Key Issues

The out-of-hospital system could be impacted directly by the crisis scenario (e.g., damage to a long-term care facility or dialysis center) or indirectly by requested support for surge in the other components of the health care spectrum (e.g., early discharge from hospitals creating surge in home care needs). The engagement of the out-of-hospital care delivery partners with local public health and in health care coalitions is critical to ensuring that resources are maximized during disasters or public health or medical emergencies. Maximization of out-of-hospital care improves access to care (and thus potentially avoids complications) and reduces the pressure on emergency departments and inpatient care. Creating bidirectional communication linkages among the components of the out-of-hospital providers and with the other traditional medical providers helps to ensure the ability to function effectively during crises. This is also important for better coordination with emergency management, which has the primary responsibility for ensuring the continuity of private-sector resources.

DISCUSSION AND DECISION-SUPPORT TOOL

Suggested participants for a discussion focused on out-of-hospital care are listed below. Building on the scenarios and overarching key questions presented in Chapter 3, this tool contains additional questions to help participants drill down on the key issues and details for out-of-hospital care. It also contains a chart that provides example out-of-hospital care indicators, triggers, and tactics, and a blank chart for participants to complete. The scenarios, questions, and example chart are intended to provoke discussion that will help participants fill in the blank chart for their own situation.1 Participants may choose to complete a single, general blank chart, or one each for various scenarios from their Hazard Vulnerability Analysis.

Discussion Participants

Suggested participants for a discussion focused on out-of-hospital are listed below.

• Local public health;

• Home care agencies;

• Assisted living;

• Long-term care;

• Skilled nursing facilities;

• Outpatient clinics (multispecialty group practices, federally qualified health centers, dialysis centers, etc.);

• Private practice community;

• Hospice care;

• Specialty associations (e.g., dialysis networks);

• Behavioral health providers;

• Poison control and other call centers;

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1 The blank table for participants to complete can be downloaded from the project’s website: www.iom.edu/crisisstandards.



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