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Enhancing Medical Surge Capacity
Kevin Yeskey, MD Principal Deputy
ASPR April 11, 2018
2 Saving Lives. Protecting Americans.
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
16 Saving Lives. Protecting Americans.
Questions?
