Communication and Coordination

Surge Management and Continuity Planning

 

The learning objective of this module is to provide you with a foundational understanding of surge management and continuity planning. At the end of this module, you should be able to:

 

·         Describe the six domains of emergency preparedness;

·         Summarize key elements of managing a medical surge;

·         Explain the principles of continuity planning; and

·         Apply ICS priorities and objectives to creating a continuity plan.

 

 

 

 

The U.S. CDC Public Health Emergency Preparedness Program works to advance six main areas of preparedness:(Murthy, Molinari, LeBlanc, Vagi, & Avchen, 2017)

 

·         Biosurveillance

·         Community Resilience

·         Countermeasures and Mitigation

·         Incident management

·         Information Management

·         Surge management

 

Biosurveillance includes identifying and investigating health threats:

·         Laboratory testing

·         Surveillance and epidemiological investigations

 

Community resilience includes preparing for and recovering from emergencies. That means:

·         The community’s preparedness

·         The community’s ability to recover from an emergency – both structurally and psychologically.

 

Medical Countermeasures and mitigation includes getting medicines and supplies where they are needed, such as:

 

·         Medical countermeasure dispensing, including vaccines;

·         Medical material management and distribution, including personal protective equipment;

·         Nonpharmaceutical interventions, including closing schools and businesses or canceling mass gatherings in an effort to keep sick people away from those who are not sick; and

·         The safety and health of responders.

 

Incident management includes coordinating an effective response, including emergency operations coordination.

 

Information management includes making sure that people have the information they need to make informed decisions about ways to protect themselves and their loved ones. This includes:

 

·         Emergency public information and warning

·         Information sharing

 

AND

 

Surge management, which focuses on expanding medical services to handle large threats. Issues such as:

 

·         Fatality management;

·         Mass care;

·         Volunteer management; and

·         Medical Surge.

 

Let’s talk about surge management.

 

Medical surge describes the ability to provide adequate medical evaluation and care during events that exceed the limits of normal medical infrastructure of an affected community.

 

Surge requirements cover a broad range of specialized medical services – including information, expertise, equipment and personnel.

 

Medical surge capacity refers to the ability to evaluate and care for a markedly increased volume or number of patients – an increase that challenges or exceeds the normal operating capacity of the hospital or health facility. ("What is Medical Surge?," 2012)

 

Conventional capacity refers to the people, spaces and supplies consistently used in typical daily operations.

 

Contingency capacity refers to the people, spaces and supplies that are used in ways that are NOT consistent with daily practices. Maybe an unexpectedly high number of patients appear at a certain medical clinic. It may stretch operations, but it’s not a catastrophe.

 

Medical surge capability refers to the ability to manage patients who require unusual or specialized medical attention and care. Is a facility capable of isolating and caring for an infectious patient? Does staff have the skills and training? That’s an example.

 

Capability is not about the number or volume. It’s about specialized skillsets and equipment – those kinds of issues.

 

During the 2014-2016 outbreak of Ebola in West Africa, the health infrastructure of the region was overwhelmed. The ability to manage the surge in volume – the straight numbers in terms of people who needed help – wasn’t in place.

 

Over the course of two years, more than 30,000 people were infected, and 11,000 people died. Of the 11,000 deaths, 500 were health care workers. (Mulinge & Soyemi, 2016)

 

The majority of deaths of healthcare workers occurred during the initial months of the outbreak. This then depleted the number of active healthcare workforce available for the remainder of the response. (Mulinge & Soyemi, 2016)

 

So, the surge capability was effectively reduced even before the surge capacity was hit the hardest.

 

A surge is an emergency. A Surge Demand Plan is a critical component of preparedness planning. The Incident Command System provides a framework to manage an emergency and to develop a Surge Demand Plan.  

 

What does that look like?

 

In the context of public health, we should plan for three levels of surge: conventional, contingency and crisis.

 

 

 

Conventional surge:

 

The surge is such that the hospital can mobilize its existing on-site human and materiel resources. Planning for a minor surge would include, for example, strategies to conserve supplies and resources. But generally speaking, it would be business as usual.

 

Contingency surge:

 

Medical facilities will need to deploy additional resources without changing the traditional standard of care. The hospital may activate its Incident Command System, and normal operations may change. Non-critical appointments, for example, may be postponed to deploy staff elsewhere.

 

A crisis surge changes everything.

 

A crisis surge is a game changer. In the context of health emergencies: Limited resources – both on the hospital campus and elsewhere – will impact the standard of care and the ability. In some cases, a crisis surge may impact a hospital’s ability to provide care at all. Normal operations will be interrupted. New needs may pop up, such as requirements for:

 

·         Triage centers;

·         Isolation areas; and

·         Demand for safe and dignified burials.

 

Depending on the scope of the emergency, there’s a good chance that a regional-level or national-level Incident Management System may be active.

 

Where does a Hospital Surge Demand Plan fit in?

