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OCR for page 69
Medical Surge Capacity: Workshop Summary
B
Agenda
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.
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Medical Surge Capacity: Workshop Summary
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.
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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-casualty 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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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.
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
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Medical Surge Capacity: Workshop Summary
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?
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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
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Medical Surge Capacity: Workshop Summary
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.
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Medical Surge Capacity: Workshop Summary
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
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