Planning for Medical Surge

Transcription

1 Planning for Medical Surge A step-by-step approach to tangible public health preparedness Bruce Binder, MPH, CEM Mike Ciraolo, RN, MS

2 Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure It encompasses the ability of the healthcare system to survive a hazard impact and maintain or rapidly recover operations that were compromised.

3 Medical Surge Partners Tier 1 - Individual Healthcare Institution Tier 2 - Healthcare Coalition Tier 3 - Jurisdiction Incident Management Tier 4 - State Response and Coordination of Intrastate Jurisdictions Tier 5 - Interstate Regional Management Coordination Tier 6 - Federal Support to State and Jurisdiction

4 Recipes for Disaster Staff turnover Loss of institutional knowledge lodged in key staff Scare resources Sense of irrelevance, disaster du jour, and funding-driven planning Disconnect between funding planning efforts, actual planning efforts, and local needs Siloed planning efforts Distraction by expensive gear acquisition efforts; buying stuff isn t planning Playing the surge whack-a-mole game

5 The surge whack-a-mole game The ugly problem: where do we accommodate the surge in the system The game: Revolving sequence of solutions, none of which address the surge The real problem: the game avoids hard truths and planning for real world solutions The hard truths: it won t be medical care as usual

6 Recipes for Success Completing key planning steps with tangible, documented results before staff leaves Engaged partners Pursue operational plans from the outset Surge planning is local Use a step-by-step approach to chunk the challenge into achievable goals

7 1 Set clear planning goals Numeric targets based on scenarios Pre-hospital Hospital Scenarios High-probability, low frequency events Jurisdictionally relevant HVA-driven scenarios Surge events transcend any sense of the routine It s not Friday night in the ER during flu season Not a typical MCI

8 2 Get one s house in order first Identify jurisdictions, roles, responsibilities, ICS structures Who owns surge planning? Lead agency for surge response? Are all the joint partners (EMS, public health, EOM) at the table? Ensure adequate internal training Engage internal (government) partners early Complete surge-related planning efforts MCI plans Mass fatality plans

9 One s house includes Bridge interjurisdictional gaps from the outset Vertically state, county, local Horizontally across response agencies Develop or solidify public health/medical infrastructure, policies and procedures information flow resource requesting mutual aid processes communication bed availability reporting

10 3 Engage external partners Healthcare facilities must be engaged Clinics SNFs/long-term care facilities Specialty units (surgery, endoscopy, dialysis centers) Hospitals to have their surge houses in order

11 Healthcare facility preparedness for surge means Internal surge plans in place and drilled ICS in place in healthcare facilities, including routine staff training Facilities prepared to receive and use volunteer health professionals Reciprocal evacuation and 1:1 mutual aid agreements with like facilities

12 4 Then develop the surge plan Beware of a plan to plan vs. a real, operational surge plan Use the best resources available Keep internal and external partners engaged via a planning coalition Get to tangible results: Concept of operations for surge response Draft documents

13 5 Develop corollary plans and programs Alternate care site plans ACS are a potential solution to surge, one arrow in the quiver but not the solution ESAR-VHP (Emergency System for Advance Registration of Volunteer Health Professionals) Medical Reserve Corps

14 6 Expensive equipment acquisitions efforts Equipment without plans or unified vision isn t a solution to surge! Area-wide patient tracking systems are nice (if they work), but not a solution to surge! Equipment such as alternate care site caches/trailers are crucial if there s an ACS plan which fits into a surge response

15 How? 7 Put it all into practice Set the bar for surge plan activation low so the entire surge system gets exercised frequently Activate the surge plan during a small MCI or during flu season Exercises & drills Why? Builds institutional knowledge and combats loss of knowledge through staff turnover Process improvement

16 QUESTIONS? For information, please contact: Michael Ciraolo, RN MS Ciraolo Consulting, LLC Bruce Binder, MPH, CEM Global Vision Consortium