Delivering Essential Healthcare Services
A severe influenza pandemic or wide-scale public health disaster would severely affect how communities provide healthcare services. Communities need to consider methods for delivering healthcare in spite of large-scale disruptions or challenges. Communities would need to define and prioritize which of their healthcare services would be essential to maintain during such an event. They would also need to consider the ethical consequences of delaying or canceling other healthcare services.
In 2007-2008, nine states and local communities received grants to begin to address the challenges of delivering essential healthcare services. The Pandemic Influenza Guidance Supplement to the 2006 Public Health Emergency Preparedness Cooperative Agreement was the source of this funding. Communities that received the grants had to achieve several intended outcomes. Each community had to develop its ability to coordinate various unrelated healthcare delivery resources such as staff, supplies, and medicines. Each community also had to determine how it would maintain delivery of essential healthcare services while providing care for large numbers of influenza patients during a pandemic. In addition, the communities developed plans, guidelines, and tools to assist with these activities (e.g., staffing plans, triage and care plans, supply and resource lists).
Six of the nine awardees have made their products available online to share with other planners.
The Georgia Division of Public Health, Georgia Hospital Association, and Regional Coordinating Hospitals leveraged their existing partnerships to develop the Regional Planning Guide for Maintaining Essential Health Services. The project included a replicable model for effective coordination of essential healthcare delivery. The model is designed to function despite stresses and the influx of large numbers of influenza patients during a pandemic.
This guide also addresses the following topics:
- Services in a Crisis Care Environment
- Risk Communication
- Legal Issues and Waivers During a Declaration of a State of Emergency for Pandemic Influenza
Georgia also provides other supporting documents. Users must register at www.gha911.org to access these documents. Once registered, the documents are available under the “Resources” Tab, entry “Crisis Standards of Care”.Michigan
Michigan developed a set of planning and operations guidelines to be used by healthcare providers. These guidelines identify and determine how to provide essential healthcare services while caring for large numbers of hospitalized and homebound patients of an influenza pandemic. The guidelines also describe how communities would work together to support services and where those services would be provided. In addition, the guidelines include discussions about how communities can maintain supply lines, staffing levels, and other critical infrastructure.
Michigan’s “Caring for the Community” report is available online.
- General description of project
- Project Assumptions
- Ethical Considerations
- Legal Considerations
- Pre-Emergency Department Considerations
- Essential Healthcare Services Planning
- Staffing and Supply Issues
- Surge Capacity Staffing Flow Chart
- Sample MOU
- Medical Equipment and Pharmaceutical Supply Lists
- Infrastructure Support (e.g., technology)
- Multidisciplinary Planning (e.g., coordination)
- In-Home Care Planning (i.e., outpatient care)
- Cross-Border Concerns (i.e., multijurisdictional planning)
- State Local Health Department Integration
Minnesota’s project described how to create flu centers. Flu Centers - Assessment, Referral & Treatment Centers for Pandemic Influenza includes the following resources and educational materials:
- Flu Center Plan Template
- Activation Flowchart
- Overview of the Minnesota Flu Line
- Legal Authority for Pandemic Influenza Planning
- Patient Care Record
The New Hampshire project group investigated ways to improve regionalized public health emergency responses to an influenza pandemic. New Hampshire created plans to use acute care centers, casualty transportation systems, and mass care and functional needs shelters. These plans use the Modular Emergency Medical Systems (MEMS) framework.
The New Hampshire project group also considered cross-border international partnerships. The project addressed situations that would arise near the border with Canada during a pandemic scenario.
Additional MEMS framework resources were included in the Emergency Response Strategy and Preparations for an Influenza Pandemic: Lessons Learned from the CDC Pandemic Influenza Project report:
- Influenza Pandemic Response Contract Draft Report
- Modular Emergency Medical Systems
- Oxygen Calculator Planning and Operation Documents
- Regional Response System Planning Guide
- Resource Requirements and Allocation Modeling Documents
Oregon HPP Region 1 addressed care in the multi-county region centered in the Portland metropolitan area. The project looked at care for influenza, as well as other essential health services. The Project Evaluation Report describes how the project group assembled a health and medical collaboration group. The collaboration group considered the system of care, healthcare demands during a “normal” flu season, healthcare demands during a severe influenza pandemic, and the resources available for care. The team used modeling data and a Multi-Agency Coordination (MAC) Group to create an effective tool for making decisions. They designed the decision-making tool to integrate with the Incident Command System. The tool also includes practical local health response strategies and tools for urban communities.
The evaluation report includes the following resources:
- Access to Influenza Care System Description and Report
- Community Focus Groups Final Report
- Ethical Framework
- Ethical Framework PowerPoint
- Hospital Discharge Data Analysis and Summary
- MAC Group Handbook
The Virginia project expanded the Virginia Department of Health’s existing Critical Resource Shortages Planning Guide. This toolkit helps hospitals plan for the continuation of essential services. It provides a systematic approach for allocating scarce resources during emergencies and disasters.
Elements of the Critical Resource Shortage Planning Guide Toolkit include the following:
- Critical Resource Shortages Planning Guide
- Critical Resource Shortages Planning Guide - Hospital Implementation Guide
- Critical Resource Shortages Planning Guide - Implementation Aids
- Sample Critical Resource Shortages Response Plan
- Critical Resource Shortages Planning Guide - Implementation Presentations
- Implementation Toolkit Power Point Navigation Guide
- Chapter 1: Planning Infrastructure
- Chapter 2: Critical Resource Vulnerability Analysis
- Chapter 3: Ethical Framework
- Chapter 4: Operational Infrastructure
- Chapter 5: Protocol Development
- Chapter 6: Ad Hoc Infrastructure
- Chapter 7: Coordination with Health and Medical Delivery Organizations
- Chapter 10: Communication Plans