Section 5: Select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities Performance Measures

This section only applies to the U.S. Territories of American Samoa, Commonwealth of Northern Marianas, and U.S. Virgin Islands; the Freely Associated States of Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands; and Remote and Isolated Frontier Communities. The U.S. Territories of Guam and Puerto Rico are not included in this category and shall report on all performance measures (PMs) except 23 to 28. Select U.S. Territories, Freely Associated States, and remote and isolated frontier communities who complete PMs 23-28 are not required to complete PMs 14-21, which are specific to the CST.

Please refer to the section, Overview of Performance Measures for Select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities, for guidance on measures in other sections of this document that are relevant to these select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities. For a crosswalk of PMs to the 2017-2022 Health Care Preparedness and Response Capabilities, see Appendix 3: Crosswalk of Performance Measures to 2017-2022 Health Care Preparedness and Response Capabilities.

The following table lists the data entity—the organizational level at which the data are captured (recipient or HCC)—and PM type for each PM:

The definitions for the PM types are:

• Output: Products and services produced by HPP activities; and,
• Outcome: Changes or benefits resulting from program activities and outputs. Outcomes can be intended or unintended, positive or negative, and are often divided into short-, intermediate-, and long-term timeframes.

Hospital Surge Test

The HST will only be required annually for the select U.S. Territories, Freely Associated States, and Remote and Isolated Frontier Communities. The HST is a user-friendly peer assessment designed to identify gaps in a hospital’s preparedness and help assess its ability to respond to a mass casualty event. The HST includes a low- to no-notice exercise and incorporates the real-life considerations of health care delivery in acute care settings. The HST is intended for use by hospital emergency managers, hospital administrators, and clinical staff to assess and improve their hospital’s surge plans. Hospitals need to exercise their preparedness for a mass casualty incident regularly. The HST can help hospital emergency managers make recurring table top exercises a reality by providing a fully-developed table top exercise that can be used at their facilities. The HST has two components, one for triaging patients in the emergency department (ED) and another for the hospital incident command center.

The HST measures were waived for FY2019 (July 1, 2019 – June 30, 2020) due to COVID-19 response.  

Command Center Table Top Exercise Component

The Command Center component requires incident command leadership and necessary staff to respond and to assess capabilities, such as bed availability within the facility. Both the Command Center and ED components of an exercise are run concurrently.

Emergency Department Table Top Exercise Component

The Emergency Department (ED) component requires that the players in the exercise, typically a nurse and physician, be free of clinical duties and able to take instructions from the Command Center during the course of the exercise. They will be asked to triage the auto-generated list of patients who are presenting. The ED must be able to communicate with the hospital’s Command Center.

Expected Outcomes

At the conclusion of the exercise, there will be an after action review to discuss a variety of quantitative and qualitative metrics. The after action review includes feedback from the two areas of activity for the exercise, the ED and Command Center. This is supported by graphical displays of data that are automatically generated using the data collected throughout the exercise. These data displays, which can be projected on screen and saved for future use, include:

1. Immediate Bed Availability Over Time
2. Patient Arrivals Over Time (By Criticality Type)
3. Patient Transfers Out of the ED Over Time

Staff Commitments & Time Requirements

In order for the exercise to be successful, four peer assessors, preferably from another health care entity, are required. Two will be positioned in the ED at the start of the exercise (with their laptops and applicable exercise software); two will be positioned in the Command Center (with their laptops and applicable software).

The peer assessor roles are:

1. The ED Controller
2. The ED Qualitative Evaluator
3. The Incident Command (Command Center) Evaluator
4. The Bed Control Evaluator

As mentioned above in the ED Table Top Exercise Component section, two ED staff, typically a doctor and a nurse, who are free of other clinical duties for the duration of the actual exercise (75 to 90 minutes), need to be on hand. These ED staff will triage the auto-generated list of patients who are presenting. The Command Center component requires incident command leadership and necessary staff to respond and to assess capabilities, such as bed availability within the facility.

HPP estimates that it will take two to three hours for the exercise director to become familiar with the HST materials. The HST should take between 90 minutes to two hours to complete. The exercise scenarios can be modified and customized by incident type, patient load, and treatment requirements. Additional time (approximately one to two hours) is also necessary for an after action review with the peer assessors (as described above).

The current version of the HST incorporates lessons learned from pilot tests with a number of hospitals during the second half of 2014. To learn more about the HST and how it works, see the HST. For additional questions, or to discuss this tool further, please contact your HPP FPO.

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