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U.S. Department of Health and Human Services

Performance Measure 21

Goal or Target

SPPR will establish a baseline based on performance data collected in initial fiscal years, which will be used to set programmatic targets and goals for subsequent years. As the CST exercise (Phase 1) concludes at 90 minutes, each HCC’s goal is to complete the exercise within 90 minutes.

Operational Intent

Once evacuating patients and receiving facility beds have been identified and counted, appropriate modes of transport for patients should be identified. This indicator measures how quickly HCCs can coordinate between EMS, evacuating facilities, other member organizations, and community resources to identify appropriate transport for evacuating patients.

Data Reporting

During the specified time period for end-of-year reporting, each HCC should report the following data in the CAT. Recipients should enter this information on behalf of each HCC into the end-of-year performance measure module in PERFORMS. SPPR will calculate percentages.

Data Point Data Entity Data Source Response
PM21.1 Time in minutes for an available and appropriate mode of transport to be identified for the last evacuating patient after start of a Coalition Surge Test (or real-world evacuation of at least 20 percent of the coalition’s total staffed acute care beds)HCCCST (or AAR/IP)

HCC Name:________

Time: ________(min)

Definitions and Interpretation

  • Time [in minutes]: Measured from the start of Phase 1 of the CST and ending when the last evacuating patient has an available and appropriate mode of transport identified or 90 minutes elapses, whichever is less. If an available and appropriate mode of transport is not identified for the last evacuating patient before 90 minutes elapses, the HCC should indicate ‘not complete in 90 minute Phase 1 exercise’.

  • Appropriate mode of transport to be identified for the last evacuating patient: Evacuating facilities are instructed to take a current patient count and to work (using whatever communication mechanisms it would during a real evacuation) to find appropriate destinations and appropriate transport for each patient. Appropriate refers to the clinically appropriate decision based on the patient’s specific health care needs. However, there will be no movement of actual patients. Evacuating facilities identify appropriate mode(s) of transport that could move patients to their new locations (players are asked to match transportation assets to each individual patient). The LEAD Excel tool from the CST provides a table for organizing this information.

  • CST: The CST tests a coalition’s ability to work in a coordinated way using their own systems and plans to find appropriate destinations for patients by using a simulated evacuation of inpatient facilities (that collectively represent at least 20 percent of a coalition’s staffed acute care bed capacity). The CST is designed to help HCCs identify gaps in their surge planning through a no- or low-notice exercise. The exercise’s foundation comes from a real-world health care system disaster challenge—the evacuation of a hospital or other patient care facility. Further, the test incorporates lessons learned from pilot tests with HCCs in South Dakota, Texas, Michigan, and Wyoming, which contributed significantly to the tool’s development. The test is available and free for all to use in their health care disaster preparedness and planning. The CST and related materials are available online.

  • AAR/IP: An AAR/IP is used to provide feedback to participating entities on their performance during an exercise. The AAR/IP summarizes exercise events and analyzes performance of the tasks identified as important during the planning process. It also evaluates achievement of the selected exercise objectives and demonstration of the overall capabilities being validated. The IP portion of the AAR/IP includes corrective actions for improvement, timelines for implementation of corrective actions, and assignment to responsible parties. AAR/IPs should follow HSEEP principles, and HPP will provide an optional template for future use. 15

15.Phase 4: After Action Report and Improvement Planning.” City and County of San Francisco Department of Emergency Management. Accessed 6 Aug. 2020.

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  • This page last reviewed: November 05, 2020