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Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. impact and maintain or rapidly recover operations that were compromised.CAPABILITY 10: Medical Surge 194 It encompasses the ability of the healthcare system to survive a hazard 195
Function 1: Assess the nature and scope of the incident In conjunction with jurisdictional partners, coordinate with the jurisdiction’s healthcare response through the collection and^ This capability consists of the ability to perform the following functions:^ Function 1:^ Function 2:^ Function 3:^ Function 4:^ Assess the nature and scope of the incidentSupportSupport jurisdictional medical surge operationsSupport demobilization of medical surge operations^ activation of medical surge
analysis utilization of incident command system, mutual aid agreements, and activation of Emergency Management Assistance Compact agreements) Tasks This function consists of the ability to perform the following task: Task 1: of health data (e.g., from emergency medical services, fire service, law enforcement, public health, medical, public works,At the time of an incident, participate in a unified incident management structure. Capability 3: Emergency Operations Coordination) to define the needs of the incident and the available healthcare staffing and resources. (For additional or supporting detail, see
Task 2: Task 3: At the time of an incident, complete a preliminary assessment of the incident and document initial resource needs and availability ( see Capability 3: Emergency Operations Coordination, Capability 7: Mass Care, Capability 9: Medical Materiel Management and Distribution, Capability 13: Public Health Surveillance and Epidemiological Investigation, and Capability 15: Volunteer Management)At the time of an incident, provide health-related data to healthcare organizations or healthcare coalitions that will assist the healthcare organizations or healthcare coalitions in activating their pre-existing plans to maximize scarce resources and prepare for any necessary shifts into and out of conventional, contingency, and crisis standards of care.e.g., personnel, facilities, logistics, and other healthcare resources). (For additional or supporting detail,
Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as P1: (Priority) incident management roles as applicable to a given response. Health departments must be prepared to staff emergency operations centers at agency, local, and state levels as necessary. Written plans should include documentation of staff assigned and trained in advance to fill public health196,197,198 Priority (For additional or supporting detail, see.
P2: P3:^ Capability 3: Emergency Operations Coordination) (Priority emergency management) emergency incidents, exercises, and preplanned (i.e., recurring or s accordance with Incident Command Structure organizational structures, doctrine, and procedures, as defined in the National Incident Management System. Coordination) (Priority) ) (^) Written plans should include documentation that all joinWritten plans should include process to ensure access into the jurisdiction’s bed-tracking system to maintain199,200 (^) (For additional or supporting detail, see Capability 3: Emergency Operationst (e.g., healthcare organizations, public health, andpecial) events operate in
U.S. Department of Health and Human Services Centers for Disease Control and Prevention^ PLANNING (P)^ visibility of bed availability across the jurisdiction.^ Suggested resources–^ –^ Hospital Preparedness Program, Office of the Assistant Secretary of Preparedness and Response: National Standards for State and Local PlanningPublic Health Preparedness Capabilities: 92
P4: (Priority) coalition partner will play to obtain and provide situational awareness. or relieve healthcare systems of their institutional responsibilities during an emergency, or to subvert the authority and responsibility of the state– –^ –^ http://www.phe.gov/preparedness/planning/hppHospital Preparedness Program Guidance FY10:^ http://www.phe.gov/preparedness/planning/hpp/Documents/fy10_hpp_guidance.pdfIntegrate plan and activities of all participating healthcare systems into the jurisdictional response plan and the Written plans should include processes to engage in healthcare coalitions and understand the role that each or local jurisdiction. The purpose of jurisdictional healthcare coalitions is as follows:201,202,203 (^) Coalitions are not expected to replace
