Emergency Management Strategies for Identifying and Integrating Community Resources to Expand Medical Surge Capacity:

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Emergency Management Strategies for Identifying
and Integrating Community Resources to Expand
Medical Surge Capacity Role for Health Call
Centers

• Gregory M Bogdan, PhD
• - Research Director Medical Toxicology
  Coordinator
• Rocky Mountain Poison Drug Center Denver
  Health
• Associate Professor, Dept. Pharmaceutical
  Sciences
• University of Colorado Health Sciences Center

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Challenges For Healthcare

• Lack of surge capacity in healthcare systems
• Information and triage needs of worried well
  and walking wounded
• Quarantine and isolation to halt spread of
  disease
• Mass prophylaxis or immunization of communities
• Pandemic or severe seasonal influenza

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Estimates of Influenza Impact
Demands for health resources during a severe
influenza outbreak may cripple healthcare systems
Health Outcomes 15 Gross Attack Rate 35 Gross Attack Rate
Fatalities 87,000 207,000
Hospitalizations 314,400 733,800
Outpatients Visit 18.1 million 42.2 million
Self-care Ill 21.3 million 49.7 million
US population with a clinical case of
influenza
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Challenges for Preparedness

• 2004 Redefining Readiness Project
• 60 of public would not heed official
  instructions to get vaccinated during smallpox
  outbreak
• 40 of public would not heed official
  instructions to shelter in place during a dirty
  bomb incident
• Its not disregard for authority, but the need to
  obtain additional information from a trusted
  source that would limit public compliance with
  these directives
• Need to educate, inform and support
• what the public should do in an emergency
• R. Lasker, Center for the Advancement of
  Collaborative Strategies in Health

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Public Does Rely Upon Call Centers in Emergencies
Toronto lines received gt300,000 calls with daily
peak of 47,567 calls (using gt200 PH nurses)
Hotline Contacts ( population)
Certain events (bioterrorism, child-targeted, new
emerging disease) will effect the amount of
public concern and numbers of people having
information or others needs.
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How Can Call Centers Help?
Information partners relay accurate, up-to-date,
consistent messages and collect data from public
Public Health/Safety agencies announce health
emergency
Controlled Messages
Uncontrolled Messages
Public will initially receive information from
the mass media
Poison Center
Nurse Line
Health Hot Line
Perhaps up to 25 of the public will have
questions which call centers can help with
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Interactive Response
Recordings
Tools for Call Center Responses
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Health Call Centers Reduce Hospital Surges
Everyday

• United States Poison Control Centers
• Of 2.4 million contacts about potential toxic
  exposures each year, 1.8 million (75) are
  managed outside of health care facilities
• Denver Health NurseLine
• Manages 40 of callers at home
• Study 70 of callers change their plans after
  calling (most seek lower intensity of care than
  originally planned home gt clinic gt ED)

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Health Emergency Line for the Public (HELP) Model

• Standardized, prepared response to public health
  events
• Providing consistent, accurate information
• Collecting and maintaining structured data to
  characterize events and responses (for both
  sentinel events and situational awareness)
• Capability and capacity to adapt to other public
  health emergencies (using technology tools)
• Operating daily since 2003 (7a-10p) and has
  responded to several major health events in
  Colorado
• Used in annual WNV influenza responses (gt80,000
  calls)
• Collects data used for situational awareness
  (influenza, dead animal, emerging disease
  reports)
• Model of poison center/public health partnership

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HEALTH EMERGENCY LINE FOR THE PUBLIC
Hospitals Healthcare Facilities
GOAL Preventing Patient Surges to
Overwhelmed Healthcare Agencies
Medical Evaluation Treatment
H E L P
Referral of Screened Patients For Triage
Evaluation
Health Information
General Public
Triage Decision Support
Info Delivery
Info Request
Disease Surveillance
Quarantine Isolation Support
Health Professionals
Outpatient Drug Info Adverse Events
Real-Time Reporting of Collected Epidemiologic
Information
Local State Public Health Agencies
GOAL Redirection of Contacts from
Overwhelmed Health Agencies
Epidemiologic Surveillance, Investigation
Control Measures, Prophylaxis
(Operational Model From an AHRQ Task Order)
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HELPs First Test - 2003

