Providing Mass Medical Care with Scarce Resources:

[sharon sanders]

]Providing Mass Medical Care with Scarce Resources:
A Community Planning Guide


Purpose of the Guide
The purpose of this guide is to provide community planners – as well as planners at the facility/community, institutional, State, and Federal levels – with valuable information and insights that will help them in their efforts to plan for and respond to a mass casualty event (MCE). This guide provides information on:
�� The circumstances that communities likely would face as a result of an MCE.
�� Key constructs, principles, and structures to be incorporated into the planning for an MCE.
�� Approaches and strategies that could be used to provide the most appropriate standards of care possible under the circumstances.
�� Examples of tools and resources available to help States and communities in their planning process.
�� Illustrative examples of how certain health systems, communities, or States have approached certain issues as part of their MCE-related planning efforts.
This information will be useful in helping planners address the issues associated with preparing for and responding to an MCE in the context of broader emergency planning processes, such as those laid out in Standing Together: An Emergency Planning Guide for America’s Communities, published by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO, 2005).
This document is not intended to reflect HHS policy, but to provide State and local planners options to consider when planning their response to an MCE.

http://www.ahrq.gov/research/mce/mceguide.pdf

 

[sharon sanders]

Re: Providing Mass Medical Care with Scarce Resources:

This is a MUST READ.

 

[sharon sanders]

Re: Providing Mass Medical Care with Scarce Resources:

CONSIDER VULNERABLE POPULATIONS.

Explicit planning must occur at all levels for vulnerable populations including infants, children, the frail elderly, pregnant women, the disabled and the mentally ill, and those with chronic medical conditions (e.g., cardiac, dialysis, HIV, and oncology patients). Experience has demonstrated that without explicit planning, the needs of these populations will not be adequately met. Planners must ensure that appropriate expertise is included; and that they understand that specialty caregivers are valuable resources. Specific pediatric issues planners must consider include:
�� Children have physiologic, anatomic, developmental, and emotional differences that require appropriate planning and equipment.
�� The overwhelming effect of caring for children on the emotions of our health professionals must be appropriately managed.

DEVELOP ROBUST SECURITY PLANS. Security is especially important in the case of a large-scale MCE due to the chaos and confusion such an event engenders. Having a uniformed presence (e.g., hospital security personnel, off-duty police officers, National Guard members, volunteers) helps maintain order as do clear identification tags; visiting rules; and procedures for accessing supplies, service sites, and patients.
Clearly, the optimal allocation of scarce resources in response to an MCE is unlikely to occur without proper advance planning at the institutional, community, State, and Federal levels. Simply put, the goal of this document is to promote and assist in those planning efforts.

 

[sharon sanders]

Re: Providing Mass Medical Care with Scarce Resources:

DUAL DECLARATIONS.

Community health planners must be prepared to respond to emergencies under a new legal framework consistent with a state of emergency, disaster, or public health emergency. Assessing responses can be complicated, however, particularly when jurisdictions issue conflicting declarations of emergency. For example, as occurred in Louisiana in responses to Hurricane Katrina in 2005, a State governor may declare a general state of emergency initially (because the standard for such a declaration is often broader) and declare a public health emergency later as specific facts unfold. Two major problems arise from dual declarations: (1) the flow of specific powers and protections from emergency declarations vary depending on the type of declaration, and (2) responsibility and authority for emergency responses may become convoluted when differing State or local agencies are legislatively assigned to coordinate responses.18 In some States, public health authorities are responsible for managing a public health emergency while public safety or emergency management authorities handle general emergencies.19 Although advance emergency planning at State and local levels may limit potential conflicts, murky issues of governmental responsibility and authority can cloud key decisions in allocating scarce resources.

 

[sharon sanders]

Federal Power

Federal Power

FEDERAL DECLARATIONS.
The Federal Government also has the power to declare an emergency or disaster. The President may declare a national emergency pursuant to the National Emergencies Act of 1976.20 The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act)21 also grants presidential declarations of an emergency or major disaster and vests the President with various powers to coordinate and implement disaster response assistance measures. The President may authorize emergency assistance "to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe in any part of the United States" at the request of a State governor or when the emergency is primarily a Federal responsibility.22 Under the Stafford Act, depending on whether the event is an emergency or a major disaster, the Federal Government has differing powers to assist in response efforts.23 For example, Federal disaster assistance is only available on the request of the State Governor for major disasters, including natural catastrophes, fires, floods, or explosions, "of such severity and magnitude that effective response is beyond the capabilities of the State and the affected local governments?."24
In addition, pursuant to the Public Health Service Act, 25the HHS Secretary is authorized to declare a public health emergency.26 This declaration authorizes a host of Federal actions. At any time, the HHS Secretary may deploy members of the Public Health Service or intermittent disaster response personnel to assist in meeting surge capacity in health care facilities nationwide.

 

[sharon sanders]

CDC guidlines may impact local distribution decisions

CDC guidlines may impact local distribution decisions

Federal or State agencies may prescribe specific laws or guidance concerning the prioritization of vulnerable populations in making decisions involving distribution of scarce resources. For example, during the 2004?2005 influenza season, flu vaccines ran short because of manufacturing problems with a major supplier. The Centers for Disease Control and Prevention (CDC) issued guidance concerning distributions of available vaccine that prioritize infants, the elderly, and pregnant women. Many States legally incorporated CDC guidance into their own State allocation decisions.30 These types of legal actions prior to and during emergencies demonstrate how laws can facilitate allocation decisions (literally by dictating a specific outcome), but also how they may interfere with local decisions of community health planners (who may not agree always with lawmakers and policymakers concerning specific allocations).

 

[sharon sanders]

Re: Providing Mass Medical Care with Scarce Resources:

Requiring hospitals to adhere to EMTALA provisions during emergencies may be unworkable, especially when they are engaging in triage to filter and treat patients. Recognizing the burden that EMTALA would impose on multiple hospital systems during Hurricane Katrina, HHS temporarily suspended its application in affected regions.35 The HHS Secretary waived EMTALA sanctions for a specified time period (not to exceed 72 hours from implementation of a hospital?s disaster protocol).

note:

EMTALA = Emergency Medical Treatment and Active Labor Act.

It is a statute which governs when and how a patient may be refused treatment or transferred from one hospital to another when he is in an unstable medical condition.

 

[sharon sanders]

Re: Providing Mass Medical Care with Scarce Resources:

Please post any excerpts that you wish to emphasize. I will be posting more throughout the day.