Health and Medical Surge Capacity

1. Draft for discussion only.  This document is not for general distribution and has not been approved by any agency or entity.No further / external distribution is authorized

2. Health and Medical Surge Capacity Draft Part I: Concept of Operations

3. Surge Capacity • Patient care (includes EMS & private healthcare) • Epidemiologic investigation • Risk communication (coordination with PIOs) • Mass prophylaxis or vaccination (coordination of local health department plans ) • Mass fatality management (medical examiners) • Other activities (hospice, facilities) • (To completed later) behavioral health

4. The Process • Based on previous work, including the COG “Planning Guidance for Health System Response to a Bioevent” (9/6/01) and other plans (State Health Plans, Federal Plans) • This team was appointed by the SPG to create a surge plan • Led by State Health Departments with active Local and Federal participation. Invited participation from all sectors of health and medical arena

5. So far… • Focused on tri-”State” and multi-jurdistionals system linkages with medical partners • At each level of event –description of how medical information is evaluated, and by whom • Description of how medical hypothesis generated, and what officials are involved • Analysis of information gathered and disseminated methods

6. Now… • The states have developed detailed systems and solicit, evaluate and support input from local responders and partners • Limited distribution for comments until April 29 • To read the full document, visit: www.MWCOG.org/committee/committee/default.asp?COMMITTEE_ID=182 and select Documents • Submit comments to health@mwcog.org

7. The Players • 3 “states” • 5 Virginia Counties • 3 Maryland Counties* • 40 hospitals • Assorted Cities • Seat of Federal Government • Independent Healthcare Providers • NCR Health Information Group • Representatives of Hospice, Private Practice Medicine, and Other Medical Partners • Representatives of the State and local EMS

8. Purpose • Coordinate the emergency response activities of the health care systems which make up the National Capitol Region during a natural or man-made catastrophic event • The next edition will incorporate progress on the interoperability grant

9. The Health Information Group Does NOT • Replace, supersede or dictate the response of sovereign jurisdictions • Drill down to implementation level standards and benchmarks

10. The Health Information Group Does • Pull decision makers together • Facilitate communication, and • Facilitate coordination of decision making

11. Health Information Group Info shared Coordination by State/District Health Directors Info shared Info shared

12. Response System • Tiered system • Based on US HHS handbook (Medical Surge Capacity and capability august 2004) • Adapted to fit the NCR conditions

13. 6 Tiers • Management of Individual Healthcare Assets – focus on local events • Management of Healthcare Coalition – when an event affects more than one jurisdiction • Jurisdictional Incident Management • Management of State Response • Interstate Regional Management Coordination – when the entire region is affected • Federal support to state and jurisdiction management – national emergency

14. Public Health • A government function • Provide and where appropriate, coordinate: • Planning • Assessment • Direct medical care where none other exists • Assurance that appropriate health care services are being provided • State/District Health Directors coordinate the response to public health emergencies • Public health is woefully understaffed (about 2,000 in NCR)

15. “State” Systems • Each “state” system is unique, but in all cases a large part of the legal public health responsibility is primarily at the state level rather than at the local jurisdictional level • Many decisions are made at the state level • The federal government communicates and coordinates through state health departments

16. Private Health Care • Where most medical care occurs • Willing partners with public health • Operate independently under standards of care. • Often first to report emerging disease or problem • Major concern is surge capacity and capability: beds, equipment, supplies, medications, space and staff, and ability to meet specialized needs (burns, pediatrics, etc.)

17. Emergency Medical Services detained descriptions covered in EMS-ESF • Scene triage • Scene treatment • Transportation • Inter-facility transport (when possible) • Scene management • Certain patient care supplies • Coordination of definitive care resources • Support to health care system • Documentation of patient care records

18. Behavioral Health • This section to be developed by behavioral health surge committee • Normal reaction to an abnormal situation--provide information and assistance • Serious reactions --provide treatment

19. Medical Examiners • Identify deceased • Examine deceased • Provide services for the dead and their families • Each state will follow own plan • Memoranda of understanding being developed

20. Coordinated With • US DHHS Medical Surge Capacity and Capability • NIMS • NRP • 15 scenarios • Additional tools, standards and guides as they become available

21. Next • Final sign off from state health departments • Present to SPG • Provide hard copies and/or CD versions to EOCs and partners • Post partial version on open website? • Part 2: benchmarking and gap analysis • Develop plans to fill the gaps