• Jul 22 Colorado (4.4 million) confirms 1st human
  WNV case, HELP launched just two hours prior
• HELP received 12,150 calls (Jul 22 - Oct 11)
  including gt2,500 dead bird reports (5 information
  providers)
• 60 of callers serviced with upfront messaging
• As of Oct 30 47 deaths and 2,543 confirmed cases
  
• Toronto (4.6 million) SARS experience - 44
  deaths and 438 SARS cases

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Our Experience Shows

• Need for and importance of providing information
  and support to public (trust)
• Surveillance - not the original purpose of line,
  became an important function (data)
• Structured hotline capabilities are an important
  response component (capacity)
• Health call centers can and do serve a vital role
  in response efforts (ready or not)
• Need tools and guidance for large events

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Latest AHRQ Task Order

• Develop, implement and test a model to adapt
  community health call centers to support home
  management and shelter-in-place approaches in
  certain mass casualty or health emergency events
• Determined best DHS scenarios for such strategies

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DHS National Planning Scenarios

• Strategies and tools were developed specifically
  for 4 of the 15 scenarios
• Biological Attack Aerosol Anthrax
• Biological Disease Outbreak Pandemic Influenza
• Biological Attack Plague
• Biological Attack Food Contamination
• Tools have wider applicability and can be
  modified for other scenarios
• Dept of Transportation (EMS/911) and CDC
  exploring call centers roles in pandemics

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Response Model Tools

• HELP Model (strategies blueprint for structured
  call center emergency response)
• Interactive Response (IR) Tools
• Quarantine Isolation Monitoring (outbound)
• Zip Code Specific Messaging (inbound)
• Pill Identification/Information (inbound)
• FAQ Library (inbound)

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Why Quarantine Monitoring?

• Taiwan - 131,132 people in quarantine for SARS
  (10 to 14 days)
• Quarantine included limited travel and health
  monitoring (primarily with in-person home visits,
  some phone calls)
• 99 of those in quarantine did not develop SARS
  and only needed monitoring
• Call center
• Periodic checks
• Referral to other sources if symptoms develop.

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But Will It Be Acceptable in US?

• Harvard School of Public Health Survey revealed
  that
• 76 favor quarantine of people suspected of
  having been exposed to a serious contagious
  disease
• 29 no longer favor if people are arrested for
  refusing
• 75 favor use of periodic telephone calls to
  monitor quarantined people (84 favor daily
  visits)
• 43 guards, 40 e-bracelets, 31 periodic video
  screening
• 70 prefer they or family member be quarantined
  at home
• These factors suggest quarantine monitoring by
  call centers is good strategy for disease
  control/containment

Blendon RJ et al. Attitudes Toward The Use Of
Quarantine In A Public Health Emergency In Four
Countries. Health Affairs 2006 25w15-w25.
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Why this response capability?

• Public health events will continue to occur and
  will require coordinated responses to protect our
  healthcare systems
• Need structured, integrated responses that are
• Cost-effective
• Efficient (use of staff and technology)
• Accurate
• Consistent
• Adaptable
• Health call centers can fill a vital role in
  providing information, collecting surveillance
  data and monitoring/supporting home care
  strategies

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Summary

• Health call centers already exist within
  communities and should be considered/integrated
  as part of emergency response strategies
• Health Call Centers can
• Improve information support for public and
  providers
• Assist with surge capacity
• Provide surveillance signals, situational data
• Realize the new Public Health environment
• Increase visibility (extend response capabilities
  outside of Mon to Fri 8 am to 5 pm period,
  improve access)
• Handle evolving info while maintaining control
  (assist with info management, improve
  dissemination)
• Aid decision support (assist with healthcare
  utilization)

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Further Information

• For inquiries regarding presentation
• Gregory M. Bogdan, PhD
• Rocky Mountain Poison Drug Center Denver
  Health
• 777 Bannock St, Mail Code 0180
• Denver CO 80204
• 303-739-1239
• Greg.bogdan_at_rmpdc.org
• For additional info on AHRQ task orders
• Health Emergency Assistance Line and Triage Hub
  (HEALTH) Model - www.ahrq.gov/research/health/
• Adapting Community Call Centers for Crisis
  Support A Model for Home-Based Care and
  Monitoring - www.ahrq.gov/prep/callcenters/