6State Public Authority Process: Event-based use of State Disaster Medical Advisory Committee

The Event:

7Incident Management – State Role; Community and Provider Engagement: Stakeholder roles and involvement

In early fall, a novel influenza virus was detected in the United States. Cases rapidly spread across pockets of the United States. The virus exhibited a mortality rate double the usual expected influenza mortality, with a predilection toward school-age children. Emergency departments across the state began to see a marked rise in patient volumes, and concerns were expressed that resources required for the sustained delivery of patient care might be strained. The state disaster medical advisory committee6 was convened, with supplemental representation from pediatric and pediatric critical care in addition to the committee’s usual representatives. The committee made revisions to their prior guidance to manage a surge in patient care demand based on available epidemiologic information. Information was circulated to clinicians and nursing personnel7 reminding them of the planning work and several interviews and television news features were used as an opportunity to reinforce hopeful, yet realistic messaging about preparedness8 for a possible scarce resource situation. The state Department of Health (DOH) opened their Department Operations Center9 to monitor the situation, passing along updates from the Centers for Disease Control and Prevention (CDC) and other partners as needed. The State Disaster Medical Advisory Committee (SDMAC) worked with DOH staff to develop and vet outpatient screening tools. A few of the in-state regional hospital coalitions convened their own regional advisory committees10 to modify and customize this guidance to make it applicable for their local needs. At the hospital level, pandemic planning included members of the predesignated disaster clinical care committees11, who approved and/or modified these tools and guidance for institutional use. As the pandemic increased in intensity, state and regional advisory committee members updated contact information and participated in weekly conference calls.

8Crisis Standards of Care Operations: Use of Regional Disaster Medical Advisory Committee

9Department Operations Center

10Incident management – State Agency Role

11Clinical Process and Operations: Clinical care in crisis situations

12Indicators and Triggers: Situational awareness

Monitoring12 of hospital ICU occupancy, hospital divert status, healthcare provider absenteeism, and business closures demonstrated a worsening situation in the state in late October. The state requested activation of the Strategic National Stockpile (SNS) for delivery of additional antiviral medications and personal protective equipment

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