Several Kansas EMS directors saw the need for a specialized team after a portion of the state was hit by a powerful tornado. Napolitano said coordination of resources is vital during an incident, and planning is an important function.

"Each of us takes turn being the duty officer, which means you get the call and start things going. We're volunteers, and we've got things covered 24/7," he said.

When the directors decided to move forward with their idea, they conducted a needs assessment and earmarked funds. They surveyed EMS companies to determine if they were familiar with incident command, if they used triage tags and if so, how often; and whether they would be willing to respond or commit resources in the event of a major incident.

They also learned how many ambulances, squads and trained personnel were available as well as any specialized equipment.

MERG members -- the majority of whom are paramedics -- wrote their own SOPs. They also wear uniforms that set them aside from other responders.

All have attended multiple classes in incident command and NIMS.

"One thing we've told people from the beginning is that we're not going in to take over. We'll do what they want. If that's assume medical command, OK. If you want us to make coffee, we can do that too. We never, ever want to take over if they don't want us to," David said, adding that MERG members also have taken their turn on ambulances as well.

MERG was also activated a few years ago after an ice storm. After an incident, the team holds a critique. Personal relationships take a back seat during the sessions, David said.

Napolitano said he believes organizations understand MERG's role. "We've gone to many conferences and seminars over the years to explain what we do. They know everyone has to be on the same page."