Engaging the Private-Sector Health Care System in Building Capacity to Respond to Threats to the Public's Health and National Security Proceedings of a Workshop (2018) / Chapter Skim
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2 Perspectives on the Nation's Capacity to Respond to Threats to Health, Safety, and Security
2 Perspectives on the Nation's Capacity to Respond to Threats to Health, Safety, and Security
Pages 7-24
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From page 7... ...
The four panelists were Brent James, formerly at Intermountain Healthcare and now at the Institute for Healthcare Improvement; Michael Wargo from the Hospital Corporation of America (HCA) ; Ronald Stewart from the University of Texas School of Medicine at San Antonio and the Southwest Texas Regional Advisory Council (STRAC)
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From page 8... ...
From Ronald Stewart's perspective as chair of STRAC's executive committee, the regional trauma system serves as a great framework for disaster response, in large part because every health care system in the region -- including emergency medical services (EMS) , public and private health care, and public safety and public health -- is included in the trauma system.
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From page 9... ...
This council allows Wargo and others from the private sector to share information openly with colleagues in the public sector and gain both national and global situational awareness of potential
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From page 10... ...
Coalition models such as the regional advisory councils in Texas can help address that gap by serving as a consolidator of information on available beds and supply chain issues that would be closely held business intelligence, but critically important to have in the event of a large-scale disaster. He noted that the biggest challenges for HCA arose from the combination of Hurricanes Harvey and Irma, when communication among the various levels of government and the private sector was less than ideal.
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From page 11... ...
That realization, he said, raises the issue of how to maintain a level of coordination and communication during good times. Noting that STRAC served as the main coordinating center during Hurricane Harvey and the Sutherland Springs, Texas, church shooting that killed 26 people, Stewart said those two events stressed the system in different ways and revealed there was value in information sharing and coordination in general.
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From page 12... ...
Unfortunately, he added, during the recent hurricane season, FEMA had one approach, HHS had another, and DoD brought a separate set of capacities to the table. The private sector, meanwhile, did not have the information to understand the whole of the community and public-sector response, and thus, was slow to brings its resources to the response effort.
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From page 13... ...
DISCUSSION Ricardo Martinez from Adeptus Health started the open discussion by asking the panelists to comment on how the private sector can interface with public health when the response to a regional disaster, such as Hurricane Harvey, has to transition from an acute care mode to one that has to provide care for someone who is homebound and cannot get an oxygen delivery, for example. HCA, said Wargo, has a hurricane playbook that starts 120 hours before the hurricane, continues through the hurricane, and turns to community resilience once the immediate event has passed.
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From page 14... ...
Every hospital also has connections to coordinate and work with home health organizations to expand home health care capacity in such situations. James added that an integrated health system, such as Intermountain or Kaiser, can also draw on all of the components of the system, such as walk-in primary care facilities, in its response.
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From page 15... ...
Duane Caneva from the National Security Council noted the fragmentation of the medical system and called for a matrixed approach that would capture local, regional, and national standards as well as the interdependencies across critical sectors. Disasters, he said, are not just one-time events because the threats are ongoing, including the annual influenza disaster that Witt discussed earlier.
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From page 16... ...
"There are conflicting issues of autonomy versus society benefit that have not been solved," he said. For the final question of the session, Sara Roszak from the National Association of Chain Drug Stores asked the panelists if they had ideas for quality metrics that could be used for preparedness purposes.
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From page 17... ...
health care system. While the program's initial efforts were directed at building surge capacity at individual hospitals, it has expanded to build capacity across regional health care coalitions after recognizing that hospitals will be overwhelmed during
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From page 18... ...
FEMA, said Macintyre, is best known for its role in coordinating interagency relief efforts for presidentially declared disasters and emergencies and for administering the Disaster Relief Fund as outlined in the Stafford Disaster Relief and Emergency Assistance Act.3 As he explained, the Stafford Act contains specific details about how FEMA and other federal agencies can engage and support regions affected by these presidentially declared incidents. He noted that FEMA, working through specific federal agencies such as HHS, provides assistance that the affected state, territory, or tribal government has requested or prioritized, though that can play out in unexpected ways.
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From page 19... ...
Macintyre explained that HHS, not FEMA, is the primary federal entity responsible for health and medical preparedness, but FEMA does work with HHS on multiple initiatives, such as the Biological Incident Annex, which outlines the actions, roles, and responsibilities associated with response to a human disease outbreak of known or unknown origin requiring federal assistance.4 The North American Aerospace Defense Command (NORAD) , explained Jody Wireman, director of the Force Health Protection Division, is part of USNORTHCOM, and therefore it serves as the DoD operational lead for events that occur in the United States, and in particular, for those that fall under a FEMA mission assignment to support local, state, and regional authorities.
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From page 20... ...
Too often, she said, coalition members do little more than exchange business cards and then revert to their individual roles in their own individual health care facilities when an emergency takes place. "Those coalitions have to stand up and be able to share information and coordinate resources," said Harvey.
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From page 21... ...
Macintyre noted that FEMA is still undergoing its after-action exercise from the 2017 hurricane season, but in his opinion, there is more work to be done to improve private-sector resiliency even with the considerable progress that has occurred with the development of best practices gained from real experiences. As an example, the private-sector dialysis system in Puerto Rico was tremendously well organized and had generators ready for most of the clinics there.
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From page 22... ...
At the same time, while the military response can be slow, the delay offers the opportunity to accurately assess needs following the first 72 to 96 hours of response, when the initial responders may be at the point of exhaustion and stockpiled supplies are being drawn down. Wireman noted that DoD can deploy worker health and safety people sooner, and in the case of Puerto Rico, DoD was able to work with the Puerto Rican Health Department on water quality and mosquito trapping.
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From page 23... ...
Harvey thanked Kaplan for that suggestion. She pointed out, however, that rural areas in particular have little capacity and yet in some ways need the type of coordinating capabilities a coalition would offer Noting the absence of someone from CMS on the federal perspectives panel, Daniel Hanfling from the Johns Hopkins Bloomberg School of Public Health asked if there was a role for the federal government, perhaps through CMS, to incentivize health systems to build facilities that would be more resilient in the face of a natural disaster.
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From page 24... ...
In a final remark to close the session, Mashid Abir from the University of Michigan Medical School wondered if the VA and private hospitals could share intensive care unit and burn care capabilities in a bidirectional manner.
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