Public Health Emergency Public Health Emergency Preparedness: Surge Capacity Preparedness: Surge Capacity

IssuesIssues

Sally Phillips, RN, PhDSally Phillips, RN, PhD

AHRQ Objectives for theAHRQ Objectives for theHHS Strategic Framework HHS Strategic Framework

Develop and Assess:Develop and Assess: Alternative approaches to ensuring health care surge capacityAlternative approaches to ensuring health care surge capacity Models that address training and information needsModels that address training and information needs Alternative uses of information technology and electronic Alternative uses of information technology and electronic

communication networkscommunication networks Protocols and technologies to enhance interoperability among Protocols and technologies to enhance interoperability among

health care systemshealth care systems

BT/Public Health Emergency BT/Public Health Emergency Planning and Response ResearchPlanning and Response Research

Seed knowledge research projects

Miscellaneous tools and resources

Diversified body of knowledge

Similar but incompatible tools

Integrated multipurpose systems

2002 2006200520042003

Currentsituation

Desiredscenario

Critical mass ofcomplementary tools

Web-Based Tool: Emergency Web-Based Tool: Emergency Preparedness Resource Inventory Preparedness Resource Inventory

Emergency Preparedness Resource Inventory Emergency Preparedness Resource Inventory (EPRI)(EPRI) Web-based tool helps local, regional, or State planners Web-based tool helps local, regional, or State planners assemble an inventory of critical resources that would assemble an inventory of critical resources that would be useful in responding to public health emergenciesbe useful in responding to public health emergencies

Also includes implementation report, technical manual, Also includes implementation report, technical manual, and appendixand appendix

http://www.ahrq.gov/research/epri http://www.ahrq.gov/research/epri

Altered Standards of Care in Altered Standards of Care in Mass Casualty EventsMass Casualty Events

Report offers guidelines for officials on how to plan for Report offers guidelines for officials on how to plan for delivering health and medical care in a mass casualty delivering health and medical care in a mass casualty eventevent

Includes recommendations of an expert panel Includes recommendations of an expert panel convened by HHS’ AHRQ and the Office of Public convened by HHS’ AHRQ and the Office of Public Health Emergency Preparedness Health Emergency Preparedness

Available online: Available online: http://www.ahrq.gov/research/altstand/http://www.ahrq.gov/research/altstand/

Altered Standard of CareAltered Standard of CareRecommendationsRecommendations

Examine how current standards of care might need to Examine how current standards of care might need to be altered in a mass casualty situationbe altered in a mass casualty situation

Identify appropriate planning, guidance, and tools and Identify appropriate planning, guidance, and tools and related issues to ensure an effective health and related issues to ensure an effective health and medical care responsemedical care response

Recommend specific action steps to address the Recommend specific action steps to address the needs of Federal, State, regional, community, and needs of Federal, State, regional, community, and health systems plannershealth systems planners

Emergency Information Center Model: Emergency Information Center Model: Rocky Mountain Regional HEALTHRocky Mountain Regional HEALTH

Rocky Mountain Regional Rocky Mountain Regional HHealth ealth EEmergency mergency AAssistancessistance L Line and ine and TTriage riage HHub Model:ub Model:– Helps public health agencies and other first Helps public health agencies and other first

responders provide timely, accurate information responders provide timely, accurate information during a health emergencyduring a health emergency

– Follow up project: “Follow up project: “A Model for Voluntary Shelter-A Model for Voluntary Shelter-in-Place through Community Health Call in-Place through Community Health Call Centers”Centers”

Mass Casualty Response: Mass Casualty Response: Alternate Care Site SelectorAlternate Care Site Selector

Tool helps regional planners locate and rank potential alternative Tool helps regional planners locate and rank potential alternative sites during a bioterrorism or other public health emergencysites during a bioterrorism or other public health emergency

Recommendations for staff, supplies and equipment are included Recommendations for staff, supplies and equipment are included as appendices as appendices

Available as an Excel spreadsheetAvailable as an Excel spreadsheet

Included in report, Included in report, Rocky Mountain Regional Care Model for Rocky Mountain Regional Care Model for Bioterrorist EventsBioterrorist Events: : http://www.ahrq.gov/research/altsites.htmhttp://www.ahrq.gov/research/altsites.htm

Community-Based Mass Community-Based Mass Prophylaxis: A Planning Guide for Prophylaxis: A Planning Guide for

