Broadcast on November 29, 2006, the Web conference Providing Mass Medical Care With Scarce Resources: Strategies and Tools for Community Planners gave an overview of the community planning guide and provided planners at the institutional, State, and Federal levels with valuable insights and information that will help them plan for and respond to a Mass Casualty Event (MCE).
John L. Hick, M.D., an emergency physician with the Hennepin County Medical Center, and Chair of the Metropolitan Hospital Compact, delivered a presentation during the conference entitled Hospital Care. This is the text version of Dr. Hick's slide presentation. Select to access the PowerPoint® Slides (225 KB).
Hospital Care
Slide 1
Hospital Care
John L. Hick, M.D.
Emergency Physician
Hennepin County Medical Center
Chair, Metropolitan Hospital Compact
Slide 2
Planning Assumptions
- Overwhelming demand.
- Greatest good.
- Resources lacking.
- No temporary solution.
- Federal level may provide guidance.
- Operational implementation is State/local.
- State emergency health powers.
- Provider liability protection.
Slide 3
Coordinated Mass Casualty Care
- Effective incident management critical.
- Fully integrated
- Conduct action planning cycles.
- Anticipate resource needs.
- Make timely requests and allocate.
Slide 4
Coordinated Mass Casualty Care
- Increased system capacity; surge capacity.
- Decisionmaking process for resource allocation
- Shift from reactive to proactive strategies.
- Administrative versus clinical changes.
Slide 5
At the top left of the slide are the words Incremental Changes to Standard of Care. An arrow points rightward from there. Underneath the words are Usual Patient Care Provided and Low-Impact Administration Changes. Underneath the point of the arrow are Austere Patient Care Provided and High-Impact Clinical Changes. Underneath all of these is a bar containing Administrative Changes to Usual Care at the left and Clinical Changes to Usual Care at the right.
Four columns of four boxes each have arrows pointing upward to the bar. The leftmost column, from top to bottom, reads Triage Set Up in Lobby Area, Meals Served by Nonclinical Staff, Nurse Educators Pulled to Clinical Duties, and Disaster Documentation Forms Used. The second column on the left reads Significant Reduction in Documentation; Significant Changes in Nurse-Patient Ratios; Use of Non-Health Care Workers to Provide Basic Patient Cares: Bathing, Assistance, Feeding; and Cancel Most or All Outpatient Appointments and Procedures. The second column on the right reads Vital Signs Checked Less Regularly, Deny Care to Those Presenting to ED with Minor Symptoms, Stable Ventilator Patients Managed on Step-Down Beds, and Minimal Lab and X-Ray Testing. The rightmost column reads Re-Allocate Ventilators Due to Shortage; Significantly Raise Threshold for Admission: Chest Pain with Normal ECG Goes Home, Et Cetera; Use of Non-Health Care Workers to Provide Basic Patient Cares: Bathing, Assistance, Feeding; and Allocate Limited Antivirals to Select Patients.
At the bottom left of the slide are the words Need Increasingly Exceeds Resources. An arrow points rightward from there.
Slide 6
State-Level Responsibilities
- Recognize resource shortfall.
- Request additional resources or facilitate transfer of patients/alternative care site.
- Provide supportive policy and decision tools.
- Provide liability relief.
- Manage the scarce resources in an equitable framework.
Slide 7
Hospital Responsibilities
- Plan for administrative adaptations; roles and responsibilities.
- Optimize surge capacity planning.
- Practice incident management and work with regional stakeholders.
- Decisionmaking process for scarce resource situations.
Slide 8
Scarce Clinical Resources
- Process for planning versus process for response.
- Response concept of operations:
- IMS recognizes situation.
- Clinical care committee.
- Triage plan.
- Decision implementation.
Slide 9
Clinical Care Committee
Multiple institutional stakeholders decide, based on resources and demand:
- Administrative decisions: primary, secondary, tertiary triage.
- Ethical basis: AMA principles, et cetera.
- Decision tool or tools to be used.
Slide 10
Triage Plan
- Assign triage staff.
- Review resources and demand.
- Use decision tools and clinical judgment to determine which patients will benefit most.
- Advise "Bed Czar" or other implementing staff.
Slide 11
Implementing Decisions
- "Bed Czar" or other designated staff.
- Transition of care support, as needed.
- Behavioral health issues.
- Security issues.
- Administrative issues.
- Palliative care issues.
Current as of November 2006
Internet Citation:
Hospital Care. Public Health Emergency Preparedness: Providing Mass Medical Care with Scarce Resources. Web Conference, broadcast on November 29, 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/massresources/hick.htm
540 Gaither Road Rockville, MD 20850