1. 1 Draft for discussion only. This document is not for general distribution and has not been approved by any agency or entity. No further / external distribution is authorized

2. 2 Health and Medical Surge Capacity Part I: Concept of Operations Draft

3. 3 Surge Capacity Patient care (includes EMS & private healthcare) Patient care (includes EMS & private healthcare) Epidemiologic investigation Epidemiologic investigation Risk communication (coordination with PIOs) Risk communication (coordination with PIOs) Mass prophylaxis or vaccination (coordination of local health department plans ) Mass prophylaxis or vaccination (coordination of local health department plans ) Mass fatality management (medical examiners) Mass fatality management (medical examiners) Other activities (hospice, facilities) Other activities (hospice, facilities) (To completed later) behavioral health (To completed later) behavioral health

4. 4 The Process Based on previous work, including the COG “Planning Guidance for Health System Response to a Bioevent” (9/6/01) and other plans (State Health Plans, Federal Plans) Based on previous work, including the COG “Planning Guidance for Health System Response to a Bioevent” (9/6/01) and other plans (State Health Plans, Federal Plans) This team was appointed by the SPG to create a surge plan This team was appointed by the SPG to create a surge plan Led by State Health Departments with active Local and Federal participation. Invited participation from all sectors of health and medical arena Led by State Health Departments with active Local and Federal participation. Invited participation from all sectors of health and medical arena

5. 5 So far… Focused on tri-”State” and multi-jurdistionals system linkages with medical partners Focused on tri-”State” and multi-jurdistionals system linkages with medical partners At each level of event –description of how medical information is evaluated, and by whom At each level of event –description of how medical information is evaluated, and by whom Description of how medical hypothesis generated, and what officials are involved Description of how medical hypothesis generated, and what officials are involved Analysis of information gathered and disseminated methods Analysis of information gathered and disseminated methods

6. 6 Now… The states have developed detailed systems and solicit, evaluate and support input from local responders and partners The states have developed detailed systems and solicit, evaluate and support input from local responders and partners Limited distribution for comments until April 29 Limited distribution for comments until April 29 To read the full document, visit: www.MWCOG.org/committee/committee/default.asp?COMMITTEE_ID=182 and select Documents To read the full document, visit: www.MWCOG.org/committee/committee/default.asp?COMMITTEE_ID=182 and select Documents www.MWCOG.org/committee/committee/default.asp?COMMITTEE_ID=182 www.MWCOG.org/committee/committee/default.asp?COMMITTEE_ID=182 Submit comments to health@mwcog.org Submit comments to health@mwcog.orghealth@mwcog.org

7. 7 The Players 3 “states” 3 “states” 5 Virginia Counties 5 Virginia Counties 3 Maryland Counties* 3 Maryland Counties* 40 hospitals 40 hospitals Assorted Cities Assorted Cities Seat of Federal Government Seat of Federal Government Independent Healthcare Providers Independent Healthcare Providers NCR Health Information Group NCR Health Information Group Representatives of Hospice, Private Practice Medicine, and Other Medical Partners Representatives of Hospice, Private Practice Medicine, and Other Medical Partners Representatives of the State and local EMS Representatives of the State and local EMS

8. 8 Purpose Coordinate the emergency response activities of the health care systems which make up the National Capitol Region during a natural or man-made catastrophic event Coordinate the emergency response activities of the health care systems which make up the National Capitol Region during a natural or man-made catastrophic event The next edition will incorporate progress on the interoperability grant The next edition will incorporate progress on the interoperability grant

9. 9 The Health Information Group Does NOT Replace, supersede or dictate the response of sovereign jurisdictions Replace, supersede or dictate the response of sovereign jurisdictions Drill down to implementation level standards and benchmarks Drill down to implementation level standards and benchmarks

10. 10 The Health Information Group Does Pull decision makers together Pull decision makers together Facilitate communication, and Facilitate communication, and Facilitate coordination of decision making Facilitate coordination of decision making

