Management of Individual Healthcare Assets (Tier 1)
Tier 1 is the primary site for point-of-service (i.e., hands-on) medical evaluation and treatment. It includes hospitals, integrated healthcare systems, clinics, community health centers, alternative care facilities, private practitioner offices, nursing homes and other skilled nursing facilities, hospice, rehabilitation facilities, psychiatric and mental health facilities, and Emergency Medical Services (EMS). The Medical Reserve Corps and State and Federal healthcare assets (e.g., Veterans Affairs Hospitals) that are co-located within a jurisdiction also fall into Tier 1 because they may become local assets for emergency response.
Key Points of the Chapter
In a mass casualty and/or mass effect incident, the vast majority of medical care is provided at the local level in hospitals, outpatient clinics, community health centers, and private physician offices. The success of an incident response, therefore, depends in part on how well these and other point-of-service healthcare organizations (HCOs) are managed and their ability to coordinate with other response agencies.
The ability of an HCO to optimally manage its resources and to integrate with the larger response community is driven by its Emergency Management Program (EMP). The EMP includes all activities undertaken by the HCO to mitigate, prepare for, respond to, and recover from potential hazards. An integral component of the EMP is the Emergency Operations Plan (EOP), which defines the management structure and methodology to be used by an HCO during emergency response. The EOP is critically important because it also describes the management processes that enable the HCO to coordinate its actions with other responders.
The two Incident Command System (ICS) functions that facilitate cooperation among HCOs and integration with the larger response community are the Command element and the Planning Section:
- HCO Incident Command: As an incident unfolds, the HCO incident management team must rapidly transition from reactive to proactive management by establishing HCO incident objectives and setting an overall HCO strategy for response. Information will have to be obtained from both inside and outside the HCO to conduct adequate response planning. A defined management structure that specifies roles for HCO personnel facilitates internal organization and external integration.
- HCO Planning Section: The development of incident action plans (IAPs) and support plans allows the HCO incident management team to remain proactive, even as the incident parameters change. Likewise, a well-defined information function that is always operational (even at a minimal baseline during times of non-response) allows an HCO to rapidly process and disseminate vital incident- related data to divisions within the HCO and to outside responders. This promotes coordination with other entities and consistency across the response system.
- EMS is not usually included in this category and is not a facility per se. In a major emergency or disaster, however, EMS may provide definitive medical care in the field and should be integrated into Tier 1.
- In this document, an HCO is any hospital, integrated healthcare system, private physician office, clinic, nursing home or other skilled nursing facility, or other resource that may provide point-of-service medical care.
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