National Hospital Preparedness Program: Priorities, Progress & Future Direction Gregg Pane, MD, MPA, FACEP Director National Healthcare Preparedness Programs HHS/ASPR

1 Mission Statement: “To ready hospitals and supporting health care systems, in collaboration with other partners, to deliver coordinated and effective care, to victims of terrorism and other public health emergencies “ Hospital Preparedness Program (HPP)

2 Pandemic and All Hazards Preparedness Act (PAHPA) Signed into law December 2006 Establishes the ASPR – Leadership – Personnel – Countermeasures – Coordination – Logistics HRSA program  ASPR Title III: All Hazards Medical Surge Capacity – Transfers NDMS from DHS to HHS – Section 302: Enhancing Medical Surge Capacity – Section 305: Partnerships for State and Regional Hospital Preparedness to Improve Surge Capacity

3 FY02-FY08 HPP Funding History Fiscal Year (FY) Cooperative Agreements (millions) Healthcare Facility Partnerships (millions) FY 2002$125n/a FY 2003$498n/a FY 2004$498n/a FY 2005$471n/a FY 2006$460n/a FY 2007$415 Facilities $18 E-care $25 FY 2008$398n/a

4 Tiers of Response

5 FY08 HPP Funding Opportunity ($398M) $398M in Cooperative Agreement Funds Released August 2008 Overarching Requirements: – National Incident Management System (NIMS) – Education and Preparedness Training – Exercises, Evaluation and Corrective Actions – Needs of At-Risk Populations

6 FY08 HPP Funding Opportunity Required Activities (Level One sub-capabilities) – Interoperable Communications Systems – ESAR VHP – Tracking of Bed Availability (HAvBED) – Fatality Management – Medical Evacuation / Shelter-in-Place – Partnership/Coalition Development Once all the above are met in full States may propose a host of other activities: – PPE, Decon, Pharm Caches – ACS and Mobile Medical Assets – CIP – MRC

7 FY08 HPP Funding Opportunity Significantly increased accountability in 2008 that will affect funding in 2009: – Meeting mid year and end-of-year targets for performance measures – Pan Flu plan submission and successful “grade” on medical surge and fatality management sections – Not exceeding established maximum carry-over limits – Maintenance of Effort for State funding

8 Performance Measures State/Territory can report available beds for at least 75% of participating hospitals per HAvBED definitions S/T can query ESAR-VHP system during drill/exercise/event and generate list of potential VHP, by discipline and credential level, within 2 hours of request S/T can compile initial list of VHP within 12 hours, and report verified list of available VHP with 24 hours of a request S/T conducts statewide and regional exercises that incorporate NIMS concepts and principles, and include hospitals Proportion of hospitals that can report beds by HAvBED within 60 minutes Hospitals demonstrate redundant communications capability; and two-way capability with local Operations Command or coalition partners Hospitals have written plans for mass fatalities and medical evacuation Incorporate NIMS concepts/principles; identify training needs and verify courses

9 Charting Progress: A Comparative Look at Hospital Preparedness FY02 to FY06 Preparedness Element Federal Guidance Limited infrastructure for integrated and coordinated hospital preparedness activities among US hospitals 87% (5,067) of all US hospitals participate in HPP Surge Bed Capacity No known surge bed capacity among US hospitals Participating hospitals report the ability to surge over 200,000 beds above the current daily bed staffed bed capacity within a 24-hour period. Decontamination Two-thirds (66%) of hospitals report the ability to handle less than nine patients an hour through a 5-minute decontamination shower per 100 staffed beds Over 400,000 persons could be decontaminated nationwide over a 3-hour period. Personnel Training Seven out of ten hospitals trained their staff to diagnose biological-agent-related illnesses, with unknown extensiveness of the training 629,083 healthcare personnel nationwide were trained in competency-based programs in fiscal year 2006 Source: FY03 GAO Study, April 2003 and FY06 End-of-Year Data

10 Charting Progress: A Comparative Look at Hospital Preparedness FY02 to FY06 Preparedness Element Personal Protective Equipment Half of all hospitals reported having three or fewer PPE suits Nearly 80% (3995) of hospitals report having appropriate PPE for staff and volunteers Isolation Capacity Half of all hospitals reported having fewer than four isolation beds per 100 staffed beds Over 79% of US hospitals (4,655) report the capacity to maintain at least one suspected infectious disease case in negative pressure isolation Drills and Exercises About half of all hospitals had participated in drills or tabletop exercises focused on a biological attack during the past two years 9751 drills, 2914 tabletop exercises, and 4120 functional exercises completed. Nearly 80% of hospitals prepared After Action Reports within 60 days of the drill or exercise Source: FY03 GAO Study, April 2003 and FY06 End-of-Year Data

11 Future Directions Shared focus on required program performance metrics Proactive approach to problem-solving; achieving goals Broad, pre-decisional input on policy, guidance, measures Adoption and spread of exemplary practices Focus on health system preparedness and coordination Medical surge and health system resiliency Lessons and accomplishments from actual events Longer planning cycle