Public Health PreparednessPublic Health Preparedness Planning guide helps communities nationwide prepare Planning guide helps communities nationwide prepare

for vaccine and drug dispensing in the event of a for vaccine and drug dispensing in the event of a bioterrorism or other public health bioterrorism or other public health emergency:emergency:– Provides framework for understanding dispensing operationsProvides framework for understanding dispensing operations– Applies dispensing concepts to be run on the Applies dispensing concepts to be run on the

Bioterrorism and Epidemic Outbreak Response Bioterrorism and Epidemic Outbreak Response Model (BERM)Model (BERM)

– Discusses command and control framework for dispensing clinics Discusses command and control framework for dispensing clinics based on CDC’s National Incident Management Systembased on CDC’s National Incident Management System

Available in print (1-800-358-9295) or on the Web Available in print (1-800-358-9295) or on the Web (http://www.ahrq.gov/research/cbmprophyl/cbmpro.htm)(http://www.ahrq.gov/research/cbmprophyl/cbmpro.htm)

Planning and ResponsePlanning and Response

Bioterrorism and Epidemic Outbreak Response Model (BERM)Bioterrorism and Epidemic Outbreak Response Model (BERM)– Tool provides basis for Mass Prophylaxis Model calculations--change input Tool provides basis for Mass Prophylaxis Model calculations--change input

values at any time to observe effect on staffing, campaign length, and values at any time to observe effect on staffing, campaign length, and population coverage estimates (TRIPOD/NYC OEM/ NYCDHMH)population coverage estimates (TRIPOD/NYC OEM/ NYCDHMH)

Computer Staffing Model for Bioterrorism ResponseComputer Staffing Model for Bioterrorism Response– Computer model designed to give estimates of staff needed to operate a Computer model designed to give estimates of staff needed to operate a

mass prophylaxis center given specific population size and staff limitations mass prophylaxis center given specific population size and staff limitations of a jurisdiction--can be downloaded as spreadsheet or accessedof a jurisdiction--can be downloaded as spreadsheet or accessed on Web: on Web: http://www.ahrq.gov/research/biomodel.htmhttp://www.ahrq.gov/research/biomodel.htm

Regional Hospital Caseload Regional Hospital Caseload CalculatorCalculator

Computer model that uses published epidemiological Computer model that uses published epidemiological data on two well-know bioterrorist threats, data on two well-know bioterrorist threats, Bacillus Bacillus anthracisanthracis and and Yersinia pestisYersinia pestis, the causative agents of , the causative agents of inhalational anthrax and plague, to provide public inhalational anthrax and plague, to provide public health and emergency planners with estimates of the health and emergency planners with estimates of the number of exposed individuals who may develop number of exposed individuals who may develop symptomatic illness. symptomatic illness.

This model is unique in that it allows the user to This model is unique in that it allows the user to interactively evaluate the impact of both the timing interactively evaluate the impact of both the timing and size of mass prophylaxis campaigns on and size of mass prophylaxis campaigns on population outcomes and on potential hospital population outcomes and on potential hospital admission rates. admission rates.

Evidence-Based Tool: Evaluation of Evidence-Based Tool: Evaluation of Hospital Disaster DrillsHospital Disaster Drills

Helps hospitals to:Helps hospitals to:– Identify strengths and weaknesses in Identify strengths and weaknesses in

their responses during a disaster drilltheir responses during a disaster drill– Improve their ability to fulfill required Improve their ability to fulfill required

emergency management plansemergency management plans Based on need to:Based on need to:

– Plan drill objectivesPlan drill objectives– Train observersTrain observers– Document drill activitiesDocument drill activities– Debrief all participantsDebrief all participants

Available at: http://www.ahrq.gov/research/hospdrills.htmAvailable at: http://www.ahrq.gov/research/hospdrills.htm

Research Addressing Needs Research Addressing Needs of Childrenof Children

Pediatric Decontamination DVDPediatric Decontamination DVD AAP Pediatric Resource GuideAAP Pediatric Resource Guide Pediatric Protocols ( schools)Pediatric Protocols ( schools) Syndromic Surveillance for ChildrenSyndromic Surveillance for Children Consensus conference: Guidelines for Consensus conference: Guidelines for

Children and people with Disabilities Children and people with Disabilities

Mass Casualty Surge Mass Casualty Surge Capacity Response -05Capacity Response -05

Expanding Surge Capacity through Use of Former (Shuttered or Expanding Surge Capacity through Use of Former (Shuttered or Converted) Hospitals Converted) Hospitals

Standardized “Real Time” National Hospital Bed Availability and Standardized “Real Time” National Hospital Bed Availability and Patient Tracking System Patient Tracking System