11. 11 Info shared Health Information Group Coordination by State/District Health Directors Info shared

12. 12 Response System Tiered system Tiered system Based on US HHS handbook (Medical Surge Capacity and capability august 2004) Based on US HHS handbook (Medical Surge Capacity and capability august 2004) Adapted to fit the NCR conditions Adapted to fit the NCR conditions

13. 13 6 Tiers Management of Individual Healthcare Assets – focus on local events Management of Individual Healthcare Assets – focus on local events Management of Healthcare Coalition – when an event affects more than one jurisdiction Management of Healthcare Coalition – when an event affects more than one jurisdiction Jurisdictional Incident Management Jurisdictional Incident Management Management of State Response Management of State Response Interstate Regional Management Coordination – when the entire region is affected Interstate Regional Management Coordination – when the entire region is affected Federal support to state and jurisdiction management – national emergency Federal support to state and jurisdiction management – national emergency

14. 14 Public Health A government function A government function Provide and where appropriate, coordinate: Provide and where appropriate, coordinate: –Planning –Assessment –Direct medical care where none other exists –Assurance that appropriate health care services are being provided State/District Health Directors coordinate the response to public health emergencies State/District Health Directors coordinate the response to public health emergencies Public health is woefully understaffed (about 2,000 in NCR) Public health is woefully understaffed (about 2,000 in NCR)

15. 15 “State” Systems Each “state” system is unique, but in all cases a large part of the legal public health responsibility is primarily at the state level rather than at the local jurisdictional level Each “state” system is unique, but in all cases a large part of the legal public health responsibility is primarily at the state level rather than at the local jurisdictional level Many decisions are made at the state level Many decisions are made at the state level The federal government communicates and coordinates through state health departments The federal government communicates and coordinates through state health departments

16. 16 Private Health Care Where most medical care occurs Where most medical care occurs Willing partners with public health Willing partners with public health Operate independently under standards of care. Operate independently under standards of care. Often first to report emerging disease or problem Often first to report emerging disease or problem Major concern is surge capacity and capability: beds, equipment, supplies, medications, space and staff, and ability to meet specialized needs (burns, pediatrics, etc.) Major concern is surge capacity and capability: beds, equipment, supplies, medications, space and staff, and ability to meet specialized needs (burns, pediatrics, etc.)

17. 17 Emergency Medical Services detained descriptions covered in EMS-ESF Scene triage Scene triage Scene treatment Scene treatment Transportation Transportation Inter-facility transport (when possible) Inter-facility transport (when possible) Scene management Scene management Certain patient care supplies Certain patient care supplies Coordination of definitive care resources Coordination of definitive care resources Support to health care system Support to health care system Documentation of patient care records Documentation of patient care records

18. 18 Behavioral Health This section to be developed by behavioral health surge committee This section to be developed by behavioral health surge committee Normal reaction to an abnormal situation-- provide information and assistance Normal reaction to an abnormal situation-- provide information and assistance Serious reactions --provide treatment Serious reactions --provide treatment

19. 19 Medical Examiners Identify deceased Identify deceased Examine deceased Examine deceased Provide services for the dead and their families Provide services for the dead and their families Each state will follow own plan Each state will follow own plan Memoranda of understanding being developed Memoranda of understanding being developed

20. 20 Coordinated With US DHHS Medical Surge Capacity and Capability US DHHS Medical Surge Capacity and Capability NIMS NIMS NRP NRP 15 scenarios 15 scenarios Additional tools, standards and guides as they become available Additional tools, standards and guides as they become available

21. 21 Next Final sign off from state health departments Final sign off from state health departments Present to SPG Present to SPG Provide hard copies and/or CD versions to EOCs and partners Provide hard copies and/or CD versions to EOCs and partners Post partial version on open website? Post partial version on open website? Part 2: benchmarking and gap analysis Part 2: benchmarking and gap analysis Develop plans to fill the gaps Develop plans to fill the gaps