Michael Clark, MD, EMS Medical Director, Ministry Saint Clare’s Hospital
Anyone who has been involved in EMS and/or emergency preparedness activities is well aware that the various disciplines involved in emergency preparedness and response all too often operate in silos with minimal coordination and interaction. These silos will hopefully be eroding over the next few years as the concept of healthcare coalitions is further developed and implemented.
What is a Healthcare Coalition?
“A healthcare coalition is a group of healthcare organizations, public safety and public health partners that join forces for the common cause of making their communities safer, healthier and more resilient. Coalitions are forming all around the United States to support communities before, during and after disasters and other crises.”
The development of healthcare coalitions is being spearheaded by the U.S. Department Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. As a result of both planning activities and after action review of incidents such as Hurricane Katrina, it was determined that medical surge and healthcare system preparedness and response requires multi-disciplinary/inter-agency coordination to be successful. Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness provides a comprehensive review of the capabilities that need to be addressed by healthcare coalitions
What are the disciplines that comprise a healthcare coalition?
There is no one answer to this question as the composition of healthcare coalitions varies depending on local resources, anticipated hazards, and type of incident being considered. The primary members of healthcare coalitions are emergency management, EMS, hospitals, trauma and public health as no matter how large or small an event is, all five disciplines will play key roles in the response to the event. Additional partners include long term care facilities, tribes, mental and behavioral health providers, community and faith-based partners, specialty service providers (e.g., dialysis, pediatrics, woman’s health, stand-alone surgery, urgent care), support service providers (e.g., laboratories, pharmacies, blood banks, poison control), primary care providers, community health centers, medical supply vendors, home health agencies, Red Cross, Salvation Army, etc… basically any organization that plays a role in the delivery of health services or supports the organizations that provide direct services.
Importance of Healthcare Coalitions
Healthcare coalitions are not intended to change the daily and diverse activities for emergency management, EMS, hospitals, public health, trauma and other partners; rather develop and provide a common planning and response framework for medical surge events. The importance of healthcare coalitions lies in the importance of coordination. In any medical surge event, resources are limited so in order to achieve the best outcome for all those affected by the event, resources and patient movement must be coordinated. This coordination needs to not only be within disciplines but across disciplines. For example, a tornado cuts across your town resulting in many people injured and loss of power to many parts of the town, including a local nursing home. The local hospitals prepare for the injured but, in order to best respond, the hospitals need the help of local EMS and local long term care facilities. EMS needs to equally distribute patients to local hospitals based on hospitals’ capabilities and capacities. Hospitals need to rapidly discharge those patients no longer needing acute care but still in need of rehabilitation and other long term care skilled nursing care, therefore local long term care and rehabilitation facilities need to be ready to accept such discharges on short notice. In addition, the nursing home that lost power needs to have a plan for back-up power and/or an arrangement with other facilities to care for those residents dependent on powered equipment; and their plan cannot be “send them to hospital, they will take care of those residents”.
Current State and Next Steps in Healthcare Coalitions in Wisconsin
The planning for and development of healthcare coalitions is in progress at both the state and regional levels. In late 2013 and early 2014, stakeholder meetings were held to review current regional boundaries for emergency management, Wisconsin Hospital Emergency Preparedness Program (WHEPP), public health, regional trauma advisory committees (RTAC), and EMS. After extensive discussion, seven Health Emergency Regions were determined and will follow the existing WHEPP boundaries. Given that the WHEPP boundaries are based on established referral patterns, it seemed the most reasonable starting point for health response coordination. The WHEPP and RTAC boundaries are similar with the most notable exception being in the northwest corner of the state where three RTAC’s are located in one WHEPP region.
These Health Emergency Regions will serve as the core boundaries for healthcare coalitions. It is important to understand that the region boundaries are not intended to be exclusionary but rather provide a common starting point for planning, response and funding. There will always be boundary issues and organizations along borderlines will always have unique strengths and being involved in two or more regions; such cross regional cooperation is encouraged.
The next steps for healthcare coalitions are the development of state and regional leadership groups to begin to form the initial healthcare coalition structure. Each healthcare coalition will need to define an executive committee that represents regional emergency management, EMS, hospitals, trauma and public health organizations, identify and hire a full-time coalition director/manager/coordinator and part-time medical director/advisor.
Disclaimer: Dr. Clark serves as a Medical Advisor to the Wisconsin Hospital Emergency Preparedness Program (WHEPP) within the WI Department of Health Services; however the contents of this article represent his interpretations of current federal grant requirements, their implications for emergency planning and response, and do not necessarily represent the views of the WI Department of Health Services.