Facilitating Hospital Emergency Preparedness: Introduction of a Model Memorandum of Understanding
ABSTRACT Effective emergency response among hospitals and other health care providers stems from multiple factors depending on the nature of the emergency. While local emergencies can test hospital acute care facilities, prolonged national emergencies, such as the 2009 H1N1 outbreak, raise significant challenges. These events involve sustained surges of patients over longer periods and spanning entire regions. They require significant and sustained coordination of personnel, services, and supplies among hospitals and other providers to ensure adequate patient care across regions. Some hospitals, however, may lack structural principles to help coordinate care and guide critical allocation decisions. This article discusses a model Memorandum of Understanding (MOU) that sets forth essential principles on how to allocate scarce resources among providers across regions. The model seeks to align regional hospitals through advance agreements on procedures of mutual aid that reflect modern principles of emergency preparedness and changing legal norms in declared emergencies.
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ABSTRACT: CONTEXT: Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice. METHODS: A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health. FINDINGS: The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings. CONCLUSIONS: The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.Milbank Quarterly 03/2013; 91(1):78-122. DOI:10.1111/milq.12003 · 5.06 Impact Factor
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ABSTRACT: The objective of this review is to stimulate the reader's considerations for developing community disaster mitigation. Disaster mitigation begins long before impact and is defined as the actions taken by a community to eliminate or minimize the impact of a disaster. The assessment of vulnerabilities, the development of infrastructure, memoranda of understanding, and planning for a sustainable response and recovery are parts of the process. Empowering leadership and citizens with knowledge of available resources through the planning and development of a disaster response can strengthen a community's resilience, which can only add to the viability and quality of life enjoyed by the entire community.Southern medical journal 01/2013; 106(1):13-6. DOI:10.1097/SMJ.0b013e31827cb037 · 1.12 Impact Factor
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ABSTRACT: Background:Disasters and pandemics can result in large numbers of critically ill or injured patients that may overwhelm available resources despite implementing surge response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in this chapter are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients including front line clinicians, hospital administrators and public health or government officials. Methods:The triage work group reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. Results:The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This chapter provides eleven suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Conclusions:Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.Chest 08/2014; 146(4). DOI:10.1378/chest.14-0736 · 7.13 Impact Factor