Healthcare Planning for Pandemic FAQ
Answers to questions posed at the May, 2006 pandemic plan preview meetings.
Updated 10/11/06
How/when will the funds earmarked for clinic supplies be distributed? What supplies? Respirators, communications equipment, other?
As part of an all hazards approach to healthcare system preparedness, regional Bioterrorism Hospital Preparedness Program (BHPP) planning committees have been allocating up to 15% of their BHPP funding toward clinic preparedness activities since FY 2003. Most regions completed an initial needs assessment to determine how best to spend this funding. The allocation of 5% to 15% of BHPP funding will continue to be designated to clinic preparedness.
Additional funding to support pandemic influenza planning for clinics may available through the Public Health Preparedness Program (CDC pandemic influenza funding). State funding will be used to purchase transport ventilators as part of a statewide cache that would be distributed to hospitals based on need. It is unlikely that clinics will receive ventilators.
What will the altered standards of care be for clinics during a pandemic?
If we experience a severe pandemic influenza, it is anticipated that clinics will modify their daily schedules to accommodate the significant surge in outpatient care. Most regions are participating in regional clinic preparedness planning committees to determine how to collaborate with hospitals and alternate care sites (off-site care facilities) to provide surge capacity. For clinics, this could include expanding clinic hours and determining whether a clinic will provide routine or specialized care during a pandemic influenza. For example, some clinics may provide specialized care including overnight stays. Other clinics may decide to close and send staff to work at neighboring clinics or alternate care sites.
Will the ethical framework give direction on how to triage for hospitalization and ventilator placement?
The triage of resources is a difficult but necessary consideration in a pandemic influenza that is anticipated to severely overwhelm available healthcare system resources. The all hazards healthcare system preparedness planning supported financially by the Health Resources and Services Administration (HRSA) has provided Minnesota with funding since 2002 to increase the capacity of the healthcare system to care for victims of terrorism or other public health emergency, including pandemic influenza.
Each region is developing an All Hazards Health and Medical Response and Recovery Plan to assure an integrated approach to medical surge capacity. Hospitals, clinics, and alternate care sites (off-site care facilities) are working together to provide a continuum of patient care options from the in-home care of people with mild illness to the outpatient care of people with moderate illness to the hospitalized care of people with severe illness. To assist in this planning, the Patient Care Coordination Guidance and Planning Document/CD was developed and distributed to planning teams. Each region of the state is developing a plan for how to triage patients to the most appropriate care setting within the context of these Guidelines.
A Science Advisory Team is developing guidelines for the triage of ventilators to assist hospitals and providers when the need for ventilators exceeds the available capacity. These guidelines are based on physiological parameters that would prioritize ventilator use for patients who would benefit most from their use. This group may also be involved in developing guidelines for the triage of other specialized medical equipment or resources.
Recognizing that this is an extremely difficult decision for hospitals and providers to make, multiple opportunities will be provided for hospitals, healthcare providers, ethicists and the public to participate in the discussion of triaging ventilators and other specialized medical equipment or resources.
Is there a hospital pandemic file plan template?
The MDH has not developed a specific hospital pandemic influenza plan template. Many hospitals have developed a Pandemic Influenza Annex as a component of their All Hazards Hospital Emergency Preparedness Plans. If a hospital would like some additional assistance with developing a Pandemic Influenza Annex, the MDH will assist them as needed.
Does the state have seats on mission mode? Many metro and national hospitals do. Recent metro wide table top/JCAHO also belongs.
On an as-needed basis, the MDH has had several seats on Mission Mode, which is a web-based emergency communication system used by the Metro Region. For example, the MDH has used Mission Mode as participants in Metro Region exercises. In addition, the MDH and all of the Regional Hospital Resource Center Coordinators (RHRCs) used Mission Mode to communicate during the 2005 Minnesota hurricane response at Camp Ripley.
Mission Mode is a subscription-based electronic communication tool. During the Camp Ripley response, the Metro Region graciously extended subscriptions to the MDH and RHRCs to improve the communication process among hospitals, the MDH and Camp Ripley.
MNTrac, which is being rolled out in 2006 and 2007, is used to assess hospital bed availability, emergency room diversion status, along with specialized medical equipment and supplies. Sometime in 2007, MNTrac will include an electronic emergency communication tool very similar to Mission Mode that will be available to all hospitals without subscription (free). It is anticipated that MNTrac will provide the same level of service as Mission Mode and can be customized to add functionality based on need.
What volunteer groups besides Red Cross are you considering?
During a pandemic, all of the volunteer groups organized under the Minnesota Volunteer Organizations Active in Disasters (VOAD) will be needed to assist with community needs. These programs and the Minnesota Responds Medical Reserve Corp will work through HSEM to coordinate resources, logistics, and planning. Minnesota Responds is also part of a nationwide initiative to coordinate and mobilize health volunteers to help their communities respond to all types of needs in disasters. Depending on the type and scope of an event, resources may be available from other areas to respond. Because a pandemic will likely strain all resources and reduce the availability of resources from other states, MDH is working to identify “non-traditional” health resources to assist. For example, the National Guard is training non-medical personnel as certified nursing assistants. MDH is recruiting retired and non-active health professionals, and laypersons who could assist during a pandemic influenza. An emphasis on teaching families to care for members at home whenever possible will also be implemented.
