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Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events. Medical Surge Capacity: Workshop Summary. Washington (DC): National Academies Press (US); 2010.

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Medical Surge Capacity: Workshop Summary.

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BAgenda

June 10, 2009

Keck Center, Room 100

500 Fifth Street, NW

Washington, DC 20001

Background:

The mission of HHS’s Hospital Preparedness Program is to enhance the ability of hospitals and healthcare systems to prepare for and respond to bioterrorism and other public health emergencies. The United States constantly faces the real possibility of catastrophic public health incidents that could involve thousands, or tens of thousands, of patients. Therefore it is critically important for health systems to identify, plan, and prepare for the possibility of a mass-casualty incident. To help address these needs, the Institute of Medicine’s Forum on Medical and Public Health for Catastrophic Events is organizing a workshop around the topic of “medical surge capacity” that will help inform future guidance developed by HHS’s Healthcare Preparedness Program.

Audience:

Policy makers from federal agencies and state and local public health departments. Providers from the healthcare community, including relevant medical disciplines, nursing, emergency medical services (EMS). Healthcare and hospital administrators.

Objectives:

The workshop will feature invited presentations and discussions focused on the following topics, including specific discussion of the role of the Hospital Preparedness Programs (HPP) in facilitating each of these efforts, specifically through guidance developed by the HPP.

  • Definitions of medical surge that are applicable to local, state, territorial, tribal governments, and federal government entities;
  • The capability and tools available to local, state, territorial, tribal, and federal government entities to assess the current status of preparedness to conduct medical surge operations;
    • Identify metrics that can be used to improve performance and preparedness for a mass-casualty incident; and
  • Strategies to facilitate public- and private-sector work to improve surge capability for victims and the distressed, including new or modified guidance and legal and funding mechanisms.

For each area, current capabilities, perceived gaps, future opportunities and innovative options should be identified and discussed.

Note: Continental breakfast will be available at 7:30 a.m.