- state response planIncrease medical response capabilities in the community, region and state □ □ □ □ Prepare for the needs of at-risk individuals and the general population in their communities in the event of a public health emergencyCoordinate activities to minimize duplication of effort and ensure coordination among federal, state, local and tribal planning, preparedness, response, and de-escalation activitiesMaintain continuity of operations in the community vertically with the local jurisdictional emergency management organizationsUnify the management capability of the healthcare system to a level that will be necessary if the normal Suggested resource^ □^ day-to-day operations and standard operating procedures of the health system are overwhelmed, and^ disaster operations become necessarySupport sufficient jurisdiction-wide situational awareness to ensure that the maximum number of^ people requiring care receive safe and appropriate care, which may involve, but is not limited to,^ facilitating the triage and/or distribution of people requiring care to appropriate facilities throughout^ the jurisdiction and providing appropriate support to these facilities to support the provision of optimal^ and safe care to those individuals P5: (Priority) with emergency management, healthcare organizations, coalitions, and other partners to develop written strategies that clearly define the processes and coalitions transition into and out of conventional, contingency, and crisis standards of care. the risk assessment to build jurisdiction-specific strategies and triggers.^ –^ Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources^ During Large-Scale Emergencies:^ http://www.phe.gov/preparedness/planning/mscc/handbook/pages/default.aspx Written plans should include processes (e.g., MOUs or other written agreements) to work in conjunction indicators as to when the jurisdiction’s healthcare organizations and health care205,206 (^) (For additional or supporting detail, see (^204) Jurisdiction should utilize Capability 1: Suggested resources – Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, Institute of Medicine, 2009. Examples of triggers for action identified (by the Institute of Medicine in 2009) include: Community Preparedness) □ □ Critical infrastructure disruptionDisruption of facility or community infrastructure and function healthcare organization, more than one hospital affected or critical-access hospital affected in the state) affected in the region, and more than five hospitals (e.g., utility or system failure in □ □ □ □ □ □ □ Failure of ‘contingency’ surge capacity (i.e., resource-sparing sHuman resource/staffing availabilityEmergency medical services call volume twice the usual amountEmergency department wait time more than 12 hoursStaff illness rate more than 10%Material resource availabilityLess than 5% ventilators available in healthcare organization trategies overwhelmed)
Resource Elements^ Function 1: Assess the nature and scope of the incident (continued)
PLANNING (P)
U.S. Department of Health and Human Services Centers for Disease Control and Prevention
S1: S2: S3: Public health personnel who may participate in medical surge operati National Emergency Medical Services Information SystemPublic health staff who may participate in medical surge operations should be trained to use the jurisdictional bed- tracking system to obtain data for jurisdictional situational awareness activities.Staff should understand the role of the public health department in incident management as described in the following resources: – Emergency Support Function #8 – Public Health and Medical Services (IS-808)210,211 and 911 data.ons should be aware of how to use local and state
E1: E2: Have or have access to a computer with primary and back-up internet connection to access local and sta Emergency Medical Services Information System,Have or have access to the jurisdictional bed-tracking system that complies with current Hospital Preparedness Program^ –^ –^ –^ –^ Introduction to Incident Command System (IS-100.b)Incident Command System for Single Resources and Initial Action Incidents (IS-200.b)National Incident Management System, An Introduction (IS-700.a)National Response Framework, An Introduction (IS-800.b) 911 data, or access bed-tracking data. (Does not apply to territories)te National E3:^ standards.Bed-tracking data are to be reported in aggregate by the state, therefore the state must have a system that collects bed-tracking data from the participating healthcare systems, or states may use existing systems to automatically transfer required data to the https://havbed.hhs.gov/v2/ Suggested resources – Further inform HAvBEDation on the HAvBED system can be found at server using the HAvBED EDXL Communication Schema, found at www.ahrq.gov/prep/havbed/ Function 2: Support staff, beds and equipment) to provide access to additional healthcare services (e.g., call centers, alternate care systems, emergency medical services, emergency department servic healthcare coalitions and response partners in the expansion of the jurisdiction’s healthcare system (includes additional^ –^ Support HAvBED Communications activation of medical surge^ Schema:es, and inpatien^ https://havbed.hhs.gov/v2/t services) in response to the incident.
