Coordinating a System of Care

Overall healthcare system coordination during mass casualty events is critical to achieving a successful response


In January 2012, the Health and Human Services Assistant Secretary of Preparedness and Response (ASPR) released Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness.

This document discusses the need for overall healthcare system coordination during mass casualty events such as Hurricane Katrina and the H1N1 pandemic, and is one of the first to look at the entire healthcare system—including EMS, hospitals and public health entities—and define the roles and responsibilities for each in regard to their capabilities to prepare for, respond to and recover from large-scale incidents or events that impact operations.

The document focuses on eight over-arching capabilities that ASPR, along with various other federal entities (such as the Department of Homeland Security) and private partners (such as the Association of State and Territorial Healthcare Officials and the National Association of County and City Health Officials) worked to develop, along with corresponding functions, tasks and resource elements.

These capabilities are aligned with a previous CDC document, Public Health Preparedness Capabilities: National Standards for State and Local Planning, which was released in May 2011 and specifically addressed public health emergency preparedness capabilities. These capabilities, which are specific to state and local public health entities, are listed below:

  1. Community Preparedness
  2. Community Recovery
  3. Emergency Operations Coordination
  4. Emergency Public Information and Warning
  5. Fatality Management
  6. Information Sharing
  7. Mass Care
  8. Medical Countermeasure Dispensing
  9. Medical Materiel Management and Distribution
  10. Medical Surge
  11. Non-Pharmaceutical Interventions
  12. Public Health Laboratory Testing
  13. Public Health Surveillance and Epidemiological Investigation
  14. Responder Safety and Health
  15. Volunteer Management

Prior to outlining the actual capabilities, the document details the planning efforts that will be needed from the multiple entities represented in the healthcare system. Some of the threats that the healthcare system faces are discussed before the document offers pearls on planning principles; the differences between strategic, operational and tactical planning; various planning approaches; and the need for stakeholder engagement.

The eight capabilities identified by ASPR were designed in conjunction with the 15 capabilities listed above. They are:

  • Healthcare System Preparedness
  • Healthcare System Recovery
  • Emergency Operations Coordination
  • Fatality Management
  • Information Sharing
  • Medical Surge
  • Responder Safety and Health
  • Volunteer Management

The first capability mentioned, healthcare system preparedness, calls for the establishment of healthcare coalitions in an effort to bring everyone to the table on planning and response efforts or, as stated in the document, the first step of planning is the formulation of a collaborative planning group. The team mentioned specifically included EMS, emergency management and other entities such as public health agencies.

Another capability that may interest EMS agencies is fatality management. EMS agencies are often the first responder to these types of incidents and need to be involved in response planning efforts. It’s important to note that mass fatality management is traditionally the purview of the coroner/medical examiner with strong support from other entities such as law enforcement.

One of the more interesting components of this document is the way that EMS operations are integrated throughout the document and its various capabilities. This is seen most predominantly in the medical surge capability section where EMS is referenced in regard to the coordination of integrated healthcare surge operations with prehospital EMS operations, as well as the need to better understand EMS disaster triage protocols and CBRNE treatment protocols so as to assist with the transition of disaster patients from the field to a healthcare facility.

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