Agenda - June 10, 2009

8:00 a.m.Welcome, Introductions, and Workshop Objectives
 Lewis Goldfrank, Forum Chair
 Professor and Chair
 Department of Emergency Medicine
 New York University School of Medicine
8:05 a.m.Charge to Workshop Speakers and Participants
 Gerald Parker
 Principal Deputy Assistant Secretary
 Office of the Assistant Secretary for Preparedness and Response
 Department of Health and Human Services
8:15 a.m.ASPR Healthcare Preparedness Programs: Current Objectives and Future Priorities
 Kevin Yeskey
 Deputy Assistant Secretary
 Office of Preparedness and Emergency Operations
 Office of the Assistant Secretary for Preparedness and Response
 Department of Health and Human Services
8:30 a.m.Public Health Emergencies: HHS Legal Authorities for Responding to a Mass-Casualty Event
 Susan Sherman
 Senior Attorney
 Office of the General Counsel, HHS
SESSION I: DEFINITIONS OF MEDICAL AND PUBLIC HEALTH SURGE CAPACITY
Session Objective: Identify and discuss different definitions of medical surge capacity within a construction of an all-hazards approach. Discuss the merits of identifying a commonly accepted terminology. Examine gaps in the currently used definitions.
8:45 a.m.Session Objectives and Introduction
 Jeffrey Runge, Session Chair
 President
 Biologue, Inc.
8:55 a.m.Surge Capacity Continuum: Conventional, Contingency, and Crisis
 John Hick
 Associate Medical Director for EMS and Medical Director of Emergency Preparedness
 Hennepin County Medical Center, MN
9:10 a.m.Hospital Surge Capacity for Mass Casualty Events— Israeli Perspective
 Kobi Peleg
 Director
 Israeli National Center for Trauma and Emergency Medicine Research
9:25 a.m.Public Health Perspective on Surge Capacity
 Daniel Sosin
 Acting Director
 Coordinating Office for Terrorism Preparedness and Emergency Response, CDC
9:40 a.m.Medical and Public Health Surge Capacity: Emergency Management Perspective
 Robert Bass
 Executive Director
 Maryland Institute for Emergency Medical Services System
9:55 a.m.Discussion with attendees
  • What are the advantages of developing a consensus definition of surge capacity?
  • How can a consensus definition of medical surge capacity be established?
  • Is it possible to develop a uniform definition of surge capacity within an all-hazards approach?
  • What components of a definition are necessary to allow for “surge capacity” to be measured?
  • How can the HPP assist in the development of a commonly accepted definition of surge capacity?
10:40 a.m.BREAK
SESSION II: LOCAL STRATEGIES: CREATING AN INTEGRATED APPROACH TO AN ALTERNATE CARE SYSTEM
Session Objective: Recognizing that urban and rural communities would utilize resources and assets in different ways, discuss some common guiding principles that will guide the use of resources and assets. Identify and discuss strategies to leverage and integrate local and community resources to develop an effective alternate care system.
10:55 a.m.Session Objectives and Introduction
 Dan Hanfling, Session co-Chair
 Director
 Emergency Management and Disaster Medicine
 Inova Health System
 Deborah Levy, Session co-Chair
 Chief, Healthcare Preparedness Activity
 Division of Healthcare Quality Promotion, CDC
11:05 a.m.Panel Discussion: Opportunities to Leverage Local Components: Strategies and Guiding Principles
Leveraging Federal Resources to Bring Together Stakeholder and Develop an Integrated Response
 Richard Serino
 Chief
 Boston EMS
Developing a Healthcare Coalition Approach to Coordinating Surge Resources
 Zachary Corrigan
 Executive Director
 Northern Virginia Hospital Alliance
Role of Emergency Health Operations Centers: Managing System Capacity
 Frederick (Skip) Burkle
 Senior Fellow, Harvard Humanitarian Initiative
 Harvard School of Public Health
Role of the 9-1-1 and EMS System
 Leslee Stein-Spencer
 Manager of Quality Improvement, Chicago Fire Department
 Program Advisor, National Association of State EMS Officials
Licensing and Interstate Credentialing: Ensuring Staff Availability and Capability
 James Hodge
 Executive Director
 Center for Law and the Public’s Health
 Johns Hopkins University
11:45 a.m.Discussion with Attendees
  • What are some common guiding principles that will guide the use of resources and assets?
  • How can local components of the healthcare and public health sector resources be better leveraged, e.g., private providers, EMS, call centers, urgent care facilities?
 Dan Hanfling, Session co-Chair
 Director
 Emergency Management and Disaster Medicine
 Inova Health System
 Deborah Levy, Session co-Chair
 Chief, Healthcare Preparedness Activity
 Division of Healthcare Quality Promotion, CDC
12:45 p.m.LUNCH
SESSION III: ALTERNATE CARE SYSTEM: STRATIFICATION OF CARE
Session Objective: Discuss benefits of establishing effective alternate care facilities. How can alternate care sites be effectively used? How should alternate care sites be established so that they meet the goal of saving as many lives as possible given the limited resources? How to ensure coordination with the entire healthcare system? How should alternate care facilities be integrated into the emergency medical services system?
