Despite the progress in regional coalitions and cross-sector collaborations, much of the progress from coordinating regional partnerships developed over the past decade is in jeopardy because, as Lori Upton of the Southeast Texas Regional Advisory Council and Rosanne Prats of the Louisiana Department of Health and Hospitals pointed out, the Hospital Preparedness Program (HPP) continues to be cut. At risk is the capacity and capability to effectively evacuate patients, sustain operations in the throes of an emergency, balance the surge from increased volume of patients throughout a community, and establish systems to reunite families following an emergency. As funding for regional coalitions and HPP continues to be uncertain, coming up with innovative approaches to address surge capability across regions, casting a wide net when building pre-disaster relationships, and working to better integrate systems and decrease redundancies will be on the forefront for communities across the nation. As a country, Jennifer Ward of the Trauma Center Association of America said we should be building on the day-to-day trauma and health care systems, but in addition, health care delivery systems and public health departments can also continue to integrate elements of disaster planning into everyday routines. In addition, there is an opportunity to “socialize” the concept of preparedness wherever possible to increase our national capacity for surge management, information sharing, and community engagement.
Many of the speakers and participants underscored the importance of strong information sharing across multiple case studies. These elements can include
- Strong public–private partnerships;
- Effective rumor control/media monitoring;
- Effective public health message coordination;
- Institution of surveillance to improve situational awareness; and
- Effective communication among and between cities, counties, and states.
Some incidents may demand more of one than another, but taking the time to consider each element during a response could allow for more robust regional coordination and healthier outcomes. In any chaotic situation or disaster, accurate communication among so many stakeholders will be a challenge. However, as discussed throughout, and as Rahul Gupta, West Virginia Health Department, Dan Hanfling, UPMC Center for Health Security, and John Osborn, Mayo Clinic College of Medicine, noted, exchanging information and bringing partners together often throughout the response, identifying the right data to collect to improve situational awareness, and encouraging inclusive regional health care coalitions are a few ways this challenge can begin to be alleviated.
Many overlapping successful elements emerged regarding successful coordination. These included promoting interagency communication, building trust and relationships, holding mutual interests and objectives, developing local decision-making capacity, possessing effective negotiation skills, and using credible science to inform decision making.
Effective community engagement in the planning stages, and information sharing and management in the response stages, can each help to reduce the clinical surge during a large regional disaster. Several speakers described policies their region has instituted to reduce the flow of nonemergency patients to emergency departments during a disaster. This concept—using community outreach in planning phases and transparent information sharing during response phases—was reiterated throughout the regional meetings, as was the importance of coalition building and sustainability. Looking forward in the face of health impacts from climate change and unknown emerging threats across the globe, regions could broaden their focus on coalitions to include and sustain nontraditional partners, think proactively and integrate health information technologies, and use all available services in a community to effectively ensure successful health outcomes.