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Draft for discussion only.  Draft for discussion only.  This document is not for This document is not for general distribution and general distribution and

has not been approved by has not been approved by any agency or entity.any agency or entity.No further / external No further / external

distribution is authorizeddistribution is authorized

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Health and Medical Health and Medical Surge CapacitySurge Capacity

Part I: Concept of OperationsPart I: Concept of Operations

Draft

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Surge CapacitySurge Capacity Patient care (includes EMS & private healthcare)Patient care (includes EMS & private healthcare) Epidemiologic investigationEpidemiologic investigation Risk communication (coordination with PIOs)Risk communication (coordination with PIOs) Mass prophylaxis or vaccination (coordination of Mass prophylaxis or vaccination (coordination of

local health department plans )local health department plans ) Mass fatality management (medical examiners)Mass fatality management (medical examiners) Other activities (hospice, facilities)Other activities (hospice, facilities) (To completed later) behavioral health(To completed later) behavioral health

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The ProcessThe Process Based on previous work, including Based on previous work, including

the COG “Planning Guidance for the COG “Planning Guidance for Health System Response to a Health System Response to a Bioevent” (9/6/01) and other plans Bioevent” (9/6/01) and other plans (State Health Plans, Federal Plans)(State Health Plans, Federal Plans)

This team was appointed by the SPG This team was appointed by the SPG to create a surge planto create a surge plan

Led by State Health Departments Led by State Health Departments with active Local and Federal with active Local and Federal participation. Invited participation participation. Invited participation from all sectors of health and from all sectors of health and medical arenamedical arena

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So far…So far… Focused on tri-”State” and multi-Focused on tri-”State” and multi-

jurdistionals system linkages with medical jurdistionals system linkages with medical partnerspartners

At each level of event –description of how At each level of event –description of how medical information is evaluated, and by medical information is evaluated, and by whomwhom

Description of how medical hypothesis Description of how medical hypothesis generated, and what officials are involved generated, and what officials are involved

Analysis of information gathered and Analysis of information gathered and disseminated methodsdisseminated methods

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Now…Now… The states have developed detailed The states have developed detailed

systems and solicit, evaluate and systems and solicit, evaluate and support input from local responders and support input from local responders and partnerspartners

LimitedLimited distribution for comments until distribution for comments until April 29April 29

To read the full document, visit: To read the full document, visit: www.MWCOG.org/www.MWCOG.org/committee/committee/default.asp?COMMITTEEcommittee/committee/default.asp?COMMITTEE_ID=182_ID=182 and select Documents and select Documents

Submit comments to Submit comments to health@mwcog.orghealth@mwcog.org

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The PlayersThe Players 3 “states”3 “states” 5 Virginia Counties5 Virginia Counties 3 Maryland Counties*3 Maryland Counties* 40 hospitals40 hospitals Assorted CitiesAssorted Cities Seat of Federal GovernmentSeat of Federal Government Independent Healthcare ProvidersIndependent Healthcare Providers NCR Health Information GroupNCR Health Information Group Representatives of Hospice, Private Practice Representatives of Hospice, Private Practice

Medicine, and Other Medical PartnersMedicine, and Other Medical Partners Representatives of the State and local EMSRepresentatives of the State and local EMS

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PurposePurpose Coordinate the emergency response Coordinate the emergency response

activities of the health care systems activities of the health care systems which make up the National Capitol which make up the National Capitol Region during a natural or man-made Region during a natural or man-made catastrophic eventcatastrophic event

The next edition will incorporate The next edition will incorporate progress on the interoperability grant progress on the interoperability grant

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The Health Information Group The Health Information Group Does NOTDoes NOT

Replace, supersede or dictate the Replace, supersede or dictate the response of sovereign jurisdictionsresponse of sovereign jurisdictions

Drill down to implementation level Drill down to implementation level standards and benchmarksstandards and benchmarks

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The Health Information Group The Health Information Group DoesDoes

Pull decision makers togetherPull decision makers together Facilitate communication, and Facilitate communication, and Facilitate coordination of decision Facilitate coordination of decision

makingmaking

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NCR Public Health receives information from

traditional disease reporting, syndromic surveillance system, medical community,

researchers

State Epidemiology

receives information from

CDC, all state health departments,

traditional and syndromic

surveillance systems

Private practitioners,

hospitals, clinics Report via the traditional and

syndromic system, receive pertinent

information

EMS system receives and

reports emergency medical data, scene analysis and other

important indicators of health

Info

shar

ed

Health Information GroupHealth Information Group

Coordination by

State/District Health Directors

Info shared

Info shared

Info shared

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Response SystemResponse System Tiered systemTiered system Based on US HHS handbook (Medical Based on US HHS handbook (Medical

