Capability Cliff Notes Series PHEP Capability 10—Medical Surge What Is It And How Will We Measure It?

Learning Objectives Become familiar with Capability Functions Become familiar with Tasks that complete the Functions Understand how these Functions and Tasks are measured or may be measured in the future (Performance Measures)

Medical Surge The medical surge capability is the ability to provide adequate medical evaluation and care during incidents that exceed the limits of the normal medical infrastructure within the community. This encompasses the ability of healthcare organizations to survive an all-hazards incident, and maintain or rapidly recover operations that were compromised. How can healthcare coalitions assist in evaluating the capacity of the healthcare system, and help medical care organizations to provide care beyond their normal capacity?

Medical Surge Functions What Are The Different Steps in Assisting With Medical Surge? 1.Assist with the coordination of the healthcare organization response during incidents that require medical surge. 2.Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS) operations. 3.Assist healthcare organizations with surge capacity and capability. 4.Develop Crisis Standards of Care guidance. 5.Provide assistance to healthcare organizations regarding evacuation and shelter-in-place operations.

Healthcare Coalitions’ Roles It is understood that while some healthcare coalitions take an active role in healthcare operations, others are in support and coordination positions only. All tasks can be read or adjusted to account for coalitions’ coordination rather than direct actions.

Capabilities and Measures Resources The presentation will be an overview of what the functions and tasks mean, linked to the performance measures. Please note that since the capabilities PDF document has come out, more performance measures have been developed. If performance measures have come out since the creation of the capabilities document below, they have been included in these tutorials following their function slide, even if the PDF lists that there are no measures. For functions that still have no measures, questions for health departments to begin thinking about measures have been included instead. For exact lists of the capabilities and performance measures, and data collected for the measures, documents can be found at these links: For Capabilities, Functions, and Tasks For Performance Measures

Function 1: Assist with the coordination of the healthcare organization response during incidents that require medical surge Tasks: How can healthcare coalitions assist healthcare organizations to respond during a medical surge? 1.Provide coordination for healthcare emergency preparedness activities and surge planning to guide incident management decisions. 2.Assist healthcare organizations to be represented during medical surge incidents to provide incident management with information for the allocation of resources to healthcare organizations.

Function 1 Measurement How does ASPR measure if healthcare coalitions are able to assist healthcare organizations to respond during a medical surge? Percent of HCCs that have a coordinated mechanism to support their members’ ability to deliver appropriate levels of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients), as well as to provide no less than 20% bed availability, within (four) 4 hours of a disaster Numerator: Number of HCCs that have a coordinated mechanism in place to provide an appropriate level of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients) that includes providing bed availability 20% above the daily census within 4 hours of a disaster. Denominator: Number of HCCs identified by awardees Target is 100%. All data elements must be answered ‘yes’ for an HCC to count in the numerator. Specific data elements that were included in the measure can be found at this link on pgs 43-47:

Function 2: Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS) operations Tasks: What do healthcare coalitions need to do to help healthcare organizations coordinate surge operations with pre-hospital EMS operations? 1.Promote information-sharing that allows healthcare organizations to track the status and transport of patients (situational awareness) from EMS during medical surge incidents. 2.Provide training and guidance for healthcare organizations to understand EMS disaster triage protocols and CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive) treatment protocols for the transition of disaster patients from the field to the facility.

Function 2 Measurement How does ASPR measure if healthcare coalitions are able to assist healthcare organizations to respond during a medical surge? Percent of HCCs that have a coordinated mechanism to support their members’ ability to deliver appropriate levels of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients), as well as to provide no less than 20% bed availability, within (four) 4 hours of a disaster Numerator: Number of HCCs that have a coordinated mechanism in place to provide an appropriate level of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients) that includes providing bed availability 20% above the daily census within 4 hours of a disaster. Denominator: Number of HCCs identified by awardees Target is 100%. All data elements must be answered ‘yes’ for an HCC to count in the numerator. Specific data elements that were included in the measure can be found at this link on pgs 43-47:

Function 3: Assist healthcare organizations with surge capacity and capability Tasks: What steps should healthcare coalitions take to assist in supporting medical surge operations? 1.Ensure healthcare organizations can communicate the status of the incident and the status of medical surge operations, when requested. 2.Assist healthcare organizations to provide multi-agency coordination for resource decisions during medical surge operations. 3.Develop, refine, and sustain processes that assist healthcare organizations to maximize medical surge capacity and capability during response operations.

Function 3 Measurement How does ASPR measure if healthcare coalitions are able to assist healthcare organizations to respond during a medical surge? Percent of HCCs that have a coordinated mechanism to support their members’ ability to deliver appropriate levels of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients), as well as to provide no less than 20% bed availability, within (four) 4 hours of a disaster Numerator: Number of HCCs that have a coordinated mechanism in place to provide an appropriate level of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients) that includes providing bed availability 20% above the daily census within 4 hours of a disaster. Denominator: Number of HCCs identified by awardees Target is 100%. All data elements must be answered ‘yes’ for an HCC to count in the numerator. Specific data elements that were included in the measure can be found at this link on pgs 43-47:

Function 4: Develop Crisis Standards of Care guidance Tasks: What are the things healthcare coalitions should do to assist healthcare organizations in developing Crisis Standards of Care? 1.Identify the current crisis standards of care to determine the future requirements for use by the healthcare organizations. 2.Identify the guidelines for crisis standards of care, including the effective allocation of scarce resources. 3.Identify the appropriate legal authorities and protections for healthcare providers and institutions for implementation of crisis standards of care.

Function 4 Measurement How does ASPR measure if healthcare coalitions are able to assist healthcare organizations to respond during a medical surge? Percent of HCCs that have a coordinated mechanism to support their members’ ability to deliver appropriate levels of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients), as well as to provide no less than 20% bed availability, within (four) 4 hours of a disaster Numerator: Number of HCCs that have a coordinated mechanism in place to provide an appropriate level of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients) that includes providing bed availability 20% above the daily census within 4 hours of a disaster. Denominator: Number of HCCs identified by awardees Target is 100%. All data elements must be answered ‘yes’ for an HCC to count in the numerator. Specific data elements that were included in the measure can be found at this link on pgs 43-47:

Function 5: Provide assistance to healthcare organizations regarding evacuation and shelter- in-place operations Tasks: What are the things healthcare coalitions should do to assist healthcare organizations with evacuation and shelter-in- place operations? 1.Before, during, and after an incident ensure resource assistance to healthcare organizations and providers for evacuation and shelter-in- place operations.

Function 5 Measurement How does ASPR measure if healthcare coalitions are able to assist healthcare organizations to respond during a medical surge? Percent of HCCs that have a coordinated mechanism to support their members’ ability to deliver appropriate levels of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients), as well as to provide no less than 20% bed availability, within (four) 4 hours of a disaster Numerator: Number of HCCs that have a coordinated mechanism in place to provide an appropriate level of care to all patients (including preexisting patients [both inpatient and outpatient], non‐disaster‐related patients, and disaster‐specific patients) that includes providing bed availability 20% above the daily census within 4 hours of a disaster. Denominator: Number of HCCs identified by awardees Target is 100%. All data elements must be answered ‘yes’ for an HCC to count in the numerator. Specific data elements that were included in the measure can be found at this link on pgs 43-47:

Questions? Please contact: Rachel Coles Program Evaluator--CDPHE