock disaster victims (from left) Kelly Holmenn, Lisa Grafsgaard, and Heidi Blazer work with a mannequin during a BORDERS drill at Camp Grafton.  Wilkie is a social worker with Indian Health Services in Belcourt, N.D.  She received a master’s degree in social work from UND in 1993.

How can people in very rural areas like North Dakota get the training they need to respond quickly and effectively to a public health emergency, whether the result of a bioterrorist incident or a natural disaster?

This compelling question led Linda Olson, director of special projects and an associate professor in UND’s Office of Medical Education, and her colleagues to answer a call for proposals in 2002, as the federal government began to explore better ways to ensure Americans’ health and safety, especially in light of bioterrorism and other potential threats to national security.  As they began to formulate their ideas into a grant proposal to the Health Resources Services Administration, “We knew that it would take on a life of its own,” Olson said, “but it has taken a whole lot more work than anyone ever dreamed.”  Integral to the planning were James Hargreaves, an infectious disease specialist who serves as clinical director for the project, and Rick Vari, associate dean for medical education.

The team developed BORDERS (Biochemical Organic Radioactive Disaster Educational Response System), a program of multidisciplinary education and training which has, over the past two years, earned international recognition for North Dakota and the School of Medicine and Health Sciences.   

In 2003, UND was one of only 19 applicants — from a total of 104 — to receive funding.  Reviewers were impressed with the School’s unique focus on the international border with Canada and on American Indians, a significant minority population in the Northern Plains.

“No one else has invited in the American Indian community,” Olson said.  “That aspect of the proposal set BORDERS apart from others for favorable consideration.”

“In my opinion, BORDERS is setting the bar high on a national level for education and training, exercises and tabletop scenarios,” said P. K. Carlton, Jr., director of Texas’ Homeland Security Office and a retired lieutenant general of the U.S. Air Force. 

“Involving our northern neighbors in Canada is a special opportunity in this endeavor, and they have been involved from the start,” he added. “I have seen no other master plans laid out this clearly with definable goals and objectives. 

Linda Olson, associate professor and special projects director in the Office of Medical Education, is one of the team members who drafted the successful proposal to create the BORDERS emergency training program.

“I consider the BORDERS program as a model for the nation because they have laid out a superb plan and are following through,” he said.  “North Dakota and UND have taken the long view.”  

More than 3,500 North Dakotans (9,358 people nationwide) have received training through the BORDERS project, funded by an initial $2,025,080 grant from the Department of Health and Human Services.  The team hopes to reach 49,000 more people over the next three years if the current grant proposal is approved by the agency this year.  

The “students” of the program, which has evolved into BORDERS Alert and Ready, represent a variety of disciplines, including doctors, physician assistants, nurses, physical therapists, social workers, public health and safety personnel, emergency medical services, mental health professionals, hospital and nursing home administrators, hospital environmental services, and others.

“We have also expanded to offer training to other personnel — such as firefighters and police — and shown that we can meet their needs as well,” Olson noted.  The education is discipline-specific but also multidisciplinary.  Training is organized around these topics: chemical, biological, radiological (or nuclear) and disaster (explosive and natural), as well as psychological effects and MASS (Move, Assess, Sort and Send) triage (including incident command and legal aspects). 

Mock drill participants tour a portable decontamination facility.

The education is offered online through a highly sophisticated distance-learning program.  Anyone anywhere can obtain the education free online; only those seeking to obtain certification are charged a fee. 

“We had the opportunity to provide a model for training rural and underserved people,” Olson said.  “We couldn’t afford to go everywhere (to provide training).  We had to use the technology we had on hand.”  

As a means of reaching more participants, talks are in progress to offer educational programs through the Bio-Terrorism Wide Area Network, coordinated by the North Dakota Healthcare Association.

People may also participate in on-site events which test the students’ skill and knowledge in a simulated emergency situation, made as realistic and intensive as possible with “injured” victims, hysteria, mass confusion, noise and chaos.  About 125 students participated in such events in September 2004 and last June at Camp Grafton near Devils Lake.  BORDERS personnel also travel frequently to provide training to groups in hospitals and other facilities throughout the region.  

BORDERS personnel have received extraordinary praise and feedback for their training programs.  Typical of comments from participants in the on-site, experiential learning: “I think this training has been unbelievable; it’s been way more helpful than I’d expected it to be.  I’m learning all kinds of things that I think we should be doing as a community that we’re not doing, so I’m really glad to be here.”

The most satisfying result of her work with the project, Olson says, “is when people come up and tell us it’s the best training they’ve been to” and she reviews participants’ ratings of the program.  Using a scale of 1 to 5, with 1 being the highest, she says, “98 percent of the participants gave us 1’s for the June training program.  Some said their only regret was that more of their colleagues had not attended.”      

H. David Wilson, dean of the UND School of Medicine and Health Sciences, said, “We are very pleased and proud of our leadership role to ensure that health care and other professionals in North Dakota receive the training they need to best respond to disasters."