No Vacancy: Healthcare Surge Capacity in Disasters

Presentation Transcript

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’
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’

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

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)

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

HRSAGrant

Minnesota

Local

Public

Health

Regions

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

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 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

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

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

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

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