Depending upon the size, severity, and duration of the incident and the robustness of local healthcare and public health infrastructure, SLTT capacity to provide appropriate care and services in response to a biological incident can be quickly overwhelmed. Plans should be made in coordination with public health officials and HCCs for monitoring the capacity of emergency departments and hospitals as well as the continued availability of medical supplies. Healthcare capacity to adapt to the overwhelming need depends on the implementation of triage of available hospital beds, patients, and EMS; load-balancing through use of alternate care sites (ACS) or hospitals that were not impacted; and other forms of care adaptation, such as modified care standards or the use of non-traditional locations to provide needed services.
Biological incidents may lead to the triage or prioritization of available hospital beds, including critical care space and capacity. To ensure the right resources reach those most in need, triage of patients will be critical with respect to no-notice biological incidents and also may be required for naturally occurring disease events when they are contagious and have had time to spread throughout the population. Prioritization of patients and use of triage also may occur within an individual hospital when resources are overwhelmed. While triage decisions may be made within hospitals and healthcare systems for patients and hospital beds, HCCs can facilitate coordination of these resources to help prevent the need for triage. EMS may also implement triage procedures regarding issues such as who responds to emergency calls, which patients are transported, and where patients are transported (e.g., to a Federal Medical Station [FMS] or ACS instead of hospital). EMS triage decisions and alteration of standards will be made in coordination with HCCs and local authorities.
The activation of pre-existing mutual-aid agreements with neighboring jurisdictions can help relieve pressure on local medical facilities. If the biological incident also extends into jurisdictions with which agreements have been established, resource challenges are more likely to persist. HCCs or Medical Operations Coordination Cells may initiate load-balancing in a region if a hospital or system is overwhelmed. Load-balancing may involve prehospital distribution of patients among area healthcare facilities, transferring patients from overwhelmed healthcare facilities to ones with more capacity (space, staffing, and equipment), or moving resources to support an overwhelmed facility. When put into place, triage and care adaptations should be openly communicated to the community.
Planners should consider how logistics assistance may mitigate the need to implement triage or care adaptations.
Healthcare and public health infrastructure resilience may be unavoidably impacted by supply chain disruptions resulting in limited availability of PPE, pharmaceuticals, medical equipment, and other critical resources. Insufficient PPE may lead to reuse of equipment designed for single use and increased exposure (and anxiety for potential exposure) among first responders and healthcare personnel. Supply chain disruptions may also lead to increased cost of PPE, as seen during the COVID-19 pandemic. While mutual-aid agreements may allow for transfer of PPE during a local or regional incident as discussed above, these agreements may be of little assistance if supply chains are disrupted nationally or internationally.
Challenges and Changes in Healthcare during the COVID-10 Pandemic
For much of 2020, normal medical care was constrained as facility space, staff, and resources (e.g., medical equipment, PPE) were in high demand due to the COVID-19 pandemic. The situation was further complicated in several jurisdictions facing concurrent disasters including hurricanes, wildfires, regional-scale flooding, civil unrest, etc. Care adaptation and triage occurred during the COVID-19 pandemic in the U.S., as EMS transported patients to non-acute care hospitals and ACS,83 EMS modified protocols for care related to cardiac arrest,84 hospitals adapted care based on available resources,85 and state licensing requirements were altered/waived in order to accept out-of-state healthcare workers.86
What Will You Need to Know?
- Where are the hospitals and clinics in your region? What are their specialties/capabilities, number of beds, intensive care unit capacity, and number of ventilators and respirators?
- What are the locations and capabilities of SLTT public health resources?
- Does your jurisdiction have an existing HCC? What role does emergency management serve to support their collaborative work?
- How will surge and/or care adaptations be addressed at hospitals and healthcare facilities?
- What stakeholders should be engaged for discussion around need for care adaptations as well as specific adaptations?
- How will this be communicated to the community?
- What are the likely types of supply chain disruptions that you might expect to see in larger-scale scenarios?
- How will medical resources be prioritized? How will this be communicated to the community?
- How will you manage the asymptomatic, possibly exposed populations?
- What are the pertinent MOUs and MOAs (for medical care, lab services, etc.)?
- How will you know the impact (and projected impact) on the workforce – first responders, emergency management, hospitals, clinics, laboratories, other medical and public health professionals?
- What workforce and logistical considerations will be necessary to work around the workforce impacts?