Public Health Emergency - Leading a Nation Prepared
The comprehensive EMP should establish processes that enable the HCO to coordinate and integrate with other response entities. This helps the HCO adequately provide MSCC and becomes critically important when an asset is severely challenged and must seek external assistance.
Why is it important for individual health and medical assets to have an effective interface with other tiers?
Consider the scenario of a bombing incident with large numbers of casualties. Patients may self-refer or be transported by official jurisdictional assets to multiple treatment locations. This occurred after the Pentagon attack on 9/11, as patients were transported to hospitals around the region and others self-referred to hospitals and at least two clinics (one of which was in the Pentagon). Having individual HCOs effectively integrated with other tiers will facilitate:
The two major functional areas that facilitate cooperation among HCOs and integration of individual HCOs with non-medical responders at the jurisdiction (Tier 3) level are the Command element and Planning Section.
There must be a clearly defined and tested command structure in place within an HCO in order for the facility to coordinate externally with other response entities. As an incident unfolds and details begin to emerge, the HCO incident management team should quickly transition from reactive to proactive management; this is best accomplished by establishing HCO control and operational period objectives for the response. These objectives should be defined and documented through incident planning—a process in which the incident management team outlines a response strategy and specific actions for the HCO. The result is often a formal IAP for the facility.
The IAP should be shared with HCO staff so that they understand the "larger picture" of what is happening and how their facility is responding. The IAP should also be shared externally with other local HCOs and with jurisdictional authorities (Tier 3) to enhance their understanding of the event, the response parameters, and the status of the HCO. Because some facilities may be reluctant to share their IAPs due to concerns about proprietary information, critical components (e.g., updated situation reports, resource status reports, safety and communication plans) can be isolated from internal, more sensitive material. The latter may be designated as an internal support plan and not distributed externally.
Within the Command element of ICS are multiple subfunctions that help integrate individual HCOs with other responders:
The Planning Section plays a critical role because of its involvement in processing information and developing IAPs for the HCO. When shared with other local HCOs (through Tier 2) and jurisdictional (Tier 3) authorities, the HCO IAP provides strategic information to help coordinate response efforts, and may give advance warning if mutual aid support will be necessary. For example, a strategy outlined in an HCO IAP to vaccinate staff enables other organizations to decide whether they want to proceed similarly. Even if uniform measures are not adopted across a jurisdiction, this knowledge allows HCOs to reassure their staff and the public as to why they elected a particular course of action. In addition, HCOs use long-range planning to predict extended resource needs (e.g., supplies, personnel), and contingency planning to identify alternative response actions should incident parameters change. Both long-range and contingency planning will necessarily involve close integration with organizations external to the HCO.
Information from other local health and medical assets will be critical to allow optimal coordination and operation of internal HCO divisions. By operating a well-established information management function at baseline, HCOs can receive the earliest reports of an event and immediately begin processing and distributing information within the facility and externally. Similarly, data generated by an HCO (e.g., number of emergency department visits) may provide first warning of an impending crisis and can be quickly sent to other HCOs, jurisdictional emergency managers, and public health officials to establish incident parameters.
Information on the numbers of patients seeking care in the emergency department for potential exposure to anthrax can be important to the HCO for both internal and external reasons. HCO managers could use this information to determine if objectives are being accomplished, to anticipate staffing needs for the next operational period, and to determine the need for external assistance. The data might also be analyzed for operational relevance (e.g., did patient concerns about potential exposure arise from a lack of information from jurisdictional incident management?). Similarly, it is important to transmit this information (through the HCO's senior liaison) to jurisdictional (Tier 3) incident management. Both the absolute numbers and the analysis that patients presented because of a lack of jurisdiction information would be important for Tier 3 in analyzing the effectiveness of their strategy and tactics.
An important part of information management is deciding who does not need specific information. In this example, regular inpatient units may not require detailed information about emergency department operations (though this information would be available to them, as requested, through an adequately disseminated HCO IAP). Instead, a brief status report indicating the number of patients evaluated and discharged in the emergency department may give inpatient staff an adequate sense of what is occurring without providing overly detailed information.
Provided below are several mechanisms to promote HCO integration with other tiers through an adequate information management function:
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