Health Emergency Assistance Line and Triage Hub (HEALTH) Model

Chapter 1. Problem Statement

In the fall of 2001, following the discovery that anthrax spores had been intentionally released through the United States Postal System and had infected several citizens on the East Coast, the Denver Health Medical Information Centers (DHMIC), comprising the Rocky Mountain Poison & Drug Center (RMPDC) and the Denver Health NurseLine, experienced a 10 percent increase in call volume. The additional calls came from people concerned about anthrax, although there was no actual incident in our five-State service region (Colorado, Hawaii, Idaho, Montana and Nevada). If a Weapons of Mass Destruction (WMD) event had occurred in our service area of 9.3 million people, it is likely that demand would have overwhelmed our existing services as well as other medical and public health systems.

Recognizing the need to respond to the concerns of the public in such an event while simultaneously maintaining delivery of regular essential services, we began investing in technology to manage increases in call demand. Through partnerships with the Castlerock Foundation, Avaya, and Expanets, four dedicated T-1 trunk circuits (each T-1 trunk circuit is made up of 24 telephone lines) were installed and dedicated for emergency use. Two T-1 lines are available to offer public information through the Colorado Health Emergency Line for Public (CO-HELP), and two T-1 lines are available for disseminating information to health care professionals through the Colorado Provider & Hospital Information Line (CO-PHIL). These dedicated, toll-free emergency lines allow us to receive a surge of calls while protecting our contact center's other telephone lines for the appropriate users. In February of 2002, during a regional bioterrorism functional exercise, this system was tested, with incident-specific content being recorded on these lines within 60 minutes of the event's onset.

This was only the first step in providing information and assistance to callers with increased efficiency during periods of surges in call volumes. Providing medical information and triage advice regarding the release of chemical and biological agents, either accidental or as a result of terrorism, is a core competency of the DHMIC. By expanding our capabilities to provide incident-specific information and triage, we can potentially minimize surges in demand on public health and medical service providers. These surges in public demand did occur in the Washington, DC, area during October of 2001 when thousands of the "worried well" presented to hospitals with anthrax concerns.

In August of 2002, DHMIC received a grant from the Agency for Healthcare Research and Quality (AHRQ) to research the requirements, specifications, and resources needed to develop the Health Emergency Assistance Line and Triage Hub (HEALTH) model. Using the Integrated Delivery System Research Network (IDSRN), AHRQ solicited research proposals to model the impact of a bioterrorist event on hospitals and integrated delivery systems (IDS). Denver Health and the DHMIC are one of those integrated delivery systems uniquely qualified to examine hospital and delivery system capacity to respond to a bioterrorist event. The vital linkages between these systems and their health services researchers place the IDSRN in a strategic position: that of being able to address the issues of surge capacity and regional models of care urgently needed for bioterrorism preparedness at the State and local level.

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