1:30 p.m.Session Objectives and Introduction
 Dan Hanfling, Session co-Chair
 Director
 Emergency Management and Disaster Medicine
 Inova Health System
 Deborah Levy, Session co-Chair
 Chief, Healthcare Preparedness Activity
 Division of Healthcare Quality Promotion, CDC
1:40 p.m.Panel Discussion: Effective Alternate Care Facilities: Opportunities to Integrate into Current Plans
Hospital Surge Capacity for Mass-Casualty Events
 Arthur Kellermann
 Professor of Emergency Medicine and Associate Dean of Health Policy
 Emory University
Utilizing Call Center Capabilities
 Gregory Bogdan
 Research Director and Medical Toxicology Coordinator
 Rocky Mountain Poison & Drug Center at Denver Health
Alternate Care Capabilities
 Lewis Rubinson
 Assistant Professor of Medicine
 Division of Pulmonary and Critical Care Medicine
 University of Washington
Community Mitigation: In-Home Care and Role of the Family
 Lisa Koonin
 Senior Advisor
 Influenza Coordination Unit
 Centers for Disease Control and Prevention
2:20 p.m.Discussion with Attendees
  • What are the characteristics of an appropriate alternate care site?
  • What are the most appropriate uses of alternate care sites?
  • How can alternate care facilities be established to ensure they meet the goal of saving as many lives as possible given the limited resources?
  • How can the HPP and other federal programs facilitate the increased capacity of the emergency medical services and healthcare system
 Dan Hanfling, Session co-Chair
 Director
 Emergency Management and Disaster Medicine
 Inova Health System
 Deborah Levy, Session co-Chair
 Chief, Healthcare Preparedness Activity
 Division of Healthcare Quality Promotion, CDC
3:15 p.m.BREAK
SESSION IV: CREATING SITUATIONAL AWARENESS: A SYSTEMS APPROACH
Session Objective: Examine strategies to establish an integrated systems approach for improving situational awareness for medical surge capacity. Identify current capabilities, perceived gaps, future opportunities and innovative options that could improve coordination between sectors with in a community. Identify reporting mechanisms that could be developed to ensure a community is adequately prepared.
3:30 p.m.Session Objectives and Introduction
 Eric Toner, Session Chair
 Senior Associate
 Center for Biosecurity, UPMC
3:40 p.m.Panel Discussion: Integrative Strategies and Operational Implications
Data Needs for Situational Awareness in a Mass-Casualty Disaster: Optimal and Minimal Data and Technology Requirements
 Paul Biddinger
 Chairman
 Massachusetts Medical Society Committee on Preparedness
Harnessing Electronic Health Records for Situational Awareness
 David Gruber
 Assistant Commissioner
 Division of Health Infrastructure Preparedness and Emergency Response
 New Jersey Department of Health and Senior Services
Developing a System to Improve Situational Awareness
 Cynthia Dold
 Healthcare Coalition Program Manager
 Seattle and King County
Information Systems for Just-in-Time Training: How would it work?
 Carl Taylor
 Assistant Dean
 University of South Alabama College of Medicine
 Director
 Center for Strategic Health Innovation
4:20 p.m.Discussion with Attendees
  • What is the optimal set of data needed for situational awareness in a mass- acasualty disaster?
    • What is the optimal technology needed to enable it?
    • What is the minimal set of data and technology needed?
  • How can electronic health records be harnessed for situational awareness?
  • What role would syndromic surveillance systems play in situational awareness in mass-casualty disasters?
  • Information systems for just-in-time training—how would it work?
 Eric Toner, Session Chair
 Senior Associate
 Center for Biosecurity, UPMC
SESSION V: OPPORTUNITIES TO MOVE FORWARD
Session Objective: Review the discussions that took place during the day and identify promising avenues by which the HPP and other federal programs can improve the surge capacity of our nation’s healthcare system.
5:00 p.m.Panel Discussion: Recap of Promising Ideas from Day 1
 Gamunu Wijetunge
 NHTSA/Office of Emergency Medical Services
 U.S. DOT
 David Marcozzi
 Homeland Security Council
 The White House
 Margaret Vanamringe
 Vice President
 Public Policy and Government Relations
 The Joint Commission
 Lewis Goldfrank
 Professor and Chair
 Department of Emergency Medicine
 New York University School of Medicine
 Jack Herrmann
 Senior Advisor
 Public Health Preparedness
 NACCHO
5:20 p.m.Discussion with Attendees
  • What new ideas have surfaced in this workshop that should be explored further?
  • What action steps are required to integrate these strategies into the current guidance and funding opportunities, including the HPP program?
  • What resources and further infrastructure investments will be necessary in the short- and long-term?
6:00 p.m.ADJOURN

