Transcript Augmenting Clinical Capacity in Disasters

No Vacancy: Healthcare
Surge Capacity in
Disasters
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)
State A
Jurisdiction I
(PH/EM/Public Safety)
State B
Jurisdiction II
(PH/EM/Public Safety)
Federal Response
6th Tier
State / Interstate
Coordination (MDH)
5th Tier
Coordination of Intrastate
Regions (MDH)
Jurisdiction Incident
Management (County)
Medical
Support
4th Tier
3rd Tier
nd Tier
2
Healthcare “Coalition” (Compact)
HCF A
HCF B
HCF C
Non-HCF
Providers
Healthcare Facility
1st Tier
HRSA
Grant
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
CommunityBased
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
Potential Alternative Care Sites







Aircraft hangers
Military facilities
Churches
National Guard armories
Community/recreation
centers
Surgical centers /
medical clinics
Convalescent care
facilities








Sports facilities /
stadiums
Fairgrounds
Trailers
Government buildings
Tents
Hotels/motels
Warehouses
Meeting halls
Factors to consider











Ability to lock down/Security
HVAC
Lab/specimen handling
Lighting
Laundry
Loading Dock
Equipment storage
Oxygen delivery capability
Waste disposal
Parking
Communications capability










Patient decon
Door size
Pharmacy areas
Electrical power with backup
Proximity to hospital
Family areas
Toilets/showers/waste
Food supply / prep area
Water supply
Wired for IT/Internet access
Off-site hospital








Triage / admission criteria
Level of care – basic nursing, drip meds, IVs,
NG feeds
Medications
Documentation / order management
Laboratory
Food / water / sanitary
Linen and medical waste handling
Oxygen?
Personnel Augmentation









Hospital personnel
Clinic personnel
Medical Reserve Corps
Non-clinical practice professionals
Retired professionals (eg: HC Medical Society)
Trainees in health professions
Ski patrol, civil air patrol, other service organizations
Lay public (CERT teams, etc)
Federal / interstate personnel
Sample Site
Sample Site









Food
Restrooms
Staff rehab areas
Secure
HVAC system specs
Paging /messaging
/radio
Power
Phone, T1 lines, etc.
City owned!
Resources





Off-site matrix:
www.denverhealth.org/bioterror/tools
MaHIM: www.gwu.edu/~icdrm
Model hospital planning: www.er1.org
Off-site facilities and community planning:
www2.sbccom.army.mil/hld/bwirp/
Annals of Emergency Medicine
www.mosby.com/aem ‘articles in press’ (left
side)