Exploring the Special Needs and Potential Role of Nursing Homes in Exploring the Special Needs and Potential Role of Nursing Homes in Surge Capacity for Bioterrorism and Other Public Health Emergencies Surge Capacity for Bioterrorism and Other Public Health Emergencies

Health Care System Preparedness and Surge Capacity for Health Care System Preparedness and Surge Capacity for Bioterrorism and Public Health Emergencies: A Model for Regional Bioterrorism and Public Health Emergencies: A Model for Regional Hospital Surge CapacityHospital Surge Capacity

Hospital Bed Availability and Patient Hospital Bed Availability and Patient Tracking System (HAvBED)Tracking System (HAvBED)

Prototype “real-time” standardized data reporting toolPrototype “real-time” standardized data reporting tool– Enhance system/region’s ability to care for surge of Enhance system/region’s ability to care for surge of

patients from public health emergency (e.g., flu)patients from public health emergency (e.g., flu)– Provides timely reporting of bed status data in an Provides timely reporting of bed status data in an

emergency (includes GIS)emergency (includes GIS)

Nationwide scope: prototype participantsNationwide scope: prototype participants– Denver Health Medical CenterDenver Health Medical Center– Washington Hospital Capacity WebsiteWashington Hospital Capacity Website– EMSystem (Colorado, Milwakee, WI, San Antonio, TX)EMSystem (Colorado, Milwakee, WI, San Antonio, TX)– New York State HospitalsNew York State Hospitals– Other hospitalsOther hospitals

Currently on the AHRQ web site Currently on the AHRQ web site

Federal Integrated Federal Integrated System InitiativesSystem Initiatives

Standardized “Real Time” National Bed Availability Standardized “Real Time” National Bed Availability and Patient Tracking System- Prototypeand Patient Tracking System- Prototype

Integrated Patient Tracking/Locator ModelIntegrated Patient Tracking/Locator Model

Models and Tools for Mass Casualty Surge Models and Tools for Mass Casualty Surge RequirementsRequirements

National Mass Patient Movement, Regulating and National Mass Patient Movement, Regulating and Tracking SystemTracking System

BT/Public Health Emergency BT/Public Health Emergency Planning and Response ResearchPlanning and Response Research

Seed knowledge research projects

Miscellaneous tools and resources

Diversified body of knowledge

Similar but incompatible tools

Integrated multipurpose systems

2002 2006200520042003

Currentsituation

Desiredscenario

Critical mass ofcomplementary tools

Potential Research Potential Research Next StepsNext Steps

Modify the Surge Capacity modeling project to Modify the Surge Capacity modeling project to incorporate other high probability scenariosincorporate other high probability scenarios

Develop a model/tool to plan for recovery of Develop a model/tool to plan for recovery of the health care system after a public health the health care system after a public health emergency emergency

Develop a model for training and deployment Develop a model for training and deployment of mass casualty critical care response teams of mass casualty critical care response teams and primary care response teamsand primary care response teams

Field test and evaluate the shuttered hospital Field test and evaluate the shuttered hospital assessment tool ( Katrina)assessment tool ( Katrina)

Potential Research Potential Research Next StepsNext Steps

Modify existing models and tools based Modify existing models and tools based on field use and TCL/UTL/NRP/NIMSon field use and TCL/UTL/NRP/NIMS

Evidence based planning models and Evidence based planning models and tools for preparedness, response and tools for preparedness, response and recovery initiativesrecovery initiatives

Revise and develop models and tools for Revise and develop models and tools for Pandemic Flu Pandemic Flu

Research and develop strategies unique Research and develop strategies unique to children, and other vulnerable to children, and other vulnerable Populations.Populations.

Long Term VisionLong Term Vision

Merge disparate prototype systems into Merge disparate prototype systems into an interoperable national demonstration an interoperable national demonstration of an integrated planning and response of an integrated planning and response system for a public health emergency system for a public health emergency (e.g., BT, pandemic flu, SARS) (e.g., BT, pandemic flu, SARS)

Critical Infrastructure Data System for Critical Infrastructure Data System for Situational Awareness, Response and Situational Awareness, Response and Recovery Recovery

http://www.ahrq.gov/browse/bioterbr.htmhttp://www.ahrq.gov/browse/bioterbr.htm

For More InformationFor More Information

Contact: Sally Phillips, RN, PhDContact: Sally Phillips, RN, PhD

E-mail: sphillip@ahrq.govE-mail: sphillip@ahrq.gov