 

Built around the Incident Command System, we know the surge plan must be organized in terms of objectives. The objectives are created to – fundamentally – make the ‘problems’ of the incident go away.

 

Anything that gets in the way of that objective is a ‘problem’ of the response.

 

How do we make the ‘problem’ go away? Planning helps you avoid the likelihood that you set yourself up to be a ‘problem’ in the response.

 

Continuity of Services

 

Every day, communities, regions, countries, and the global community are connected. At every level, people work together to provide essential functions, capabilities and services to each other. These essential functions include critical services, as well as structures that support access to transportation and trade.

 

Outbreaks and emergencies can disrupt the performance and provision of these essential functions, capabilities and services.

 

It is critical to have a ‘Continuity of Services’ plan in place to ensure that a coordinated effort is in place to maintain essential functions – before, during and after an emergency or threat.

 

Continuity planning is often guided by three primary principles: (Continuity Resource Toolkit)

 

·         Preparedness and Resilience;

·         Whole Community Engagement; and

·         Scalable, Flexible, and Adaptable Continuity Capabilities

 

Continuity planning doesn’t exist in a vacuum. There are a variety of moving parts that require coordination. Training, testing, and exercises help determine roles and responsibilities. Emergency operations plans describe who will do what, when, and how. Again, we’re back to the Incident Command System to answer the question:

 

“Who’s in charge of what?”

 

Continuity planning should address two types of events: an event without warning, such as an accident or disease outbreak. And an event WITH warning, such as a terrorist threat. Keep in mind: Not every event fits into these categories perfectly.

 

For example, a flood could conceivably occur WITH warning – based on a weather report or historical awareness of the impact of seasonal rains. Or a flood could occur WITHOUT warning – from an unexpected weather event or the operational failure of a large dam.

 

There’s a place for continuity planning at every level of emergency preparedness.(Norman, Aikins, Binka, & Nyarko, 2012) Hospitals need their own type of contingency planning, which includes issues such as:

 

·         Does the threat of the event impact the facility?

·         Does the threat impact personnel? If so, how? and

·         Is it safe for employees to be at the hospital?

 

The answers to these questions – among others – help inform the objective – which then guides the organization of your Incident Command System.

 

At the community, regional and national level, preparedness planning includes a variety of partners, including: (Continuity Resource Toolkit)

 

·         Individuals and households;

·         Communities;

·         Non-governmental organizations or NGOs;

·         Local governments;

·         Tribal or cultural leadership; and

·         National government

 

Continuity planning ensures that essential functions – such as communications and transportation – among many others -- can carry on during an emergency.

 

Your first step in building or improving your continuity plan is to identify your objectives. Management by objectives – one of the 14 ICS principles – deal with the ‘problems’ of the incident.

 

The objectives you define / are statements of the problem to be fixed. For planning, your ‘needs assessment’ will help identify potential ‘problems’ – which you can then address through your objectives.

 

Your needs assessment will also help you identify your priorities. We know through the Incident Command System that objectives are related to the problems created by the incident. Before the problem occurs, think about your priorities.

 

In planning, what your priorities? What’s your first order of business in the event of an emergency?

 

In every emergency, there are a variety of priorities – some of them actually competing or conflicting with each other. What comes first?

 

It’s not a one-size-fits-all decision.

 

For example, fire can be a threat to lives and property.

 

But if you’re sitting around a barbeque with friends, you’d be more than annoyed if the fire department showed up and doused the fire.

 

So, make sure you have a problem before you define an objective. Here’s the order of things:

 

·         Priorities;

·         Problems;

·         Objectives;

·         Strategies; and

·         Tactics.

If there are no problems, you don’t have to do anything about it – except be prepared.

References:

Continuity Resource Toolkit. U.S. Federal Emergency Management Agency Retrieved from https://www.fema.gov/continuity-resource-toolkit.

Mulinge, I., & Soyemi, K. (2016). End of the Ebola virus outbreak: time to reinforce the African health system and improve preparedness capacity. The Pan African medical journal, 23, 121-121. doi:10.11604/pamj.2016.23.121.8955

Murthy, B. P., Molinari, N. M., LeBlanc, T. T., Vagi, S. J., & Avchen, R. N. (2017). Progress in Public Health Emergency Preparedness-United States, 2001-2016. Am J Public Health, 107(S2), S180-s185. doi:10.2105/ajph.2017.304038

Norman, I. D., Aikins, M., Binka, F. N., & Nyarko, K. M. (2012). Hospital all-risk emergency preparedness in Ghana. Ghana Med J, 46(1), 34-42.

Okaka, F. O., & Odhiambo, B. D. O. (2018). Relationship between Flooding and Out Break of Infectious Diseasesin Kenya: A Review of the Literature. Journal of environmental and public health, 2018, 5452938-5452938. doi:10.1155/2018/5452938

What is Medical Surge? (2012). Public Health Emergency Support. Retrieved from https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedicalsurge.aspx