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8: Toolkit Part 2: Hospital and Acute Care
Pages 159-172

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From page 159...
... The clinical care committee may also be formed at the health care coalition level (e.g., hospital, primary care, emergency medical services agency, public health, emergency management, and others) , playing the role of the disaster medical advisory committee at the regional level.
From page 160...
... This will naturally lead to discussions about thresholds and decision making, and potentially to defining facility triggers. Disaster plan triggers cause activation of the facility emergency operations plan, marking the transition to contingency care.
From page 161...
... and development of recommended strategies and tactics to cope with the deficit; • Proactive strategies to acquire additional resources from coalition or emergency management part ners, or manage those available in a congruent fashion; • Communication to staff, patients, and families about the situation and what is being done in con cert with hospital and community ( Joint Information System) incident management; and • Determination if legal or regulatory actions are required to support crisis care strategies (e.g., from emergency management, public health)
From page 162...
... Following these initial discussions, sharing and coordination of this information with a much broader range of stakeholders (e.g., blood bank, EMS, trauma networks, community Department of Defense medical liaisons, federally qualified health centers, nursing homes, public health, primary care providers and emergency management, elected officials, and others listed in part one of the toolkit) is critical to an integrated response.
From page 163...
... 7. When a no-notice event moves immediately to a crisis trigger threshold, what specific actions are defined for staff to implement -- not only incident management systems but also triage processes and policies?
From page 164...
... Prompted by discussion of the key questions above, discussion participants should fill out a blank table, focusing on key system indicators and triggers that will drive actions in their own organizations, agencies, and jurisdictions. As a reminder, indicators are measures or predictors of changes in demand and/or resource availability; triggers are decision points (refer back to the toolkit introduction [Chapter 3]
From page 165...
... declaration in or specific capability (e.g., critical based on specific actionable data community care) -- see below space and supply Tactics: • Epidemiologic forecasts (Centers for considerations, as triggers should • Stand down incident management (scaled)
From page 166...
... • Unable to safely increase staff to Trigger: • High patient census patient ratios or broaden supervisory • Staff to patient ratios of 1:X achieved on • Staffing hours adjustment required to responsibilities medical floor maintain coverage • Lack of qualified staff for specific Tactics: • Staffing supervision model changes cares -- especially those with high life- • Shorten shift lengths required to maintain coverage safety impact • Adjust staff to patient ratios toward normal Triggers: Tactics: • Transition toward usual staff -- releasing less • X% staff ill call rate prompts • Tailor responsibilities to expertise, qualified staff first notification of emergency management diverting nontechnical or non- • Resume care routines group essential care to others • Resume administrative duties • School closures across area trigger • Recruit and credential staff from opening of staff day care volunteer (Medical Reserve Corps • Normal staff to patient ratios exceeded [MRC] , Emergency System for Advance • Specific staff expertise demands Registation of Volunteer Health exceeded (e.g., mass burn event -- Professionals [ESAR-VHP]
From page 167...
... to help them continue to work and provide quality care (e.g., stress "immunization," rest periods, housing support) Space/ Indicators: Indicators: Indicators: infrastructure • Increased ED volumes • Inpatient/outpatient contingency • Favorable epidemiologic curves • Increased clinic/outpatient volumes spaces maximized or near-maximized • Restoration of critical system function • Increased inpatient census • Escalating or sustained demand on • ED/outpatient volumes decreasing • Increased pending admits/ED boarding ED/outpatient despite implementing Trigger: Triggers: contingency strategies • Patients able to be matched to appropriate • Inpatient census exceeds conventional • Damage to infrastructure affecting areas for care beds critical systems Tactics: • Damage to infrastructure Crisis Triggers: • Transitional movement of sickest patients • Clinics unable to accommodate • Contingency inpatient beds maximized back into ICU environment demand for acute care (may include subset of ICU, burn, • Broaden admission criteria • >X hours ED boarding time pediatrics, etc.)
From page 168...
... or supplies that cannot be effectively • Retriage patients as resources become unsustainable conserved or substituted for without available • Vendor shortages impact ability to risk of disability or death without • Broaden indications for interventions as provide normal resources treatment conditions improve Tactics: Tactics: • Transition back from reallocation and • Use nontraditional vendors • Implement triage team/clinical care reuse to safer adaptive and conservation • Obtain from coalition facilities/ committee process strategies stockpiles (including potential state/ • Determine bridging therapies (bag- • Loosen restrictions on use of supplies federal sources) valve ventilation, etc.)
From page 169...
... Discussions should consider the benefits of anticipating the implemen tation of tactics, and of leaning forward to implement certain tactics in advance of a bright line or when no such line exists. • The example table may be consulted to promote discussion and to provide a sense of the level of detail and concreteness that is needed to develop useful indicators and triggers for a specific organization/agency/jurisdiction.
From page 170...
... 170 Scope and Event Type: __________________________________ Indicator Category Contingency Crisis Return Toward Conventional Surveillance data Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Communications and Indicators: Indicators: Indicators: community infrastructure Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Staff Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Space/infrastructure Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Supplies Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Other categories Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics:
From page 171...
... 2012. Crisis standards of care: A systems framework for catastrophic disaster response.


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