Are there state plans for providing some quick updates for clinical care for RNs who may be available for care of patients but who have not been working a direct-patient care role (the RNs who would be re-assigned during a pandemic, to patient care.
MDH currently have no plans to provide refresher training on clinical care. Our focus will be to identify persons willing to volunteer to provide basic low acuity care in alternate care sites or expanded capacity areas within the hospitals. With large patient volumes and reduced staffing capacity, an adjusted standard of care will be necessary. Training in establishing, staffing, and operating an alternate care site (Off-site Care Facility) is being developed through the University of Minnesota for volunteers, and some just-in-time training will need to be developed to meet the specific needs of the event.
Hospitals may choose to offer refresher training to clinical staff in their facilities who do not normally provide direct care, but might be called upon to do so in a pandemic influenza. These could include clinical managers and other clinicians who routinely work in education, performance improvement and other specialized departments that may close during a pandemic.
What state resources will assist with establishment of Alternative Care Sites when hospitals are over occupied and are unable to spare staff for another site?
MDH has developed and distributed an Off-Site Care Operations Plan Guidance Manual to all Regional Hospital Resource Center Coordinators and Public Health Preparedness Consultants to use for alternate care site planning. Hospitals are working regionally to identify sites and develop operational plans for alternate care, including staffing plans. Hospitals will implement their internal and regional surge capacity plans before considering the opening of Alternate Care Sites.
MDH will communicate with hospitals using the Incident Command System process to monitor patient care needs and healthcare system capacity in order to advise the State Emergency Operations Center and the governor. Upon finding that the number of seriously ill or injured persons exceeds the emergency hospital or medical transport capacity of one or more regional hospital systems and that care for those persons has to be given in temporary care facilities, the governor may issue an emergency executive order.
MDH will communicate with healthcare systems using the Incident Command System process to assist regions with identifying and deploying additional staff and volunteer resources, in collaboration with the State Emergency Operations Center. The advanced registration of healthcare workers and retirees who no longer provide healthcare or other nontraditional providers is a prime focus of current Minnesota Responds MRC efforts to increase available staff surge capacity during a pandemic influenza. In 2006-2007, MDH will work with hospitals to develop health response teams that could be deployed within region or to assist other regions, depending on supply and demand needs. Deployment of hospital response teams is a hospital-based decision.
Will MDH be providing any guidelines or criteria for hospitals to use regarding triage of which patients should be hospitalized-to allow for standardization for all facilities responses?
The MDH has developed standardized planning tools for health care systems and public health agencies to use to develop plans for the coordination of patient care. The Patient Care Coordination Roles and Responsibilities Guidance and Planning Document/CD was developed in 2004 and has been distributed to local and regional partners involved in patient care. The CD was included with the MDH Pandemic Influenza Plan distributed in May 2006. Each region is developing a plan to coordinate patient care during a pandemic influenza that integrates care between and among in-home care, outpatient care and inpatient care, including alternate care sites.
A Science Advisory Team is developing guidelines for the triage of ventilators to assist hospitals and providers when the need for ventilators exceeds the available capacity. These guidelines are based on physiological parameters that would prioritize ventilator use for patients who would benefit most from their use. This group may also be involved in developing guidelines for the triage of other specialized medical equipment or resources.
How will hospitals isolate patients with a limited number of negative pressure rooms-will recommendations for airborne isolation change?
Under extraordinary circumstances, where the quantity of engineered airborne infection isolation (AII) rooms is insufficient to meet surge demand, hospitals can take various measures to protect patients and staff. MDH has developed a manual for facility engineers, which describes temporary methods of isolating patients for one room or for larger surge capacity needs. The manual, Infectious Disease Management: Methods for Temporary Negative Pressure Isolation, is a guide to assist hospitals in following recommendations for airborne infection isolation. The manual has been distributed to each hospital and regional trainings have been conducted with facility engineers. The manual will soon be available on the MDH website and on CD. Hospitals that do not have any airborne infection isolation (AII) rooms have purchased portable HEPA filter machines that they can use to isolate patients.
In collaboration with the University of Minnesota MERET program, the manual has been made into two online modules. Both modules require free registration with the MERET program.
- Design and Maintenance of Airborne Infection Isolation Rooms (AIIR)
- Methods for Achieving Temporary Negative Pressure Isolation (TNPI)
Why have hospitals been required to implement HEICS as opposed to NIMS?
The National Incident Management System (NIMS) is a generic incident command system for use by local, regional and state agencies to manage an event. Agencies using NIMS must adapt it to their facility/agency based on the type of work that is done. The Hospital Emergency Incident Command System (HEICS) is an incident command system that has already been adapted for use by hospitals to manage an event. The new Hospital Incident Command System (HICS), a revision of HEICS, was just released and will soon be distributed throughout the nation. HICSS is NIMS-compliant (meets NIMS requirements) and will include online training modules.