Tasks This function consists of the ability to perform the following tasks: Task 1: Task 2: If indicated, support the mobilization of incident-specific medical treatment personnel, public health personnel, and non- medical support personnel to increase capacity (e.g., healthcare organizations or supporting detail, see Capability 7: Mass Care and Capability 15: Volunteer Management )During an incident, assist healthcare organizations and healthcare coalitions in the activation of alternate care facilities if requested. and alternate care facilities). (For additional
Task 3: Task 4: During an incident, assist in the expansion of the healthcare system (inclusive of healthcare coalitions), which includes hospitals and non-hospital entities (e.g., call centers, 911/emergency medical services, home health, ambulatory care providers, long-term care, and poison control centers).At the time of an incident, support situational awareness by utilizing the ongoing real-time exchange of information among response partners and coalitions (e.g., emergency medical services, fire, law enforcement, public health, and public works). (For additional or supporting detail, see Capability 6: Information Sharing)
SKILLS AND TRAINING (S)
Resource Elements^ Function 1: Assess the nature and scope of the incident (continued)
EQUIPMENT AND TECHNOLOGY (E)
U.S. D epartment of H ealth and H uman Services Centers for D isease Control and Prevention
Task 5: Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements During an incident, provide information to educate the public, paying special attention to the needs of at-risk individuals (e.g., information is linguistically appropriate, culturally sensitive, and sensitive to varied literacy levels) regarding changes to the availability of healthcare services. Capability 2: Community Recovery, and Capability 4: Emergency Public Information and Warning) (For additional or supporting detail, see Capability 1: Community Preparedness,
Note: Jurisdictions must have or have access to the resource elements designated as P1: (^) (For additional or supporting detail, see Capability (Priority) – – Documentation of process or proto Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) and the Reserve Corps program of credentialed personnel available for assistance during an incident.Documentation of processes for coordinating with health professional volunteer entities (e.g., MRC) and other personnel resources from various levels. Written plans should include the following elements:col for ho 15: Volunteer Management) (ESAR-VHPw the health agency will access volunteer resources through the Compliance Requirements) Priority. 213, 214 212 Medical P2: (Priority) healthcare coalitions and other response partners regarding the activation of alternate care systems. should also include the following elements: (For additional or supporting detail, see Capability 7: – – – Written list of healthcare organizations with alternate care system plansWritten list of home health networks and types of resources available that are able to assist in incident responseList of pre-identified site(s) that have undergone an initial assessment to determine their adequacy to serve as an alternate care facility Written plans should include documentation of the Mass Care) process for how the public health agency will engage in (^215) Documentation P3:^ Suggested resource (Priority) federal, state, lo partners. Jurisdictional processes to identify essential situational awareness requirements should consider the following elements:^ – –^ Disaster Alternate Care Facility Selection Tool:Identifying e Written plans should include processes and protocols to identify essential situational awareness information forcal, and nonssential information-governmental agencies; private sector agencies; and other Emergency Support Function # 8^ http://www.ahrq.gov/prep/acfselection/index.html P4:^ (For additional or supporting detail, see Capability (Priority) providers and leaders from a variety of settings (e.g., maternal and child health programs, clinic-based, hospital-based,^ –^ –^ –^ –^ –^ Defining required informationEstablishing requirementsDetermining common operational picture elementsIdentifying data ownersValidating d Written plans should include documentation of participation from jurisdictional and regional pediatricata with stakeholders^ 6: Information Sharing) home healthca limited to the following elements: – – Process to identify gaps in the provision of pediatric careProcess to access pediatric providers or pediatric medical liaisons for consultation related to clinical care. In order to access the appropriate level of care or consultation, plans should include list can stabilize and/or manage pediatric traumatic and medical emergencies and that have written inter-facility transfer agreements that cover pediatric patients.re, and rehabilitation) in jurisdictional response planning.216, 217, 218^ Plans should include but are nots of healthcare organizations that
Tasks^ Function 2: Support activation of medical surge (continued)
PLANNING (P)