June 11, 2009

Keck Center, Room 100 500 Fifth Street, NW

Washington, DC 20001

Note: Continental breakfast will be available at 8:00 a.m.

Agenda - June 11, 2009

8:30 a.m.Welcome
 Lewis Goldfrank, Forum Chair
 Professor and Chair
 Department of Emergency Medicine
 New York University School of Medicine
SESSION VI: VULNERABLE POPULATIONS: BEHAVIORAL HEALTH EFFECTS AND MEDICAL NEEDS FOR AT-RISK POPULATIONS
Session Objective: Discuss current capabilities, perceived gaps, future opportunities and innovative options to ensure appropriate care can be provided to individuals with medical needs. Identify strategies that could be modeled and tested to improve care to individuals with medical needs.
8:35 a.m.Session Objectives and Introduction
 Arthur Cooper, Session Chair
 Professor of Surgery
 Columbia University Medical Center
8:45 a.m.Panel Discussion: Enhancing the Health Care System’s Capacity to Care for those with Special Medical Needs
H1N1: Special Considerations for Children and Youth
 Richard Hatchett
 Homeland Security Council
 The White House
Developing Care Strategies and Capacity for the Psychologically Impacted and the Distressed
 Robert Ursano
 Professor of Psychiatry and Neuroscience
 Chairman of the Department of Psychiatry
 Uniformed Services University of the Health Sciences
Enhancing the Health Care System’s Capacity for the Young
 Joseph Wright
 Professor of Pediatrics (Vice Chair), Emergency Medicine and Health Policy
 George Washington University/Children’s National Medical Center
 Washington, DC
Enhancing the Health Care System’s Capacity for the Elderly
 Charlotte Yeh
 Chief Medical Officer
 AARP Services Incorporated
 Washington, DC
Enhancing the Health Care System’s Capacity for the Chronically Ill
 Ray Swienton
 Associate Professor, Division of Emergency Medicine University of Texas Southwestern Medical Center
9:25 a.m.Discussion with Attendees
  • What are the current capabilities and perceived gaps in providing care to individuals with medical needs?
  • What future opportunities and innovative options could ensure appropriate care can be provided to individuals with medical needs?
  • What strategies that could be modeled and tested to improve care to individuals with medical needs?
 Arthur Cooper, Session Chair
 Professor of Surgery
 Columbia University Medical Center
10:05 a.m.BREAK
SESSION VII: FATALITY MANAGEMENT STRATEGIES
Session Objective: Examine potential fatality management strategies. Identify the goals of managing fatalities during a mass-casualty incident. Discuss the resources necessary for ensuring adequate fatality management.
10:15 a.m.Session Objectives and Introduction
 Jack Herrmann, Session co-chair
 Senior Advisor
 Public Health Preparedness
 National Association of County and City Health Officials
 Lisa Ladue, Session co-chair
 Deputy Director
 National Mass Fatalities Institute
 Cedar Rapids, Iowa
10:25 a.m.Panel Discussion: Mass Fatality Strategies: Gaps and Opportunities
 Domestic Mass Fatality Response: Lessons from the DoD
 Michael Luke
 Joint Mortuary Affairs Officer
 United States NORTHCOM
Family Assistance Centers
 Virginia Mewborn
 Assistant Commissioner of Training and Exercises
 Office of Emergency Management, New York City
Responding to Mass Casualty Incidents: Medical Examiners
 Frank Depaolo
 Director of Special Operations Division
 Office of Chief Medical Examiner
 New York City
Private Sector Opportunities and Challenges
 John Fitch
 Senior Vice President, Advocacy
 National Funeral Directors Association
11:10 a.m.Discussion with Attendees
  • What strategies can be used to ensure appropriate planning for fatality management during a mass-casualty incident?
  • What are the resources necessary for ensuring adequate fatality management?
 Jack Herrmann, Session co-chair
 Senior Advisor
 Public Health Preparedness
 National Association of County and City Health Officials
 Lisa Ladue, Session co-chair
 Deputy Director
 National Mass Fatalities Institute
 Cedar Rapids, Iowa
11:45 a.m.LUNCH
SESSION VIII: RAMPING DOWN: WHEN IS IT APPROPRIATE AND HOW CAN ONE BEST TRANSITION AFTER A MASS-CASUALTY INCIDENT?
Session Objective: Discuss what are realistic assumptions about care in the short-term (not immediately following) following a mass-casualty incident. Based on these assumptions, discuss potential criteria and guidelines that may be used to assist stakeholders in transitioning from a surge environment back to a “new normal” level of “steady state” care.
