Appendix A: MSCC Management System Assumptions

Several assumptions were made in developing the MSCC Management System. These assumptions are delineated below to help the reader understand the basis and rationale for the development of this document.

Management Guidance Sought for Incident Response

Across the United States, acute-care medical providers and public health officials are recognizing the need for effective management of mass casualties and unusual types of injury and illness that exceed prior preparedness levels. Multiple interviews and discussions reflect the following prevalent views:

• Hospital-based and other acute-care medical providers are challenged by the sizable and increasing volume of literature, courses, Internet sites, and other materials being produced on medical surge capacity.
• Hospital-based and other acute medical providers seek guidance that explicitly outlines important management, operations, and support components necessary for response to complex medical incidents. Many past efforts fall short because either they focus entirely on operations (e.g., teaching triage systems) or they present only specific, isolated event parameters (e.g., characteristics of specific biological agents).
• Guidance, while specific, must also provide flexibility and allow for change that addresses the identified needs. In addition, it must "fit" within individual systems and traditions so that it is consistent with established approaches.

A Management System Must Have Practical Applications

The MSCC Management System must provide a practical organizational framework for current public health, acute-care medical, and emergency management systems. It must consider the diversity in management and practice that resides among stakeholders, especially in the private medical sector. Securing buy-in from private medical entities presents a formidable challenge, with success contingent on demonstrating the importance of an emergency response organizational structure that varies from day-to-day operations and provides such benefits as effective incident planning for emergency response.

Planning Must Consider the Interface Between State and Local Agencies

Traditionally, emergency management in the United States has been primarily a local responsibility. This is an effective approach because of the immediate needs of victims. A major area that varies from this authority construct is public health, which has evolved more as a State power. The interface between State public health and local emergency management and medical response requires careful planning because time and resource imperatives must be met primarily through local response.

Input From Public Health and Medical Providers Enhances Incident Management

The majority of emergency and disaster events are managed by non-health/medical agencies. The integration of public health and medical disciplines into this management framework presents several advantages:

• Timely input by public health and medical managers at decision- making levels regarding life and safety issues for non-health responders.
• Ability to define medical response priorities across all aspects of an incident and incorporate them into a single cohesive strategy.
• Promotion of a proactive rather than a reactive response by HCOs helps to ensure the continuity of medical operations during an incident.
• Hands-on instruction for public health and medical managers by jurisdictional managers who have extensive incident management experience.

Public Health and Medicine May Have Leadership Roles in Incident Management

Public health and medical disciplines must assume the leadership role in the management of certain events, such as bioterrorism, or other incidents involving unusual or large numbers of casualties. In these scenarios, public safety agencies, which traditionally are the lead agencies in community response, would then provide support. This represents a significant adaptation for medical and public safety groups from their traditional roles in large-scale incident management. An effective "unified command" team, with a medical/health incident commander as the lead, may be the most effective way to accomplish this important task.

Healthcare Organizations Require Broad Support To Provide MSCC

To maximize MSCC, hospitals and other healthcare organizations (HCOs) require a broad range of support (e.g., logistical, information, financial, regulatory) to address their role in a potentially overwhelming event. These support needs are not well understood outside the hospital community.

Training Efforts Must Be Based on Established, Defined Response Systems

Many previous training efforts in incident management for healthcare personnel have not been well coordinated or based on defined hospital response systems. Effective, operational-level training must be structured on existing and available systems. It must be adaptable to the healthcare circumstances so that, if participants don't have the necessary systems, the training will demonstrate how to develop and implement operational systems.

The U.S. Healthcare System Maintains Excellent Baseline Capabilities

Under normal conditions, excellent baseline capabilities exist to address everyday health and medical issues in most communities in the United States. The most cost-effective, reliable strategy in MSCC is to first provide system support to these existing resources to enhance their volume and range for medical evaluation and treatment.

There Are Finite Limits to MSCC

Any attempt to develop and implement MSCC strategies must acknowledge that definite limits exist because no system can have limitless capacity. Expectations for the end product must be established in accordance with these limitations (for example, mass casualty care cannot be provided all at once, not all victims can be saved, and triage may be used to provide "the greatest good to the greatest number"). These realities should be carefully but clearly communicated to the public. Managing public expectations may be one of the most critical strategies in a challenging or overwhelming event.

Funding Is Available To Implement Management Systems

Significant Federal grants are being given to State and local public health agencies for emergency planning and training. Thus, money is available to implement management systems in the public health and private medical communities. The most efficient use of these funds is to define and implement management systems before the purchase of specific technologies.

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