• Pharmacies; and
• Building facilities managers, especially in urban areas.
Key Questions: Slow-Onset Scenario
1. What relevant information is accessible pertaining to out-of-hospital (home care, hospice, long-term care, clinics, etc.) capacity and resources?
2. What additional information could be accessed in pre-event planning for contingency or crisis response?
3. How would this information drive actions?
4. What patient care delivery changes would be implemented, which ones are needed to address the scenario, and when would they be initiated?
5. What patient care delivery assets are preserved (prioritized) in order to support basic health care delivery needs? What information is needed to make the decision to conserve resources?
6. What indicators demonstrate that patient care services can no longer be sustained?
7. What would be done when durable medical equipment providers can no longer provide home oxygen? Does the agency have contingency plans or contracts to augment current resources?
8. What alternate care facility plans have been developed and exercised in the community and what is each stakeholder’s role in these plans? Are personnel or a facility available to serve in this capacity for response?
9. What would be done when alternate care facilities are at capacity?
10. What would be done when hospice patients are seeking treatment in acute care facilities?
11. How do stakeholders ensure consistency and coordination of community-derived patient care goals?
12. How does the agency ensure that its communications messages are shared with the Joint Information Center (JIC)?
13. In what ways do community-based care providers interface with the broader public health and medical response community (Emergency Support Function- [ESF-] 8)?
14. How is the interdependence among the organizations within a given medical specialty and with other health care delivery systems managed?
15. What plans are made to ensure mission-critical functionality?
16. Does another care model depend on the facility as part of the development of its surge response plans? If so, how is the delivery of care to patients prioritized?
2 Note: Many of the key questions are intended to ensure that planners are thinking about the situational awareness that they will need to make decisions regarding the transition of care in the outpatient setting along the surge continuum, from conventional to contingency to crisis care response. In many cases, the out-of-hospital care facilities will not necessarily have access to such information on an agency basis. Recognition of community partnerships that may facilitate access to this needed information is an important aspect of planning for such events. In particular, participation in local/regional Healthcare Coalitions (see ASPR, 2012) will be a useful entrée to coordinating out-of-hospital care with the health and medical community. These questions are provided to help start discussion; additional important questions may arise during the course of discussion. The questions are aimed at raising issues related to indicators and triggers, and are not comprehensive of all important questions related to disaster preparedness and response.