U.S. D epartment of H ealth and H uman Services Centers for D isease Control and Prevention
P12: Plans s^ (For additional or supporting detail, see CapabilityWritten plans should (e.g., pediatric equipment and staffing) f^ –^ –^ –^ –^ hould also take the following into consideration:Translation of materials/resources for populations with limited language proficiencyDevelopment of materials/resources for population with low literacyDevelopment of materials/resources that are easy-to-read for population with impaired visionDevelopment of materials/resources for the hearing-impaired include a process for the local emergency medical services system to request additional resourcesor the needs of pediatric cases as part of the jurisdictional Emergency Support^ 4: Emergency Public Information and Warning) S1: S2:^ Function #8 annex or other documentation.Training for staff involved in personnel management Suggested resourceCompetency identified in jurisdiction to recognize sick infants and children (either through telemedicine arrangements, – Developing and Managing Volunteers ( http://training.fema.gov/EMIWEB/is/is244.asp^ (For additional or supporting detail, see CapabilityFederal Emergency Management Agency: IS-244):^ 15: Volunteer Management) neighboring partnerships, or other mechanism). Identify the appropriate personnel to complete training for pediatric care. Suggested resources – – American Heart Association, Pediatric Advanced Life Support http://www.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Pediatrics/Pediatric-Advanced-Life-Support- PALS_UCM_303705_Article.jspAmerican Heart Associa not routinely perform pediatric care):tion, Pediatric Emergency Assessment, Recognition, and Stabilization (for (comprehensive course): those who do E1: Promote and assure that equipment, communication, and data interoperability are incorporated into the healthcare organizations’ acquisition programs.^ –^ –^ http://www.americanheart.org/presenter.jhtml?identifier=3052085National Association of Children’s Hospitals and Related Institutions:http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1807v1 (For additional or supporting detail, see Capability^ www.nachri.org 6: Information Sharing) Function 3: Support jurisdictional medical surge operations In conjunction with health care coalitions and response partners, coordinate healthcare resources in conjunction with response partners, including access to care and medical service, and the tracking of patients, medical staff, equipment and supplies (from intra or interstate and federal partners, if necessary) in quantities necessary to support medical response operations.
Resource Elements PLANNING (P) (continued)
Function 2: Support activation of medical surge
SKILLS AND TRAINING (S) EQUIPMENT AND TECHNOLOGY (E) U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Tasks This function consists of the ability to perform the following tasks: Task 1: During an incident, coordinate and maintain communications throughout the incident per jurisdictional authority/ jurisdictional incident management structure with federal, state, local, agencies; and other Emergency Support Function #8 partners to maintain situational awareness of the actions of all parties involved, determine needs, and maintain continuity of services during response operations. supporting detail, see Capability 3: Emergency Operations Coordination and Capability 6: Information Sharing) and non-governmental agencies; private sector (For additional or
Task 2: Task 3: During an incident, assess resource requirements during each operational period based on coordinate with partners, including those able to provide mental/behavioral health services for the community, to obtain necessary resources (e.g., personnel, facilities, logistics, and other healthcare resources) to support the augmentation of services during surge operations. Distribution)During an incident, coordinate with jurisdictional partners and healthcare coalitions to facilitate patient tracking during all phases of the incident. (For additional or supporting detail, see Capability 6: Information Sharing) (For additional or supporting detail, see Capability 9: Materiel Management and the evolving situation and
Performance Measure(s) At present there are no CDC-defined performance measures for this function. Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as P1: (Priority) federal, state, loca #8 partners at least weekly, but potentially more frequently (e.g., as often as once per operational period). Written plans should include processes and protocols to communicate situational awareness information tol, and non-governmental agencies; private sector agencies; and other Emergency Support Function Priority. 226,227, 228 (For
