Staffing Committee
Members
Pamela Boody
Byron Callies, MSHS, CHEP, CEM
Sue Engerman, RN
Lynette Kemme
Mary Lutzke
Connie Meekma, RN
Kathy Miller, RN
Cathy Ostrowski, RN BS CIC
*Sheri Waldron, RN, BSN
*Committee chair
WHD Enterprise LLC
Comprehensive Emergency Management Associates
MMPC
Zeeland Community Hospital
Kent County Health Department
Sheridan Community Hospital
Gerber Memorial Hospital
Spectrum Health
Carson City Hospital
Objectives

Determine minimal staffing by licensed and non-licensed personnel needed to deliver
essential services and care to flu patients during a severity World Health Organization
(WHO) Phase 5 pandemic, eight-week pandemic cycle.

Determine minimal medical supplies and clinical support resources needed to provide
essential care to flu patients during a severity WHO Phase 5 pandemic, eight-week
pandemic cycle.
World Health Organization (WHO) Pandemic Level Definitions
“In nature, influenza viruses circulate continuously among animals, especially birds. Even though such
viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals
have been reported to cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have
caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3 an animal or human-animal influenza reassortant virus has caused sporadic cases or small
clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain
community-level outbreaks. Limited human-to-human transmission may occur under some circumstances,
for example, when there is close contact between an infected person and an unprotected caregiver.
However, limited transmission under such restricted circumstances does not indicate that the virus has
gained the level of transmissibility among humans necessary to cause a pandemic.
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal
influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained
disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country
that suspects or has verified such an event should urgently consult with WHO so that the situation can be
jointly assessed and a decision made by the affected country if implementation of a rapid pandemic
Caring for the Community | preparing for an influenza pandemic
1
containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does
not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO
region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal
that a pandemic is imminent and that the time to finalize the organization, communication, and
implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country
in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will
indicate that a global pandemic is under way.
During the post-peak period, pandemic disease levels in most countries with adequate surveillance will
have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears
to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be
prepared for a second wave.
Previous pandemics have been characterized by waves of activity spread over months. Once the level of
disease activity drops, a critical communications task will be to balance this information with the possibility
of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be
premature.
In the post-pandemic period, influenza disease activity will have returned to levels normally seen for
seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At
this stage, it is important to maintain surveillance and update pandemic preparedness and response plans
1
accordingly. An intensive phase of recovery and evaluation may be required.”
1
Available at: http://www.who.int/csr/disease/avian_influenza/phase/en/ July, 2009
Caring for the Community | preparing for an influenza pandemic
2
Staffing Committee Assumptions
1)
Non-traditional staffing will be available to support proposed staffing models.
a) On-the-job trained or just-in-time training essential.
b) There will be an expansion of traditional roles.
2)
There will be an increased number of patients in hospitals with a higher acuity level than “normal” as
the pandemic intensifies.
a) Provide current standard of care as long as physically possible, then shift focus to
modified critical care staffing model for hospitals.
b) Seven-day stay at critical care acuity level as norm for the hospitalized patients per
CDC FluSurge calculations.
c) Hospital logistics more difficult due to layout:
i. Efforts will be made to separate infected patients from non-infected patients.
ii. Large wards are not available in hospital for cohorting.
3)
Acute Care Sites (ACS) will be staffed as a support/palliative/symptomatic service.
a) Focus on modified nursing home staffing models for ACS.
b) Basic model is for 50 bed units, which can be expanded or contracted as required.
i. Physician offices/clinics/centers could be used to provide supportive care in
addition to already contracted ACS sites.
(1) If office/clinic/center no longer able to provide care, staff may be asked
to supplement other emergency response areas.
ii. Nursing homes are additional resource for palliative care.
Background
The Staffing Committee of the Spectrum Health Centers for Disease Control and Prevention (CDC) Grant
Project “How to Deliver Essential Health Care Services During an Influenza Pandemic” is a
multidisciplinary group representing hospitals, infection prevention, emergency management, physician
offices and public health. Initial reference materials and information related to stated objectives were
reviewed.
Options for implementing an influenza pandemic staffing and supply model for acute care facilities and the
Modular Emergency Medical System (MEMS) structures associated with them were developed. The intent
