Imagine, at the height of a hurricane or other natural disaster, having to evacuate 110 nursing home patients by ambulance--two at a time! The number of round-trips and the time it would take to make them is staggering.

That was the situation for one EMS agency on the Gulf Coast in Mississippi following Hurricane Katrina in 2005, says Jim Craig, director of the Mississippi State Department of Health (MSDH) Office of Health Protection. "It took a lot of coordination and a lot of units to move those residents, and that was at a time when the general population was also being evacuated and hundreds more were coming in from New Orleans," he says.

Hopefully, that problem has been solved since the MSDH partnered with the Mississippi State Department of Education, individual school districts and several county emergency management agencies in a program called "AmbuBus," where school buses are converted to ambulances with room for up to 18 stretchers, medical equipment and eight medical personnel.

"We first learned about them at a conference for emergency preparedness, where we met people from other states that had also faced significant challenges with having enough ambulances to move patients out of healthcare facilities during Hurricane Katrina," says Craig. "In reviewing several of the healthcare facilities' operating plans, we found that a lot of them were relying on the same resource to move their patients, so it was obvious we needed some flexibility and additional resources at both the local and state level. Immediately following the conference, we decided to look for federal funding, and both Alabama and Mississippi were successful in securing funding through the Assistant Secretary of Preparedness and Response (ASPAR) at the Department of Health and Human Services."

Using a quick installation kit from Chantilly, VA-based < a href="http://firstlinetech.com/index.html"target="_blank"First Line Technology, LLC, school districts can convert a school bus into ambulance-style transportation in about two hours.

"The conversion kit consists of the beams and I-bars that can be placed into the bus to secure the litters securely and safely," says Craig. "The gases and medical equipment are added after installation. Almost 50% of Mississippi's ambulance services are hospital-based, so a lot of times the county hospitals provide the equipment and staffing. Most districts are using a 44-passenger bus, which gives them maximum use of the system. In the larger cities that have mass transit, the city buses can also be used."

Rather than having to convert the buses back to their original purpose, almost every school district has what they call "ready reserves" in case a bus breaks down or is in an accident, and those are being converted to AmbuBuses, says Craig.

"Having the ability to leave the units in the buses is great for the EMS community, because if there's a mass casualty-type incident, those units will already be on the lot, configured and ready to respond," he says. "The EMS Bureau here at MSDH played a large part in figuring out where some of the best deployment strategies would be, and we work with licensed ambulances throughout the state--especially in counties where these units will be placed--to ensure they're incorporated into the overall county emergency and mass casualty plans."

As part of the national Emergency Mutual Aid Compact (EMAC), Mississippi would make these resources available to neighboring states if the need arose, says Craig, but the units would obviously remain in the state if there was a widespread threat like a hurricane.

"The FEMA Ambulance Contract was enacted last year during Hurricane Gustav to support Mississippi with evacuations, and we were fortunate enough to get the lion's share of the resources they brought in, but it doesn't happen that way every time. Hurricanes may affect five or six states along the coast, and the federal resources are somewhat finite. Having the AmbuBus program will help us leverage locally some additional resources to help evacuate facilities."

In times of disaster, leveraging of resources is critical in EMS, says Craig.

"If you deplete all your resources during a mass casualty incident to transport patients out of the area, there will be challenges for the whole community, so having the EMAC agreements and the AmbuBuses is great. In Mississippi, we hope this is just the beginning of this process. We'd identified some counties that were ready to receive these products, and there are now other counties that would like to have buses outfitted. We're hoping to receive additional funding so we can continue this project in the future."