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U.S. Department of Health and Human Services

Management of the Healthcare Coalition (Tier 2)


Management of the Healthcare Coalition (Tier 2)Image shows figure 1-2’s six-tier construct depicting the various levels of public health and medical asset management during response to mass casualty and/or mass effect incidents. Emphasis is put on Tier 2: Healthcare “coalition” (info sharing, cooperative planning, mutual aid

The healthcare coalition (Tier 2) is composed of healthcare organizations (HCOs) and other assets described in Tier 1 that form a single functional entity to maximize MSCC in a defined geographic area. It coordinates the mitigation, preparedness, response, and recovery actions of medical and healthcare providers, facilitates mutual aid support, and serves as a unified platform for medical input to jurisdictional authorities (Tier 3).

Key Points of the Chapter

In a mass casualty and/or mass effect incident, HCOs[1] may lack the necessary resources and/or information to individually provide adequate MSCC. The healthcare coalition (Tier 2) attempts to maximize MSCC by coordinating mitigation, preparedness, response, and recovery activities among all HCOs in a jurisdiction. This allows existing medical and public health resources to be optimally leveraged, and it promotes interfacility cooperation and support. Tier 2 also promotes coordination with jurisdictional authorities (Tier 3) by providing a unified platform for medical and public health asset integration into the community response.

The healthcare coalition (Tier 2) emphasizes coordination and cooperative planning rather than a truly "unified command" of all public and private medical and health assets. This is because health and medical assets retain their individual management autonomy during incident response. However, they participate in information sharing and incident planning to promote consistent management strategies. The management organization and decision process of Tier 2, therefore, is less structured than in Tiers 1 and 3 since decision authority resides primarily at the level of each HCO. Rather than "commanding" HCOs, Tier 2 brings them together to collaborate on strategic issues and to coordinate incident planning, response, and recovery activities. Tier 2 is essentially a NIMS-consistent Multiagency Coordination System (MACS), with the coalition providing the Multiagency Coordination Center (MACC) functions, and intermittent conferencing of HCO decision-makers providing the Multiagency Coordination Group (MAC Group) component. Ideally, these efforts are closely integrated with the jurisdiction's (Tier 3) preparedness planning and response activities.

The function in Tier 2 that collects, processes, and disseminates data and information is referred to as a "clearinghouse function." It ensures that all HCOs have the information they need to adequately prepare for and respond to major events. This information exchange builds consistency in response activities and in the public message. It also allows the Tier 2 coalition to effectively integrate with non-medical responders at the jurisdiction level (Tier 3) by providing timely and accurate "snapshots," or composite situation updates of local HCO operations.

An integral component of the coalition response is medical mutual aid—the redistribution of personnel, facilities, equipment, or supplies to HCOs in need during times of crisis. Mutual aid provides surge capacity and capability that is immediately operational, reliable, and cost-effective. The Tier 2 coalition provides a mechanism to formally establish processes for requesting and receiving mutual aid during preparedness planning. It also allows such issues as staff credentialing, liability, reimbursement, and transfer of patient responsibility to be addressed in preparedness planning, thus ensuring a rapid distribution of aid when it is needed.

  1. In this document, an HCO is any hospital, integrated healthcare system, private physician office, clinic, community health center, nursing home or other skilled nursing facility, or other resource identified in Tier 1 that may provide point-of-service medical care.

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  • This page last reviewed: February 14, 2012