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1: Introduction
Pages 11-40

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From page 11...
... . CSC planning is intended to help the emergency response system -- including emergency management, public health, behavioral health, emergency medical services (EMS)
From page 12...
... To gather stakeholder input, the current committee held an open meeting in January 2013. Panelists from different stakeholder perspectives were invited, including public health, emergency management, EMS, health care coalitions, home health, long-term care and nursing homes, behavioral health, specialty burn care, and information management.
From page 13...
... Chapter 3 provides the overarching framework for the toolkit and should be read first by everyone. Chapters 4 through 9 are customized for each component of the emergency response system: emergency management (Chapter 4)
From page 14...
... The scenarios also serve to help participants achieve an understanding of what the different components of the emergency response system would be facing during a catastrophic disaster and what they would be focused on, providing a necessary common picture to support discussions across these components. Scenario-based planning is the first component of the "hybrid planning approach" that is strongly advocated by the Federal Emergency Management Agency (FEMA)
From page 15...
... CONTINUUM OF CARE: CONVENTIONAL, CONTINGENCY, AND CRISIS Rather than focusing exclusively on the most extreme circumstances, the committee that authored the 2009 and 2012 reports, as well as the current committee, envision surge capacity as occurring along a continuum based on resource availability and demand for health care services. One end of this continuum is defined by conventional care, which describes services that are provided in health care organizations on a daily basis.
From page 16...
... A SYSTEMS APPROACH TO CATASTROPHIC DISASTER RESPONSE Successfully responding to a catastrophic disaster will require integrated planning, coordination, cooperation, and consultation of many response disciplines and agencies, including state and local governments, EMS, health care organizations, and health care providers in the community. The 2012 report developed a systems framework for catastrophic disaster response, which includes, but is not limited to, the development and implementation of CSC plans.6 This framework is illustrated in Figure 1-2; certain elements are discussed briefly below, but much greater detail is available in the 2012 report.7 In this framework, ethical considerations and the legal authority and environment form the foundation.
From page 17...
... used for patient care Staff Usual staff Staff extension (brief deferrals of non- Trained staff unavailable or called in and emergent service, supervision of broader unable to adequately care for utilized group of patients, change in responsibilities, volume of patients even with documentation, etc.) extension techniques Supplies Cached and Conservation, adaptation, and substitution Critical supplies lacking, usual supplies of supplies with occasional re-use of select possible reallocation of life used supplies sustaining resources Standard Usual care Functionally equivalent care Crisis standards of carea of care Normal operating Extreme operating conditions conditions Indicator(s)
From page 18...
... Education and information sharing are the cornerstones of the framework; together with the process of performance improvement, they support the key elements of CSC planning and enable midcourse corrections during the implementation of the framework. The response functions are performed by each of the five components of the emergency response system: hospitals and acute care, public health, out-of-hospital care, prehospital and emergency medical services (EMS)
From page 19...
... Emergency Management Because the successful implementation of CSC efforts requires full mobilization and participation of the entire emergency response system, local and state offices of emergency management can play an important role in serving as the conveners of subject matter experts and stakeholders responsible for the development of CSC plans. The 2012 report includes emergency management as a key component of the emergency response system, but the concepts presented in this section provide additional details beyond those included in that report.
From page 20...
... •  Ensure ESF-8 needs are appropriately prioritized and adequately resourced •  Assist in coordination of resource and human capital to support ESF-8 requirements •  Provide leadership and direction for incident action planning that occurs within ESF-8 •  Establish processes and procedures to ensure appropriate financial management and recovery of costs •  Support facilities, security, and logistics if needed for alternate care sites, and distribution and dispensing nodes for public health and medical equipment and supplies ESF-6 – Mass Care, Support the ability and maintain the lead role to provide mass care and sheltering Emergency Assistance, • Facilitate planning with local health departments and health care organizations on Housing, and Human shelter operations planning and response, including medical special needs shelters Services • Coordinate with health care organizations in conjunction with public health to assure that medical needs are being met for sheltered population • Coordinate with public health and health care organizations to assure that the reunification of families and households is facilitated by patient tracking mechanisms and occupant logs of shelters ESF-7 – Logistics Provide incident logistics planning, management, and sustainment capability Management and Resource • Provide resource support (supplies, contracting services, etc.) , including provision of Support water, sanitation, and backup electrical services to affected health care organizations • Provide support to alleviate identified supply chain issues related to public health and medical 20 CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS
From page 21...