Surge Capacity and capability august Surge Capacity and capability august 2004)2004)

Adapted to fit the NCR conditionsAdapted to fit the NCR conditions

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6 Tiers6 Tiers Management of Individual Healthcare Management of Individual Healthcare

Assets – focus on local eventsAssets – focus on local events Management of Healthcare Coalition – when Management of Healthcare Coalition – when

an event affects more than one jurisdictionan event affects more than one jurisdiction Jurisdictional Incident ManagementJurisdictional Incident Management Management of State ResponseManagement of State Response Interstate Regional Management Interstate Regional Management

Coordination – when the entire region Coordination – when the entire region is affectedis affected

Federal support to state and jurisdiction Federal support to state and jurisdiction management – national emergencymanagement – national emergency

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Public HealthPublic Health A government functionA government function Provide and where appropriate, coordinate:Provide and where appropriate, coordinate:

– PlanningPlanning– AssessmentAssessment– Direct medical care Direct medical care where none other existswhere none other exists– Assurance that appropriate health care services Assurance that appropriate health care services

are being providedare being provided State/DistrictState/District Health Directors coordinate Health Directors coordinate

the response to public health emergenciesthe response to public health emergencies Public health is woefully understaffed Public health is woefully understaffed

(about 2,000 in NCR)(about 2,000 in NCR)

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““State” SystemsState” Systems Each “state” system is unique, but in Each “state” system is unique, but in

all cases a large part of the legal public all cases a large part of the legal public health responsibility is primarily at the health responsibility is primarily at the state level rather than at the local state level rather than at the local jurisdictional leveljurisdictional level

Many decisions are made at the state Many decisions are made at the state levellevel

The federal government communicates The federal government communicates and coordinates through state health and coordinates through state health departmentsdepartments

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Private Health CarePrivate Health Care Where most medical care occursWhere most medical care occurs Willing partners with public health Willing partners with public health Operate independently under standards of Operate independently under standards of

care.care. Often first to report emerging disease or Often first to report emerging disease or

problemproblem Major concern is surge capacity and capability: Major concern is surge capacity and capability:

beds, equipment, supplies, medications, space beds, equipment, supplies, medications, space and and staff,staff, and ability to meet specialized and ability to meet specialized needs (burns, pediatrics, etc.)needs (burns, pediatrics, etc.)

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Emergency Medical Services Emergency Medical Services detained descriptions covered detained descriptions covered

in EMS-ESF in EMS-ESF Scene triageScene triage Scene treatmentScene treatment TransportationTransportation Inter-facility transport (when possible) Inter-facility transport (when possible) Scene managementScene management Certain patient care suppliesCertain patient care supplies Coordination of definitive care resourcesCoordination of definitive care resources Support to health care systemSupport to health care system Documentation of patient care recordsDocumentation of patient care records

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Behavioral HealthBehavioral Health This section to be developed by This section to be developed by

behavioral health surge committeebehavioral health surge committee Normal reaction to an abnormal Normal reaction to an abnormal

situation--provide information and situation--provide information and assistanceassistance

Serious reactions --provide treatmentSerious reactions --provide treatment

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Medical ExaminersMedical Examiners Identify deceasedIdentify deceased Examine deceasedExamine deceased Provide services for the dead and Provide services for the dead and

their familiestheir families Each state will follow own planEach state will follow own plan Memoranda of understanding being Memoranda of understanding being

developeddeveloped

2020

Coordinated WithCoordinated With US DHHS Medical Surge Capacity and US DHHS Medical Surge Capacity and

CapabilityCapability NIMSNIMS NRPNRP 15 scenarios15 scenarios Additional tools, standards and Additional tools, standards and

guides as they become availableguides as they become available

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NextNext Final sign off from state health Final sign off from state health

departmentsdepartments Present to SPGPresent to SPG Provide hard copies and/or CD versions Provide hard copies and/or CD versions

to EOCs and partnersto EOCs and partners Post partial version on open website?Post partial version on open website? Part 2: benchmarking and gap analysisPart 2: benchmarking and gap analysis Develop plans to fill the gapsDevelop plans to fill the gaps