is to provide a flexible and adaptable model for staffing and supply requirements in an influenza pandemic.
Initial discussions indicated there were a number of assumptions about “how things were supposed to
work”, including who would staff acute care facilities and MEMS structures designed to expand acute care
capacity. After considerable research it was determined that assumed staffing availability did not match
with realistic staffing expectations.
The Process
Monthly meetings and “homework” assignments created a shared workload. We created a foundation of
information on which to base decisions and support the achievement of planning objectives in a short time
line. Collaboration and clarification with other project committees was accomplished through general
sessions, indirect question and answer, and direct discussion.
Caring for the Community | preparing for an influenza pandemic
3
While many topics were reviewed, discussed, and addressed concurrently, the process included defining
the extent of the problem. Legal issues related to staffing models and supply models were researched
extensively.
Extent of Problem
Literature review was conducted to define the extent of the problem using various federal, state, local, and
organizational response plans related to pandemic influenza. Drawing from experience, an understanding
was developed of the impact pandemic influenza could have on communities.
World Health Organization’s (WHO) pandemic influenza level definitions were reviewed. WHO defines a
Phase 5 pandemic as the last phase of the Pandemic Alert period and goes on to state “Phase 5: Larger
cluster(s), meaning between 25-50 people, lasting from two to four weeks, appear. While human-to-human
transmission is still localized, the virus appears to be increasingly better adapted to humans. Though it is
2
not yet fully transmissible, there is a substantial pandemic risk.”
3
The triage matrix (see attached document) modified by Dr. Mark Hall, Project Medical Director, was
reviewed as a portion of the framework for meeting committee objectives. The matrix provided additional
definitions to consistently assess patient care intensity.
To determine potential pandemic influenza morbidity and mortality impact within Region 6, the CDC’s
4
FluSurge tool was used. While various “rates” used in the tool are not validated, the tool provided a basis
for determining how hospital staffing, space, patient care supplies and equipment would be impacted.
FluSurge2.0 indicated, based on Region 6 population data (368,794 0-19 years of age, 891,543 20-64
years of age and 178,734 65 years or older), that the health care system could expect:
 Average length of non-Intensive care unit (ICU) stay of three days
 Average length of ICU stay of seven days
 Average length of ventilator usage of seven days
 Average proportion of influenza patients that, if admitted, will need ICU 15%
 Average proportion of admitted influenza patients that will need ventilators 7.5%
 Average proportion of influenza deaths assumed to be hospitalized 70%
 Daily percentage increase in cases arriving compared to previous day 3%
Additionally, CDC lists attack/mortality rates to assist local pandemic planners in estimating potential
impact of the next pandemic in their community.
2 Cheng, M “WHO Handbook for Journalists: Influenza Pandemic” World Health Organization, December,
2005 available at http://www.who.int/csr/don/Handbook_influenza_pandemic_dec05.pdf
3 Private communication “Hall Triage Matrix” Spectrum Health CDC Grant Project, February, 2009
4 www.cdc.gov/flu/excel/FluSurge2.0.xls
Caring for the Community | preparing for an influenza pandemic
4
PANDEMIC FLU CASUALTY PROJECTIONS5
HHS Estimates
Number in
Region 6
Number ill
25% require outpatient care
3% require
hospitalization
2.5% will die
719,536
179,884
HHS Estimates
Number in
Region 6
Number ill
15% require outpatient care
0.3% require
hospitalization
0.1% will die
431,721
64,758
ATTACK RATE 50%
Number in
Number in
community of
community
1,000
of 500
500
250
250
125
Number in
community
of 100
50
25
21,586
30
15
3
17,988
25
13
2-3
ATTACK RATE 30%
Number in
Number in
community of
community
1,000
of 500
300
250
150
125
Number in
community
of 100
50
25
1,295
30
3
>1
432
25
1
>1
During the planning process, the H1N1 (Spring 2009 Novel Influenza A) influenza outbreak occurred.
Lessons learned from acute care hospitals, health departments, risk management, and physician practices
were reviewed.
Staffing capabilities of hospitals for surge and MEMS structures (ACS/Neighborhood Emergency Help
Centers) were discussed in depth. Recognizing that staffing would be in short supply as a pandemic
outbreak progresses, alternate resources for staffing are explored further in the Staffing Models section of
this work.
Legal Issues
Acquisition of staff from different sources engendered discussion of numerous legal challenges, prompting
the review of various regulations including the following:
 OSHA 29 CFR 1910.134 and MIOSHA Part 451, Respiratory Protection
 Public Act (PA) 390, Michigan Emergency Management Act
 Public Act (PA) 368, Michigan Public Health Code
 Emergency Medical Treatment and Labor Act (EMTALA)
 Health Insurance Portability and Accountability Act (HIPAA)
Other legal issues considered include:
 Credentialing
 Pre-Event executive orders
 Region 6 Hospital Mutual Aid Memorandum Of Understanding (MOU) – attachment
 Health Care Mutual Aid Memorandum of Understanding (MOU) – attachment
5
*http://www.whitehouse.gov/issues/homeland_security
Caring for the Community | preparing for an influenza pandemic
5