... response Materials Response • Coordinate response needs with public health, EMS, and health care organizations to assure consistent approach to use of personal protective equipment and need for medical countermeasures • Provide decontamination support and washwater containment support for victim decontamination operations as requested by public safety agencies/health care facilities • Ensure establishment of perimeters when appropriate based on sampling or modeling Environmental short- and long-term cleanup • Proactively engage ESF-8 partners in mitigating any potential foreseen or unforeseen medical concerns related to contamination events • Support epidemiological studies of the health impacts of environmental contamination ESF-11 – Agriculture and Provide for animal welfare needs, coordination of response to plant disease and pest Natural Resources response •  Assure support (access to veterinary care, food) available for service animals Coordinate food safety and security oversight requirements Provide for safety and well-being of household pets per local plans Coordinate management of mass fatalities of animals ESF-12 – Energy Energy infrastructure assessment, repair, and restoration • Assure priority restoration of services to impacted health care organizations • Facilitate the provision of fuel for generators, etc., as required at health care facilities and for ground, air, and waterborne emergency response organizations • Support monitoring and possible decontamination for radiological emergencies ESF-13 – Public Safety and Ensure access to public safety and security support Security • Prioritize health care facility and resource security • Provide support to access, traffic, and crowd control that may affect health care organizations in the immediate aftermath of a disaster event • Coordinate access by health care providers to "secured" areas to enable staffing of hospitals • Provide security for transportation and administration of community-based interventions (distribution of countermeasures, vaccine, etc.)
From page 22...
... Given the usual functioning of EOCs, this is the single physical location where representatives from across the emergency response system are co-located, further facilitating the exchange of key information and the request for desired resources. In a sustained health incident, emergency management may still need to be connected to the remainder of the components of the emergency response system.
From page 23...
... ASPR = Assistant Secretary for Preparedness and Response (Department of Health and Human Services) ; CDC = Centers for Disease Control and Prevention; CSC = crisis standards of care; EOC = emergency operations center; HCC = health care coalition; HCF = health care facility; HHS = Department of Health and Human Services; MAC = Medical Advisory Committee; RDMAC = Regional Disaster Medical Advisory Committee; RMCC = Regional Medical Coordination Center; SDMAC = State Disaster Medical Advisory Committee.
From page 24...
... BOX 1-3 Role of National Disaster Medical System (NDMS) Responders Large-scale disaster incidents that require the use of federal resources, including the deployment of NDMS response teams, are likely to be the types of incidents in which the delivery of care may shift, at some point, across the conventional to contingency to crisis surge response continuum.
From page 25...
... In addition, given the dynamic nature of such incidents, it is incumbent on response teams to maintain good communications in the disaster zone, as well as back to the command and control oversight teams that accompany their deployment. Given availability of resources and patient care require ments, it is clear that decisions taken one day, for example, with respect to categoriza tion of patients by triage category, may change.
From page 26...
... Capability 10: Medical Surge, Function 3: Assist healthcare organizations with surge capacity and capability •  3. Assist healthcare organizations maximize surge capacity: The state and P healthcare coalitions, in coordination with healthcare organizations, emergency management, ESF-8, relevant response partners and stakeholders, develop, refine, and sustain a plan to maximize surge capacity for medical surge incidents.
From page 27...
... The 2012 report also highlighted the "milestones" for CSC planning. The establishment of indicators and triggers most easily fits within the fourth milestone: Developing a state health and medical approach to CSC planning that can be adopted at the regional/local level by existing health care coalitions, emergency response systems (including the Regional Disaster Medical Advisory Committee)
From page 28...
... psychological support, etc. Non-pediatric hospitals may have to provide inpatient care for pediatric patients during epidemic or mass casualty incidents.
From page 29...
... . IMPLEMENTATION OF THE DISASTER RESPONSE FRAMEWORK The 2012 report outlines a process for decision making during a disaster, providing a systems approach to help health care organizations determine whether health care delivery can remain at the conventional level, or whether contingency and/or crisis care should be implemented (see Figure 1-4)
From page 30...
... In general the space before reaching a resource shortage threshold corresponds to conventional care, the space after crossing that threshold but before reaching the resource triage threshold corresponds to contingency care, and the space after crossing the resource triage threshold corresponds to crisis care. However, the discus 30 CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS
From page 31...
... . Developing indicators and triggers at all levels of the emergency response system, as outlined in Figure 1-2, will help ensure consistency in the implementation of CSC.
From page 32...
... on emergency response decision making indicate that decision making in isolation is not effective in 32 CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS
From page 33...
... Decision-making capabilities during a large-scale incident are enhanced though preplanning strategies, practicing response plans, and building a response framework that recognizes threats to responder health and sustained response capabilities by integrating responder physical and psychological health care strategies into response protocols (HHS, 2005)
From page 34...
... . Moreover, it highlighted the issue that despite some jurisdictional calls for "mandatory evacuation," some health care organizations may not be capable of complying with the requested actions given the lack of suitable trans portation and the staff to accompany patients.
From page 35...
... The decision to evacuate is not an easy one. By necessity, health care facility evacuations force the adoption of a change in the delivery of health care services along the continuum of care from conventional to contingency to crisis response.
From page 36...
... 2009. Medical surge capacity and capability: The healthcare coalition in emergency response and recovery.
From page 37...
... . FEMA (Federal Emergency Management Agency)
From page 38...
... 2013c. Emergency management discussion guide for pandemic influenza planning.
From page 39...
... 2013. Systematic review of strategies to manage and allocate scarce resources during mass casualty events.


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