Public Health Emergency - Leading a Nation Prepared
In the aftermath of the 9/11 terrorist attacks and the dissemination of anthrax in 2001, the ability of the U.S. healthcare system to provide an effective and coordinated response to mass casualty or complex incidents came under intense scrutiny. More recently, the devastation caused by Hurricane Katrina and the mass disruption of public health and medical services along the Gulf Coast spotlighted the need for cohesive strategies that focus on management systems for major public health and medical response. The critical question becomes:
What management structure will allow us to discuss, analyze, and describe complex medical and public health response under exceptional circumstances as a single system?
Examinations of major public health and medical emergencies reveal exceptionally complex management scenarios. This is true for all hazard types (natural disasters, infectious diseases, terrorism, large-scale explosives, and etc.) and is apparent even in events without large numbers of physically injured or ill patients. Medical evaluation and treatment of incident victims require many complicated tasks that extend beyond hands-on medical care and are dispersed across a wide range of resources. Surprisingly, however, the management of such complex scenarios has received very little attention.
In addition to ensuring adequate patient care, critical management responsibilities in major medical and public health incidents include:
Given the complexity of response to major public health and medical events described here and elsewhere, sustainable solutions to these multifaceted challenges have been elusive. The MSCC Management System proposed in this document outlines and recommends a systems-based approach that focuses on the management solution for these complex tasks. It describes how to manage, within a single system, the diverse public health and medical entities involved in incident response, and it identifies mechanisms to integrate medical and public health assets with traditional response disciplines (e.g., public safety, emergency management).
The basis of the MSCC handbook is the Medical and Health Incident Management (MaHIM) System, the first published U.S. effort to conceptually address the complex health and medical issues that arise during major medical incidents. The MaHIM model provides a comprehensive system description of the functional components critical to effective response for any mass casualty event. It further describes the processes that coordinate these functions to limit morbidity and mortality after exposure to a hazard. The MSCC Management System extracts key concepts from MaHIM to develop practical, operational guidance for medical and health emergency planners.
The goal of this project is to develop a management system (framework) that promotes public health and medical system resiliency and maximizes the ability to provide adequate public health and medical services during events that exceed the normal medical capacity and capability of an affected community.
The primary objectives of this project are to:
As shown below, the MSCC handbook presents a system for management integration that ranges from the individual healthcare organization (HCO) through jurisdictional, State, and Federal Government levels. Because of the local jurisdiction's central role in providing MSCC, the handbook's primary emphasis is on jurisdictional incident management and the coordination and support of HCOs. The handbook also highlights the functions and processes that promote integration of assets into an overall response system and coordination between assets.
The MSCC Management System is designed to promote the integration of existing programs for incident management used by hospitals, public health, and traditional response entities into an overarching management system for major public health and medical response. It defines the basic requirements for medical and public health asset participation in the overall response system. Rather than focus on narrow topics (e.g., communications or training), the MSCC Management System examines functional relationships across the range of response needs. In so doing, it provides a systematic approach to organize and coordinate available public health and medical resources so they perform optimally under the stress of an emergency or disaster.
The MSCC Management System seeks to enhance management integration and coordination by:
This handbook does not focus extensively on the internal management of individual public health and medical assets, nor is it specifically for hospital emergency preparedness. It does not attempt to redefine the operational methods of other entities (e.g., law enforcement, fire service, emergency management) that also have as primary missions the preservation of life and/or critical infrastructure. Though the handbook describes overall management processes and systems, it is not a compre-hensive, standalone description of MSCC. For example, it does not address the specific amounts of materials, personnel, and other resources required for specific numbers of patients. Moreover, it provides only a general description of Federal programs that currently exist, or those in development, to address quantitative adequacy in surge capacity.
The National Response Plan and individual Federal health and medical programs should be accessed for specifics on these Federal capabilities.
The MSCC Management System is intended for all professionals in the U.S. who are involved in planning for, responding to, and recovering from domestic public health and medical emergencies or disasters. They include, but are not limited to, public health (State and local) and emergency management personnel, emergency planners, planners at hospitals or other community health and medical organizations, public safety personnel, healthcare executives, public health and medical providers, and political officials responsible for emergency preparedness and response. The handbook is meant to promote collaborative planning and discussion among these professionals.
Readers may apply the management processes detailed in the MSCC handbook to ongoing preparedness planning activities. Whether undergoing initial development or revision of existing plans, readers are encouraged to examine portions of the MSCC applicable to their specific situation. Incorporating the MSCC guidance may enhance their ability to interface with other response entities. Most importantly, the material presented is intended to promote cooperative planning and community integration of public health and medical assets into the overall response. The material is also relevant as an evaluative measure during after-action analyses, and in developing and implementing education, training, drills, and exercises.
The concepts are applicable to response across all hazards, from small incidents to the largest and most intense events. They are presented in a manner that demonstrates their consistency with NIMS, a requirement for Federal funding. In fact, the MSCC Management System was incorporated into the 2006 guidance for the Hospital Preparedness Program (HPP). This represented a major shift in the program's focus towards the development of management systems for emergency public health and medical response. HPP awardees should use the MSCC to promote more consistent terminology, processes, and interfaces between HCOs and the various disciplines and levels of government involved in emergency preparedness and response.
The management processes described in the MSCC may also be leveraged to integrate local capabilities developed through other Federal programs, such as the Metropolitan Medical Response System (MMRS). MMRS program guidance embodies the concepts of the MSCC Tier 3, requiring jurisdictions to develop linkages among first responders, medical treatment resources, public health, emergency management, volunteer organizations, the private sector, and other jurisdictional elements. Finally, readers may apply MSCC management processes during exercises and small or low-intensity events (e.g., managing community healthcare issues in a snow emergency) to prepare for response under more severe incident stress.
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