Coordinating a System of Care

In January 2012, the Health and Human Services Assistant Secretary of Preparedness and Response (ASPR) released Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness.

This document discusses the need for overall healthcare system coordination during mass casualty events such as Hurricane Katrina and the H1N1 pandemic, and is one of the first to look at the entire healthcare system—including EMS, hospitals and public health entities—and define the roles and responsibilities for each in regard to their capabilities to prepare for, respond to and recover from large-scale incidents or events that impact operations.

The document focuses on eight over-arching capabilities that ASPR, along with various other federal entities (such as the Department of Homeland Security) and private partners (such as the Association of State and Territorial Healthcare Officials and the National Association of County and City Health Officials) worked to develop, along with corresponding functions, tasks and resource elements.

These capabilities are aligned with a previous CDC document, Public Health Preparedness Capabilities: National Standards for State and Local Planning, which was released in May 2011 and specifically addressed public health emergency preparedness capabilities. These capabilities, which are specific to state and local public health entities, are listed below:

1. Community Preparedness
2. Community Recovery
3. Emergency Operations Coordination
4. Emergency Public Information and Warning
5. Fatality Management
6. Information Sharing
7. Mass Care
8. Medical Countermeasure Dispensing
9. Medical Materiel Management and Distribution
10. Medical Surge
11. Non-Pharmaceutical Interventions
12. Public Health Laboratory Testing
13. Public Health Surveillance and Epidemiological Investigation
14. Responder Safety and Health
15. Volunteer Management

Prior to outlining the actual capabilities, the document details the planning efforts that will be needed from the multiple entities represented in the healthcare system. Some of the threats that the healthcare system faces are discussed before the document offers pearls on planning principles; the differences between strategic, operational and tactical planning; various planning approaches; and the need for stakeholder engagement.

The eight capabilities identified by ASPR were designed in conjunction with the 15 capabilities listed above. They are:

• Healthcare System Preparedness
• Healthcare System Recovery
• Emergency Operations Coordination
• Fatality Management
• Information Sharing
• Medical Surge
• Responder Safety and Health
• Volunteer Management

The first capability mentioned, healthcare system preparedness, calls for the establishment of healthcare coalitions in an effort to bring everyone to the table on planning and response efforts or, as stated in the document, the first step of planning is the formulation of a collaborative planning group. The team mentioned specifically included EMS, emergency management and other entities such as public health agencies.

Another capability that may interest EMS agencies is fatality management. EMS agencies are often the first responder to these types of incidents and need to be involved in response planning efforts. It’s important to note that mass fatality management is traditionally the purview of the coroner/medical examiner with strong support from other entities such as law enforcement.

One of the more interesting components of this document is the way that EMS operations are integrated throughout the document and its various capabilities. This is seen most predominantly in the medical surge capability section where EMS is referenced in regard to the coordination of integrated healthcare surge operations with prehospital EMS operations, as well as the need to better understand EMS disaster triage protocols and CBRNE treatment protocols so as to assist with the transition of disaster patients from the field to a healthcare facility.

Gregg Margolis, PhD, EMT-P, the director of the Division of Health Systems and Health Policy at ASPR, sums up the EMS-specific elements in the overall document: “One of the most exciting parts of the national guidelines for healthcare system preparedness is the emphasis on coalition building and shifting preparedness from facility-based to community-based. EMS is readily identified throughout the document as an integral part of healthcare system preparedness. EMS is listed as an essential partner for healthcare coalitions and identified as a critical medical service. The ability to coordinate healthcare surge operations with EMS is necessary for a health system to surge in response to the type of increased demand caused by disasters and public health emergencies.”

The ASPR document is the latest in a series of documents promulgated and distributed with the goal of establishing performance measures and realistic goals for the healthcare system. The move toward achieving the capabilities will certainly entail some heavy lifting from EMS, hospital and public health authorities and, as such, this collaborative planning effort will serve as a solid foundation. State and local public health departments continue to face multiple challenges, including an ever-evolving list of public health threats. Additionally, public health systems and their respective preparedness programs face many challenges.

Federal funds for preparedness have been declining, causing state and local planners to express concerns over their ability to sustain the real and measurable advances made in public health preparedness since September 2001 and seen in practice during the response to events such as the SARS near-pandemic and the H1N1 pandemic. In the near future, state and local health emergency experts will need to make difficult choices about how to prioritize and ensure that federal dollars are directed to priority areas within their jurisdictions. These entities are looking for partners in their critical emergency preparedness and response roles and EMS systems can certainly fill these roles.

Raphael M. Barishansky, MPH, is chief of public health emergency preparedness for the Prince George's County (MD) Health Department. A frequent contributor to and editorial advisory board member of EMS World Magazine, he can be reached at rbarishansky@gmail.com.