By Geoffrey Mwaungulu, JD, MPH, Program Analyst, NACCHO and Stacy Stanford, MSPH, Senior Program Analyst, NACCHO

During 2014, the Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events organized a series of workshops tasked with identifying opportunities to strengthen regional coordination to ensure effective medical and public health response to large multi-jurisdictional disasters. The workshops investigated topics related to engaging with non-traditional partners and the community to encourage involvement with preparedness work, using information and incident management to augment response efforts, and determining how surge management issues can impact preparedness and response. Results from this workshop series will be released in a summary document entitled: “Regional Disaster Response Coordination to Support Health Outcomes.”

In response to the concerns identified by IOM’s workshop series, NACCHO’s Surge Management Workgroup, whose members come from local health departments around the country, conducted a webinar in March 2015 entitled “Medical Surge: Intersection of Local Public Health & Healthcare Coalitions.” The webinar presented audiences with information related to the challenges faced by health systems in response to surge events, strategies implemented by local health departments and healthcare coalitions to achieve surge capability for health and medical services, and coordination efforts between local health departments and healthcare coalitions to achieve surge capability. Presenters included local public health preparedness officials.

A recording of the webinar may be accessed here

Following the presentation, great questions were posed by participants. The following responses were provided by the experts participating in the webinar. Learn from expert voices about the best way to start coordinating with partners, technology that may be useful for information sharing, and how others have used volunteers in the planning process.

Q&A

Q: Does your local health department have job action sheets for shared roles and responsibilities?

• Ntasiah Shaw: In relation to standing up a Point of Dispensing (POD) for mass prophylaxis purposes, yes we have job action sheets for those who will have a different role other than their everyday job duties.
• Michele Askenazi: We do not have job action sheets but have outlined each discipline’s specific roles/responsibilities within the Alternate Care Facility Annex so expectations for all partners are clear.
• Lori Upton: We are not an LHD but our organization does have job action sheets for the roles in the Catastrophic Medical Operations Center (CMOC), including the Public Health Liaison position.

Q: How are information and situational reports shared in your jurisdiction?

• NS: We use E-sponder, but are now moving towards WebEOC. There are still ways hospitals and the Emergency Operations Center (EOC) can share information through hospital web-based programs until WebEOC is fully functioning.
• MA: We utilize a variety of systems, situation dependent. This can include routine situation reports shared through our ESF #8 distribution list, conference calls, EMSystems/EMResource, and WebEOC.
• LU: We utilize EMResource and WebEOC as our primary sources. Additionally we utilize Coalition list serves and Everbridge.
• Carina Elsenboss: We primarily share information via email but are looking at other systems, including a SharePoint solution, that would enable people to go and pull information when they want it. We also work through our liaisons to get information to key stakeholders.

Q: What should be the first steps taken by jurisdictions in the early stages of coordinating with healthcare coalitions?

• NS: Between public health and area hospitals, try to get all of the area hospitals involved or see if they would like to work with a coalition. This will assist in identifying who you should work with and what roles should be in a relationship. Same goes for regional public health, you should find out who is involved, what agency they’re from, and what roles they can play.
• MA: Our approach was to make one-on-one site visits. We went to hospitals, emergency management, coroners, behavioral health, etc. These conversations helped us identify needs, collaboration opportunities, and coordinated approaches to deliverables. This used a lot of time on the back end, but helped in the creation of strong ongoing relationships that have been important once the larger group was brought together to solidify the draft documentation and subsequent exercising of the documentation.
• LU: Being in a coalition should provide a benefit back to the individual facilities invited. It is necessary to ask and respond to the questions of: 1) how do you enhance the community and 2) how do you make a community benefit for the facilities?
• CE: If your jurisdiction has a Coalition that is a great first step. Connect with them if you haven’t already and attend their meetings and get on their email list. Many coalitions will bring in healthcare organizations besides hospitals, including long-term care facilities and outpatient clinics, so it would be a good idea to familiarize yourself with the different types of healthcare – the role they play and how they operate. Your coalition will be a good resource but it’s also good for public health to have that familiarity and understand how healthcare organizations work as well as their interests in preparedness. You could review your jurisdiction’s ESF-8 plan and the roles and responsibilities healthcare has or could have a response. It’s important to understand the needs and interests of coalitions and hospitals so that you can create an alignment and “win-win.” For example, understanding Joint Commission requirements and building an exercise to support both public health’s Operational Readiness Review (ORR) and a hospital’s Joint Commission requirements.

Q: Are Medical Reserve Corps (MRC) volunteers used for staff shortages? If so, do you provide training for these volunteers?

• NS: Yes, we use the local MRC. We offer training and are establishing more training opportunities, as well as workgroups. Future trainings may include topics such as: what is a POD and what are some of the roles MRC volunteers can play in PODs. Additionally, we have recently started a Radiological MRC volunteer group that is specifically trained and designed to respond to a radiological incident.
• MA: We have a local MRC unit that is a couple years old and is growing its volunteer presence. We want to enhance training with new MRC volunteers. We are looking at a variety of training opportunities on topics such as PODs and Alternate Care Facilities so our MRC can support these types of responses.
• LU: Our public health departments do utilize MRC and Community Emergency Response Teams (CERT). Our Coalition has queried our hospitals on the use of volunteers and responses indicate that the likelihood of utilizing them is very small.
• CE: The King County MRC is active for public health missions, including alternate care sites and mass dispensing. We provide training on response plans and involve them regularly in drills and exercises. The MRC volunteers also conduct homeless outreach, including foot and blood pressure screening, on a weekly basis. They work along with staff during responses to communicable disease outbreaks and other public health events. While we have had discussions about what it could look like for MRC to be in healthcare facilities in the event of a response, there are many details to work out and a much larger discussion must be had.

Additional resources related to medical surge may be found below:

Public Health – Seattle & King County Public Health Reserve Corps (PHRC):
http://www.kingcounty.gov/healthservices/health/preparedness/phreservecorps.aspx

CDC (Capability 10):
http://www.cdc.gov/phpr/capabilities/

HHS ASPR – HPP Medical Surge Capability (See Capability 10 of this document):
http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf

National Academies, Institute of Medicine:
http://www.iom.edu/Reports/2010/Medical-Surge-Capacity-Workshop-Summary.aspx
http://www.iom.edu/~/media/Files/WIBs/WIB_Nola.pdf?la=en

Use the comments below to share any ideas you have that may benefit other jurisdictions facing similar issues around medical surge.