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Enhancing Medical Surge Capacity

Kevin Yeskey, MD Principal Deputy

ASPR April 11, 2018

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21st Century: An Increasingly Complex & Dangerous World

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ASPR’s Purpose: Unity of Command

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ASPR’s Mission

Save Lives and Protect

Americans from 21st Century

Health Security Threats

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ASPR’s Priorities: Building Readiness for 21st Century Threats

Strong Leadership

Regional Disaster Health Response

System

Medical Countermeasures

Enterprise

Public Health Security Capacity

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Why do we need a new approach?

•  Casualty estimates for 21st Century threats (and some old threats) far exceed the capacity and capability of the current healthcare system

•  Healthcare preparedness and response is fragmented and uncoordinated across jurisdictions §  Hospitals don’t routinely plan, train, or exercise together §  Communications during disasters are incomplete §  Situational awareness of health care operating status is challenging

•  State access to federal health care teams and equipment is limited in non-Stafford Act events

•  NDMS and HPP require updating to meet current challenges

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Existing Healthcare Preparedness Activities

•  CMS Emergency Preparedness Rule (effective November 2017) §  Risk assessment and emergency planning §  Policies and procedures §  Communications plan §  Training and testing

•  Hospital Preparedness Program §  Development of Coalitions

ü  2 or more hospitals ü  Public health ü  Emergency management ü  EMS

§  Issuance of Capabilities Guidance 2017-2022 ü  Develop health care coalitions ü  Response coordination ü  Continuity of service delivery ü  Medical Surge

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Key Elements of a Potential Regional Disaster Health Response System

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Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

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Building Regional Surge Capacity

Region

State

State

Coalition

Coalition

Coalition

Coalition

Trauma Systems

Burn / Pediatric / Infectious Disease

Radiation / Nuclear

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Enhance Health Care Coalitions

Health Care

Coalition

Health Care

Coalition

Trau

ma

/ Bu

rn C

ente

rs

EMS

Public

Health

Blood Banks Clinical Labs

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Improve Regional Coordination

Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

•  Regional Structure §  Sharing of resources across jurisdictions

Ø  Medical EMAC §  Common plans, procedures, and policies §  Placement of federal resources within the region

Ø  Deployment of resources by state governor §  Localized centers of excellence that can

provide expertise for complicated injuries/illnesses

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Expand Response Partners

•  Responsive §  Expand the capacity and capabilities of health care system

Ø  Expand NDMS hospital membership to all hospitals Ø  Hospital sponsored Disaster Medical Assistance Teams (DMAT) in each state

v  Increases response team capacity by ~100% v  Increases care capability

§  Using telemedicine and mobile teams to provide subject matter expertise across the system

§  Engagement of EMS §  Better engagement of VA and DoD

Ø  VA sponsored teams, training §  Training of civilian community

Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

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Enhance Awareness

•  Situational Awareness §  Collecting and sharing information on a daily basis §  Developing essential elements of information for

operational decision-making §  Regional and state-level operations centers to

collect and analyze data §  Using databases to assess population health

demographics in affected areas to inform response

Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

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Ensure Readiness to Respond

•  Focus on readiness §  Readiness standards

Ø  Training in chemical, biological, radiological, nuclear, and explosives and in Incident Command System principles

Ø  Standardized protocols, procedures, policies §  Readiness exercises evaluated by ASPR §  Designation as a “Response-Ready” coalition

Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

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Improve Federal Programs

•  Modernization of National Disaster Medical System (NDMS) §  Better-trained teams §  Hospital-sponsored teams §  Incorporation of EMS §  Increase number of NDMS hospitals

•  Integrate the Medical Reserve Corps •  Update HPP

§  Direct funding to entities other than state health departments

§  Use of risk-based formulas Regional Disaster Health

Response System

Resourced

Ready

Aware

Responsive

Regional

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Questions?