Medical Surge Capacity Workshop Summary (2010) / Chapter Skim
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Appendix D: Surge Medical Response Capability: What Is It? How Do We Get It? How Do We Know When We Have It?
Appendix D: Surge Medical Response Capability: What Is It? How Do We Get It? How Do We Know When We Have It?
Pages 99-112
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From page 99... ...
The nation's track record in planning for, funding, and achieving even minimally adequate disaster surge response capabilities within the medical community is woefully deficient. This paper offers eight transformational requirements the country should embrace in order to develop essential capabilities.
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From page 100... ...
Due to the rarity of the events and the lack of a mechanism to gather data in real-time, this expertise is usually based on experience rather than the more normal evidence-based approaches to medical decision making. The difficulty of designing a national strategy for medical surge capacity in disasters, much less the operational and tactical planning, is in evidence by the failure to produce such a strategy irrespective of the numbers of papers in the literature on the subject over this decade.
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From page 101... ...
HHS has tended to think more in terms of systems, including people and consumable resources like medicines and supplies, and is much more apt to talk about surge capability in terms of "public health." Both agencies work together through the DHS Health Sector Coordinating Council and Government Coordinating Council, for which HHS is the "lead sector-specific agency." Still, the issues around medical surge capacity cannot be managed by the federal government in a vacuum. The federal government is wholly dependent on the commitment and investment of the owners and deliverers of health care in the private sector and state and local governments.
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From page 102... ...
There is considerable attention being paid to definitions around levels of surge capability. Some experts advocate the terms "daily surge" and "disaster surge."3 Others use the capacity levels "conventional," "contingency," and "crisis" as subsets of overall surge capacity.4 These definitions have operational significance and must be linked to planning and exercises in order to be meaningful.
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From page 103... ...
To use the biological event scenarios as an example, a release of Bacillus anthracis spores using conventional agricultural technology in a densely populated city with 8 million people may result in exposure of over 2 million, approximately a quarter million of whom would contract pulmonary anthrax without post-exposure prophylaxis. For the Yersinia pestis scenario, it's a million people ill with pneumonic plague.
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From page 104... ...
Although it is a very useful planning tool to make requirements more granular, the Hospital Surge Model should be linked to other models developed by the federal government to characterize biological events and validated for smaller population centers. All personnel involved in medical response to disasters must have planning and exercising built into their job descriptions, and hospitals must do it as part of regular operations.
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From page 105... ...
Even if standards did exist, compliance with the standards may be very difficult given the absence of or the distributed nature of the necessary capacity data, no mandated reporting requirements of capacity, and few real-time resource tracking tools. Healthcare system preparedness standards would also need to be individualized to different types of medical facilities, recognizing differences in the size and density of a hospital's catchment area, space capacity, and the differences in the threats to their locales (e.g., terrorist risk levels, geological faults, hurricane risks)
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From page 106... ...
Healthcare systems can better compete with other sectors for homeland security grant funding when specific requirements are known. The HHS Hospital Preparedness Program would finally have targets to meet, rather than the more random
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From page 107... ...
. COSTS AND PAYMENT Improving the status quo in medical preparedness, including provision for reasonable surge medical response capability, will require significant investment.
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From page 108... ...
Even if the average initial investment is a modest $1 million, it would exceed the entire homeland security grant funding (approximately $4 billion) and the HHS Hospital Preparedness Program (about $400 million)
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From page 109... ...
Requirement #8: The Secretaries of HHS and DHS must issue a requirement for the federal government to invest in achieving an adequate standard of surge medical response capability, and the Administration must propose the necessary funding mechanisms as part of the President's next budget.
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From page 110... ...
U.S. Department of Homeland Security, Federal Emergency Management Agency.
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From page 111... ...
111 APPENDIX D 17. Joint Commission on Accreditation of Healthcare Organizations.
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