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No Vacancy: Healthcare Surge Capacity in Disasters. John L. Hick, MD MDH/HCMC July 22, 2004. Capacity vs. Capability. Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’

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no vacancy healthcare surge capacity in disasters

No Vacancy: Healthcare Surge Capacity in Disasters

John L. Hick, MD

MDH/HCMC

July 22, 2004

capacity vs capability
Capacity vs. Capability
  • Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’
  • Surge Capability – ‘the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions’
          • Barbera and Macintyre
different types of surge
Different types of ‘surge’
  • Unexpected vs. expected
  • Timeline and potential for secondary cases (anthrax vs. plague)
  • Static vs. dynamic
  • Triage / field treatment
  • Healthcare facility-based
  • Community-based
concepts and principles
Concepts and Principles
  • Standardization
    • Incident Management System
    • Multiagency Coordination System
    • Public Information Systems
    • Interoperability (eg: personnel and resource typing)
  • Scalability
  • Flexibility
  • Tiers of capacity (spillover to next level)
slide5

Tiers of Response – Patient Care

Federal Response

(Regional & National)

6th Tier

Federal Response

5th Tier

State / Interstate Coordination (MDH)

State A

State B

4th Tier

Coordination of Intrastate Regions (MDH)

Jurisdiction I

(PH/EM/Public Safety)

Jurisdiction II

(PH/EM/Public Safety)

3rd Tier

Jurisdiction Incident Management (County)

Medical Support

2nd Tier

Healthcare “Coalition” (Compact)

HCF A

HCF B

HCF C

Non-HCF Providers

1st Tier

Healthcare Facility

hrsa grant
HRSAGrant

Minnesota

Local

Public

Health

Regions

minnesota hospital resources
Minnesota Hospital Resources
  • 140 acute care hospitals
    • State total 16,414 licensed beds
    • Less than 50% of these operating
  • Loss of 36 hospitals, 3000 beds in past 20 yrs
  • Nearly half of MN hospitals are either ‘critical access’ or considering such designation
  • Staff shortages, particularly nursing staff
metropolitan hospital compact
Metropolitan Hospital Compact
  • Since April 9, 2002
  • 27 hospitals, approximately 4800 operating beds
  • 7 counties
  • Agreement provides for:
    • Staff and supply sharing
    • Staffing off-site facilities for first 48h
    • Communications, JPIC
    • Regional Hospital Resource Center (HCMC)
regional coordination
Regional Coordination
  • Regional Hospital Resource Center (RHRC)
    • Acts as ‘broker’ for patient transfers
    • Coordinates hospital response and requests within region
    • Represents hospital needs and issues to RCC
  • Regional Coordination Center (RCC or MAC)
    • Multi-agency coordination center for policy and strategic guidance
    • NO jurisdictional authority
    • Functions and scope determined by incident
hospital response
Hospital Response
  • At least 50% arrive self-referred
  • On average, 67% of patients in any given disaster are cared for at the hospital nearest the event (range 41-97%)
  • Redistribution from the hospital closest to the incident scene to other facilities may be as (or more) important than transport from the scene
facility based surge
Facility-based Surge
  • Usually can free up 15% of beds at a given facility
  • Get ‘em up and get ‘em out (ED, clinics)
  • Discharges and transfers (eg: nursing home)
  • Board patients in halls
  • Cancel elective procedures
  • Convert procedure/PACU areas to patient care
  • Accommodate vents on floor (or BVM or austere O2 flow powered ventilators)
  • Supply and staffing issues (72h ahead)
per 1000 patients injured
Per 1000 patients injured
  • 250 dead at scene
  • 750 seek medical care
    • 188 admitted
    • 47 to ICU
  • ‘Rule of 85/15%’ has applied to all disasters thus far inc NYC 9-11
community based surge
Community-Based Surge
  • Clinics
  • Homecare
  • Nursing homes
  • Procedure centers
  • Family-based care
  • Off-site hospitals (Acute Care Center)
  • Off-site clinics (Neighborhood Emergency Help Centers) (assessment and clinic level care)
  • Local / Regional referral / NDMS
potential alternative care sites
Aircraft hangers

Military facilities

Churches

National Guard armories

Community/recreation centers

Surgical centers / medical clinics

Convalescent care facilities

Sports facilities / stadiums

Fairgrounds

Trailers

Government buildings

Tents

Hotels/motels

Warehouses

Meeting halls

Potential Alternative Care Sites
factors to consider
Ability to lock down/Security

HVAC

Lab/specimen handling

Lighting

Laundry

Loading Dock

Equipment storage

Oxygen delivery capability

Waste disposal

Parking

Communications capability

Patient decon

Door size

Pharmacy areas

Electrical power with backup

Proximity to hospital

Family areas

Toilets/showers/waste

Food supply / prep area

Water supply

Wired for IT/Internet access

Factors to consider
off site hospital
Off-site hospital
  • Triage / admission criteria
  • Level of care – basic nursing, drip meds, IVs, NG feeds
  • Medications
  • Documentation / order management
  • Laboratory
  • Food / water / sanitary
  • Linen and medical waste handling
  • Oxygen?
personnel augmentation
Personnel Augmentation
  • Hospital personnel
  • Clinic personnel
  • Medical Reserve Corps
  • Non-clinical practice professionals
  • Retired professionals (eg: HC Medical Society)
  • Trainees in health professions
  • Ski patrol, civil air patrol, other service organizations
  • Lay public (CERT teams, etc)
  • Federal / interstate personnel
sample site19
Food

Restrooms

Staff rehab areas

Secure

HVAC system specs

Paging /messaging /radio

Power

Phone, T1 lines, etc.

City owned!

Sample Site
resources
Resources
  • Off-site matrix: www.denverhealth.org/bioterror/tools
  • MaHIM: www.gwu.edu/~icdrm
  • Model hospital planning: www.er1.org
  • Off-site facilities and community planning: www2.sbccom.army.mil/hld/bwirp/
  • Annals of Emergency Medicine www.mosby.com/aem ‘articles in press’ (left side)