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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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. 69

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70 MEDICAL SURGE CAPACITY 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; o 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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71 APPENDIX B 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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72 MEDICAL SURGE CAPACITY 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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73 APPENDIX B 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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74 MEDICAL SURGE CAPACITY 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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75 APPENDIX B 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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76 MEDICAL SURGE CAPACITY 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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77 APPENDIX B 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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78 MEDICAL SURGE CAPACITY 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? o What is the optimal technology needed to enable it? o 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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79 APPENDIX B 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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80 MEDICAL SURGE CAPACITY 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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81 APPENDIX B 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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82 MEDICAL SURGE CAPACITY • 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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83 APPENDIX B 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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84 MEDICAL SURGE CAPACITY 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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85 APPENDIX B 1:20 p.m. Discussion with Attendees • When is it appropriate to begin to transition back to “steady state” care? o 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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86 MEDICAL SURGE CAPACITY 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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87 APPENDIX B 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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