P2:^ additional or supporting detail, see Capability 6: Information Sharing) (Priority) of healthcare coalition plans to address the functional needs of at- risk individuals. written list of healthcare organizations and community providers that are able to address the functional needs for at-risk individuals and a process to communicate with list of available services that support the functional needs of at-risk individuals. Capability 1: Community Preparedness) Written plans should include documentation that public health participates in the development and execution healthcare organizations and community providers to maintain a current (For additional or supporting detail, see229, 230, 231 (^) Plans should include a P3: (Priority) include the following elements: – Capturing and transferring the following known identification information throughout the transport continuum: Written plans should include processes to support or implement family reunification. Considerations should □ □ □ □ Pickup location (e.g., cross streets, latitude & longitude,Gender and name (if possible)For nonverbal or critically ill children, collect descriptive identifying information about the physical characteristics or other identifiers of the child.Keep the primary careg possible iver (e.g., parents, guardians, and foster parents) with the patient to the extent and/or facility/school) PLANNING (P) P4: P5: Written public health requests for resources from jurisdictional, state, federal, and other Emergency Support Function #8 partners, based on the evolving situation. (For additional or supporting Management)Written plans should include protocols to participate in or coordinate with the jurisdiction’s patient tracking system. additional or supporting detail, see Capability 6: Information Sharing ) and healthcare coalition documentation should include processes to coordinate the inventory and detail, see Capability 9: Materiel Management and Capability 15: Volunteer (For U.S. Department of Health and Human Services Centers for Disease Control and Prevention
Function 3: Support jurisdictional medical surge operations
Resource Elements Note: Jurisdictions must have or have access to the resource elements designated as P1: P2: (Priority) to demobilize transportation assets used in the incident. medical resources (e.g., NDMS). Process should include identification of triggers that would identify the need for demobilization. (Priority) Written plans should include a process for the jurisdiction to coordinate with state emergency medical services Written plans should include a process to demobilize surge staff to include other state (e.g., MRC) and federal (For additional or supporting detail, see Capability 15: Volunteer Management ) Priority.
P3: P4: P5: Written plans should include processes to assist the lead agency with the facilitation or coordination transportation for patients requiring assistanceWritten plans should include process to communicate with healthcare organizations and community providers to maintain a current list of healthcare services that are available to provide information to patients if requested.Written plans should include process to coordinate, if requested by healthcare organizations, case management or other support to assist the transition to pre-incident medical environment or other applicable medical setting.. of medical P6: P7: Written plan should include processes to communicate with U.S. Department of Health and Human Services Regional Health Administrators, Regional Emergency Managers, and Regional Emergency Coordinators to address the functional needs of patients.Written plans should includ volunteer and other personnel post-deployment medical screening, stress, and well-being assessment and, when requested or indicated, referral to medical and mental/behavioral health services. Capability 2: Community Recovery, Capability 14: Responder Safety and Health, and Capability 15: Volunteer Management)e a process to coordinate with jurisdictional authorities and partner groups to support (For additional or supporting detail, see P8: Written plans should include a process for releasing volunteers and other personnel, to be used when the health department has the lead role in volunteer or other personnel coordination following: (For additional or supporting detail, see Capability 3: Emergency Operations Coordination and Capability 15: Volunteer – – – – – Demobilize volunteers and other personnel in accordance with the incident action planAssure all assigned activities are completed, and/or replacement volunteers are informed of the activities’ statusDetermine whether additional assistance is needed from the volunteer or other personnelAssure all equipment is returned by volunteer or other personnelConfirm the volunteer and other personnel’s follow-up contact information. Plans should include steps to achieve the P9:^ Management)Written plans should include a protocol for conducting exit screening during out-processing, to include collection of the following: (For additional or supporting detail, see Capability 14: Responder Safety and Health and Capability 15: Volunteer Management) – – – Any injuries and illnesses acquired during the responseMental/behavioral health needs due to participation in the responseWhen requested or indicated, referral of volunteer to medical and mental/behavioral health services.
Function 4: Support demobilization of medical surge operations PLANNING (P)
U.S. Department of Health and Human Services Centers for Disease Control and Prevention
