1. Area and Regional Medical Coordination
Developed by NCW HERC
Presented by Robbie Deede

2. First
Thank you to the “Regional Medical Coordination Planning” Team for all their work and effort in cumulating member input and development of this document.

3. Objectives Outline Area & Regional Med Coord in concept and reality
Identify the "Purpose" of Area & Regional Med Coord
Highlight "Triggers" in activating AMC & RMC
Walkthrough Initiating Facility Assumptions, Considerations and Checks
Walkthrough Receiving/Assisting Facility Assumptions, Considerations and Checks

4. Disclaimer Plan intended to provide concepts for advisory purposes
Not replace or contradict internal plans
No requirement to use
Members are ultimately responsible for their facility
This is intended to be a living document, within the NCW HERC Response Plan, with continued revisions and updates as identified

5. These are concepts you and your colleagues have identified as best practice to NCW HERC over the past year.

6. Background & Intent of the System
Event happens ---> Incident Command is opened
Events happen that become larger than we can handle by ourselves
Tiered Coordination Structure
1. Local/Internal 2. Area (NCW HERC) 3. Regional 4. Intrastate 5. Interstate 6. Federal
Area and Regional Medical Coordination "Centers"
Designated site or entity, pre-determined coordinate movement and information
Area: a county or two
Regional: all twelve counties

7. Issues in Reality Designed from a different model
Real-life events and exercises have never indicated passing of responsibility
Pre-determination can be dangerous
Area and Region lines blur very quickly. You must reach further to get needed result
All facilities need to be ready to be coordinating entity

8. Purpose Aid overwhelmed facilities
Provide a system to coordinate transportation and patients
Provide a single point of contact during the event
Centralize, enhance and expedite the flow of information
Identify and prioritize the use of available resources
Support normal referral process overwhelmed in an event

9. Scope & Authority
Does not replace a county EOC, but ensure continuity until one can opened or in event EOC will not be opened
Builds upon concepts of Hospital Mutual Aid
No rules, statutes or codes that require participation
Requires pre-incident discussions with EMS

10. Triggers to Activate
Resource needs will exceed the responding facility’s capacity (Facility Dependent)
An event that overwhelms resources
Number of expected patients to exceed normal response or mutual aid resources (MCI incident)
Healthcare facility’s ability to care for patients has been compromised (Hospital Evacuation or nursing home evacuation)
Multi-jurisdictional infectious disease event (Epidemic/Pandemic Event)

11. Initiating Facility Considerations and Assumptions
STOP ALL CURRENT TRANSFERS!
Bring in Finance immediately
Provide additional staff to your “Call Centers”
Engage EMS Medical Director (patient support)
Pre-identify multiple staging points for evacuation based on patient acuity
Contact NCW HERC

12. Assumptions and Considerations Cont'd
A physician will be designated as the referring physician
Ensure patients being discharged or transferred with 24 hours of medications
Incident command will remain at the facility where the incident is occurring until that facility requests another facility to assume incident command (Core ICS concept)
An initiating facility can request another facility to assume incident command should the event no longer be manageable internally.
Ensuring “closed-loop communication” is essential 

13. Assumptions and Consideration Cont'd
Alternative standards of care considerations
Only essential procedures
Maximize ability for transport 
Send medical staff with assigned patients 
Report after safe transport, at receiving location
Ensure the ED is able to accept patients presenting
“On Diversion” status
Alternate site
Stabilize patients presenting to ED and add to overall count  

14. Initiating Facility Checklist
Determine immediate need, activate internal incident command and notify essential internal partners. (CO-S-TR Guide for Initial Incident Actions) (see appendix A)
Broadcast on WISCOM and WITRAC to alert of need: MCI capacity, bed availability, other intel PRN and establish common operational picture
Notify essential external partners: NCW HERC, Regulating Agency, County Dispatch to notify Emergency Management, Emergency Medical Services (EMS), Public Health
Cancel elective and non-essential procedures

15. Initiating Facility Checklist
If transfer is needed: 
Contact "Call Center"
Triage patients to: 
Discharge
Transport to skilled nursing facility
Low Acuity Hospital
High Acuity Hospital
Receive initial response from Responding Facilities and identify resources to activate
Communicate resource needs and identified resource availability to "Call Centers" to coordinate approval for transfer/activation
Inform responding facilities where resources are planned to be engaged immediately (closed-loop)

16. Receiving/Assisting Facility Considerations & Assumptions
Bring in Finance immediately
Accept 75% of current availability to prevent being overwhelmed
Consider discharging patients
Cancel elective and non-required procedures

17. Receiving/Assisting Facility Considerations & Assumptions Cont'd
Designate a physician, likely Emergency Department physician, as accepting physician for all incoming transfers
Ready to provide all resources identified as available (WITRAC)
Ready to assume incident command at the initiating facility’s request
Ready internal medical staff to assist medical surge staff

18. Receiving/Assisting Facility Checklist
Receive WITRAC or WISCOM notification from Initiating Hospital
Consider activating internal incident command
Identify resource availability based on resource request and relay back to initiating facility
Receive verification of resource engagement
Begin process of staging/fulfilling need or request

19. Questions. Input. Critical elements missing
Questions? Input? Critical elements missing? How would you like this formatted?  How can you plug this into your evac or surg plan?
Talk about EMS