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U.S. Department of Health and Human Services

Executive Summary

This handbook was developed to serve as a companion to Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources during Large-Scale Emergencies, also known as the MSCC Handbook. Originally published in 2004 and revised in 2007, the MSCC Handbook proposed a management structure and processes for the medical and public health response to emergencies and disasters. Within this management construct, the Tier 2 Healthcare Coalition was defined as a group of individual healthcare organizations in a specified geographic area that agree to work together to maximize surge capacity and capability during medical and public health emergencies by facilitating information sharing, mutual aid, and response coordination.

The purpose of this handbook is to provide guidance to healthcare planners on how to develop, implement, and maintain cost-effective and response-oriented Healthcare Coalitions. It describes the common elements of an effective Healthcare Coalition that may be applied in any locale to operationally support individual healthcare organizations and the larger community response to emergencies or disasters. The Coalition is highlighted as an emergency response organization in order to distinguish this handbook from other efforts that are underway across the U.S. that primarily coordinate emergency preparedness.

For the Healthcare Coalition to achieve its desired functionality during incident response, it must have the capability to address the time stresses and uncertainty of major healthcare emergencies. The processes used to coordinate preparedness activities often are not conducive to the emergency context. Instead, response methods in this handbook are based upon those set forth in the Incident Command System (ICS) and the National Incident Management System (NIMS). The recommended response platform for the Healthcare Coalition can become immediately operational at all times, can focus on the Healthcare Coalition’s tasks as its primary mission, can expand as necessary to support its member organizations, and can sustain operations over time.

The Healthcare Coalition must have a baseline operational capability that is always available to receive initial information about an emergency (one that is already occurring or an imminent threat) and rapidly notify Coalition member organizations. This baseline capability does not need to be time or resource intensive. The Healthcare Coalition then mobilizes and activates processes for response using a medical Multiagency Coordination System (MAC System) that supports, but does not supplant, the incident response activities of individual healthcare organizations (Tier 1) and jurisdictional authorities (Tier 3). Within this handbook, the terms Healthcare Coalition Response Team and Senior Policy Group are used to describe the primary elements of the Coalition’s MAC System. Provided below is a general description of each element; however, the specific objectives, construct, and procedures for each element are expected to vary from Coalition to Coalition.

  • Healthcare Coalition Response Team (HCRT): The HCRT coordinates response activities between individual healthcare organizations (Tier 1) and between the Healthcare Coalition and jurisdictional authorities (Tier 3). A primary purpose for any Healthcare Coalition is to promote optimal situational awareness for its member organizations through the collection, aggregation, and dissemination of incident information. The HCRT can also facilitate resource support (mutual aid) between Coalition members, as well as assist with the acquisition and distribution of aid from other sources (e.g., jurisdictional authorities). An ICS-based organizational model is recommended for the HCRT because of its proven effectiveness in managing complex activities during incident response. However, despite this proposed model, it is important to emphasize that the HCRT serves principally as a coordinating entity in support of Coalition member organizations. It does not “command” the actions of Coalition members or any other response entities it might interact with during an emergency.
  • Senior Policy Group: This group represents the executive leadership of the Coalition’s member organizations. The Senior Policy Group convenes only as needed during an emergency to make high-level strategic or policy decisions, maintain situational awareness for senior executives, and monitor the strategic effectiveness of the HCRT.

The guidance contained in this handbook is not prescriptive. Because each local jurisdiction or regional area is unique, the Coalition’s structure and/or the processes that it uses may vary based on myriad factors. For example, Coalitions based in different geographical regions may choose to address a different set of response issues. The common elements described in this handbook should be adapted to reflect the realities of emergency management in a locale and to enhance (not replace) existing structures and processes used to prepare for, respond to, and recover from major healthcare emergencies and disasters.

When effectively implemented, the Healthcare Coalition provides the mechanisms for individual healthcare organizations to coordinate information sharing and other response actions using efficient response processes and procedures. A side benefit of the Healthcare Coalition for its member organizations may be an improved ability to project visible competency to the public during emergencies. In addition, participation in a Healthcare Coalition addresses accreditation and regulatory requirements for community emergency planning and other emergency preparedness activities. These benefits make the Healthcare Coalition an attractive vehicle for preparedness within the healthcare industry.

The success and long-term sustainability of a Healthcare Coalition will depend largely on the ability to develop a cost-effective system that is supported by senior executives of member organizations and by the relevant jurisdictional authorities. To overcome the day-to-day business competition that exists between healthcare organizations, the Coalition must promote open and fair representation for all its members. At the same time, the Coalition must respect the management sovereignty of each organization during incident response and recovery, as well as the inherent governmental authority of Emergency Management, Public Health, Emergency Medical Services, and other relevant public agencies.


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  • This page last reviewed: February 14, 2012