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9: Toolkit Part 2: Out-of-Hospital Care
Pages 173-184

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From page 173...
... These include community-based health care provided in diverse ambulatory care environments (public, private, tribal, veterans health, military) , home health and hospice, assisted living and skilled nursing, specialty care and resources, and others.
From page 174...
... Discussion Participants Suggested participants for a discussion focused on out-of-hospital are listed below. • Local public health; • Home care agencies; • Assisted living; • Long-term care; • Skilled nursing facilities; • Outpatient clinics (multispecialty group practices, federally qualified health centers, dialysis centers, etc.)
From page 175...
... 10. What would be done when hospice patients are seeking treatment in acute care facilities?
From page 176...
... Key Questions: No-Notice Scenario The questions below are focused on the no-notice earthquake scenario presented in Chapter 3: 1. What relevant information is accessible to pertaining to out-of-hospital (home care, hospice, long term care, clinics, etc.)
From page 177...
... Because of the extensive variability among these types of entities, developing customized indicators and triggers for participants' own situations will be particularly important. The indicators, triggers, and tactics shown in the table are intended to help promote discussion and 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; they are not intended to be exhaustive or universally applicable.
From page 178...
... • Decreasing disease burden based on • Local/regional surveillance and Crisis Triggers: surveillance/epidemiological data epidemiological data • Unable to deliver home care to meet Triggers: Triggers: patient needs • Demand for services lessens and/or • Increasing discharges from hospital • Large numbers of long-term care availability of resources improves • Increased demand for patient care patients requiring hospitalization due Tactics: services to increasing acuity • Patient care delivery adjusted toward Tactics: • Failure to adapt to changing baseline • Coordinate with local/regional health conditions, including ability to expand care coalition capacity of services • Anticipate impact of these events on Tactics: sustainment of patient care service • Postpone elective appointments delivery and make adjustments based • Implement changes to patient care on existing emergency operations service delivery and make adjustments plans based on existing emergency operations plans Community and Indicators: Indicators: Indicators: communications • Communications are delayed because • Communications infrastructure is • Communications are returning to infrastructure of partial damage to infrastructure severely damaged and will take weeks normal • Utility (e.g., power/water) failures to restore • Utility restoration allows technology impacting patients who depend on • Surge of technology-dependent dependent patients to return to their technology (e.g., home ventilator and patients seeking care at hospitals usual care dialysis patients)
From page 179...
... family members to augment care Tactics: • Staffing in long-term care facilities predominantly provided by family members • Coordination of care with neighbors and other community-based assets • Home care staff designated as emergency responders so they can travel and access gasoline supplies to see critically ill home care patients. continued 179
From page 180...
... • Alternate care facilities are no longer • Establish shelter care/use alternate • Alternate care facilities beyond needed care facilities to manage patient care capacity • Long-term care facilities and FQHCs needs • FQHCs are damaged and unable to returning to normal operations Dual purpose out-of-hospital clinics to provide surge capacity Tactics: accept surge (e.g., federally qualified • Long-term care facilities damaged and • Demobilization of federal resources health centers [FQHCs]
From page 181...
... 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 182...
... Scope and Event Type: __________________________________ 182 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 183...
... 2012. Crisis standards of care: A systems framework for catastrophic disaster response.


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