12:30 p.m.Session Objectives and Introduction
 Roslyne Schulman, Session Chair
 Senior Associate Director
 American Hospital Association
12:40 p.m.Panel Discussion: Ensuring Operational Sustainability
Demobilization and Return to Former Operations
 Mark Robitaille
 President and CEO
 Martin Memorial Medical Center, Florida
Reassessment of Needs
 Karen Sexton
 Interim Executive Vice President and Chief Executive Officer
 University of Texas Medical Branch Health System
Rebuilding of the Health Care System
 John Matessino
 President and CEO
 Louisiana Hospital Association
Repatriation
 David Lakey
 Commissioner
 Texas Department of State Health Services
1:20 p.m.Discussion with Attendees
  • When is it appropriate to begin to transition back to “steady state” care?
    • What are the triggers and how can they be recognized?
  • What tools and guidelines are necessary for stakeholders?
  • What should stakeholders be doing now to plan for rebuilding their healthcare system following a large-scale incident?
  • How should a reassessment of need be accomplished?
 Roslyne Schulman, Session Chair
 Senior Associate Director
 American Hospital Association
SESSION IX: FINANCING SURGE CAPACITY AND PREPAREDNESS
Session Objective: Based on workshop discussions, identify funding mechanisms that could be utilized to ensure effective and efficient medical surge capacity preparedness and response. Identify barriers for establishing preparedness and response. Examine potential changes in reimbursement policy to assist the healthcare system during and immediately following a catastrophic event.
2:10 p.m.Session Objectives and Introduction
 William Smith, Session Chair
 Senior Director
 Emergency Preparedness
 University of Pittsburgh Medical Center
2:20 p.m.Panel discussion
 Marc Hartstein
 Deputy Director
 Hospital and Ambulatory Policy Group
 Center for Medicare Management
 Centers for Medicare and Medicaid Services
 Kurt Krumperman
 Clinical Assistant Professor
 Emergency Health Services Department
 University of Maryland, Baltimore County
 Diana Dennett
 Counsel
 AHIP
 Jeffrey Runge
 President
 Biologue, Inc.
3:20 p.m.Discussion with Attendees
  • What resources are required to implement the changes necessary to ensure that the most efficient and effective frameworks are in place?
  • What economic barriers are preventing effective preparedness and response for a mass-casualty incident?
  • How should federal resources be integrated into local and state planning?
  • What changes can be made to the current reimbursement mechanisms to improve the stability of effected healthcare systems, e.g., modified filing deadlines and interim payments, recognizing alternate care sites, flexibility in coding, etc.?
 William Smith, Session Chair
 Senior Director
 Emergency Preparedness
 University of Pittsburgh Medical Center
SESSION X: GENERAL DISCUSSION WITH WORKSHOP PARTICIPANTS AND ATTENDEES
Session Objective: Discuss what opportunities and constraints exist to improve medical surge capacity to a mass- casualty incident. Review opportunities and challenges identified during the workshop. Identify and discuss the most promising near-term opportunities for improving standards-of-care protocols at local, state, and regional jurisdictions.
4:00 p.m.Panel Discussion: Synopsis of Workshop Discussions
 Dan Hanfling
 Director
 Emergency Management and Disaster Medicine
 Inova Health System
 Eric Toner
 Senior Associate
 Center for Biosecurity, UPMC
 Margaret McMahon
 Senior Clinical Editor—Journal of Emergency Nursing
 Emergency Nurses Association
 David Lakey
 Commissioner
 Texas Department of State Health Services
4:20 p.m.Discussion with Attendees
  • What new ideas have surfaced in this workshop that should be explored further?
  • What action steps are required to integrate these strategies into the current public health system?
  • What resources and further infrastructure investments will be necessary in the short- and long-term?
4:45 p.m.Closing Remarks: The Path Forward
 Gerald Parker
 Principal Deputy Assistant Secretary
 Office of the Assistant Secretary for Preparedness and Response
 Department of Health and Human Services
5:00 p.m.ADJOURN
Copyright © 2010, National Academy of Sciences.
Bookshelf ID: NBK32858

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