No Vacancy: Healthcare Surge Capacity in Disasters

1
No Vacancy Healthcare Surge Capacity in
Disasters

• John L. Hick, MD
• MDH/HCMC
• July 22, 2004

2
Capacity vs. Capability

• Surge Capacity the ability to manage increased
  patient care volume that otherwise would severely
  challenge or exceed the existing medical
  infrastructure
• Surge Capability the ability to manage
  patients requiring unusual or very specialized
  medical evaluation and intervention, often for
  uncommon medical conditions
• Barbera and Macintyre

3
Different types of surge

• Unexpected vs. expected
• Timeline and potential for secondary cases
  (anthrax vs. plague)
• Static vs. dynamic
• Triage / field treatment
• Healthcare facility-based
• Community-based

4
Concepts and Principles

• Standardization
• Incident Management System
• Multiagency Coordination System
• Public Information Systems
• Interoperability (eg personnel and resource
  typing)
• Scalability
• Flexibility
• Tiers of capacity (spillover to next level)

5
Tiers of Response Patient Care
Federal Response (Regional National)
6th Tier
Federal Response
5th Tier
State / Interstate Coordination (MDH)
State A
State B
4th Tier
Coordination of Intrastate Regions (MDH)
Jurisdiction I (PH/EM/Public Safety)
Jurisdiction II (PH/EM/Public Safety)
3rd Tier
Jurisdiction Incident Management (County)
Medical Support
2nd Tier
Healthcare Coalition (Compact)
HCF A
HCF C
HCF B
1st Tier
Non-HCF Providers
Healthcare Facility
6
HRSAGrant
Minnesota Local Public Health
Regions
7
Minnesota Hospital Resources

• 140 acute care hospitals
• State total 16,414 licensed beds
• Less than 50 of these operating
• Loss of 36 hospitals, 3000 beds in past 20 yrs
• Nearly half of MN hospitals are either critical
  access or considering such designation
• Staff shortages, particularly nursing staff

8
Metropolitan Hospital Compact

• Since April 9, 2002
• 27 hospitals, approximately 4800 operating beds
• 7 counties
• Agreement provides for
• Staff and supply sharing
• Staffing off-site facilities for first 48h
• Communications, JPIC
• Regional Hospital Resource Center (HCMC)

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Regional Coordination

• Regional Hospital Resource Center (RHRC)
• Acts as broker for patient transfers
• Coordinates hospital response and requests within
  region
• Represents hospital needs and issues to RCC
• Regional Coordination Center (RCC or MAC)
• Multi-agency coordination center for policy and
  strategic guidance
• NO jurisdictional authority
• Functions and scope determined by incident

10
Hospital Response

• At least 50 arrive self-referred
• On average, 67 of patients in any given disaster
  are cared for at the hospital nearest the event
  (range 41-97)
• Redistribution from the hospital closest to the
  incident scene to other facilities may be as (or
  more) important than transport from the scene

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Facility-based Surge

• Usually can free up 15 of beds at a given
  facility
• Get em up and get em out (ED, clinics)
• Discharges and transfers (eg nursing home)
• Board patients in halls
• Cancel elective procedures
• Convert procedure/PACU areas to patient care
• Accommodate vents on floor (or BVM or austere O2
  flow powered ventilators)
• Supply and staffing issues (72h ahead)

12
Per 1000 patients injured

• 250 dead at scene
• 750 seek medical care
• 188 admitted
• 47 to ICU
• Rule of 85/15 has applied to all disasters
  thus far inc NYC 9-11

13
Community-Based Surge

• Clinics
• Homecare
• Nursing homes
• Procedure centers
• Family-based care
• Off-site hospitals (Acute Care Center)
• Off-site clinics (Neighborhood Emergency Help
  Centers) (assessment and clinic level care)
• Local / Regional referral / NDMS

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Potential Alternative Care Sites

• Aircraft hangers
• Military facilities
• Churches
• National Guard armories
• Community/recreation centers
• Surgical centers / medical clinics
• Convalescent care facilities

• Sports facilities / stadiums
• Fairgrounds
• Trailers
• Government buildings
• Tents
• Hotels/motels
• Warehouses
• Meeting halls

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Factors to consider

• Ability to lock down/Security
• HVAC
• Lab/specimen handling
• Lighting
• Laundry
• Loading Dock
• Equipment storage
• Oxygen delivery capability
• Waste disposal
• Parking
• Communications capability

• Patient decon
• Door size
• Pharmacy areas
• Electrical power with backup
• Proximity to hospital
• Family areas
• Toilets/showers/waste
• Food supply / prep area
• Water supply
• Wired for IT/Internet access

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Off-site hospital

• Triage / admission criteria
• Level of care basic nursing, drip meds, IVs, NG
  feeds
• Medications
• Documentation / order management
• Laboratory
• Food / water / sanitary
• Linen and medical waste handling
• Oxygen?

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Personnel Augmentation

• Hospital personnel
• Clinic personnel
• Medical Reserve Corps
• Non-clinical practice professionals
• Retired professionals (eg HC Medical Society)
• Trainees in health professions
• Ski patrol, civil air patrol, other service
  organizations
• Lay public (CERT teams, etc)
• Federal / interstate personnel

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Sample Site
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Sample Site

• Food
• Restrooms
• Staff rehab areas
• Secure
• HVAC system specs
• Paging /messaging /radio
• Power
• Phone, T1 lines, etc.
• City owned!

20
Resources

• Off-site matrix www.denverhealth.org/bioterror/to
  ols
• MaHIM www.gwu.edu/icdrm
• Model hospital planning www.er1.org
• Off-site facilities and community planning
  www2.sbccom.army.mil/hld/bwirp/
• Annals of Emergency Medicine www.mosby.com/aem
  articles in press (left side)