Michigan’s State Pandemic Operations Plan, Legal Authorities Appendix
Altered standards of care
Throughout the review process, the Spectrum Health CDC Grant Project Legal Committee, the Michigan
Attorney General’s Office, and Michigan’s Pandemic Influenza Coordinating Committee were consulted.
Specific Findings
Discussion surrounding the use of medical students as potential staffing sources occurred. Robert Ianni,
the Michigan Assistant Attorney General, indicated that a recent amendment to PA 390 recognizes medical
6
residents as a potential staffing source.
Mr. Ianni also advised that a number of emergency executive orders have been developed. A list of
emergency executive orders was requested, since some of these orders may be related to legal barriers
that could impact recommendations.
Each state is required to have a Pandemic Influenza Coordinating Committee (PICC). In Michigan, the
PICC has a Public Safety Legal Subcommittee. This subcommittee conducted a legal assessment to
determine if local and state statutes provide adequate authority to allow for an effective response to
pandemic influenza. Points to consider include:

Public Act 390 provides broad powers to the governor that allows her/him to provide liability for
ANYONE working as disaster relief worker. As such, the “list” specifically identified in PA 390 is
not an exclusionary list.

Public Health Code stipulates that a previously licensed health care professional does not need to
7
have a current license to provide care during an emergency .
Review of the above indicates no apparent legal barriers to staffing. It does not, however, totally negate
potential legal barriers to staffing hospitals and MEMS structures during a pandemic influenza outbreak.
While legal issues to staffing appear to be limited, the Joint Commission (TJC) and the American
Osteopathic Association (AOA) require hospitals to have a disaster credentialing process. This process
allows rapid verification of licensure and background checks in an emergency.
8
Minimum core criteria for credentialing, according to Skidmore, Wall & Church include the following:
 Physicians, PAs (Physician Assistants) and NPs (Nurse Practitioners). The minimum core criteria
that should be verified for physicians are licensure, picture identification (e.g. driver’s license),
education, training or experience, clinical competence and ability to perform requested privileges.
In a disaster situation, based on state and local regulations, physician, PA and NP credentialing
should be streamlined by verifying the individuals’ current credentials and privileges at his/her
home hospital and by obtaining a copy of the relevant medical license and board certifications.
6
Callies, B. Private e-mail correspondence with Robert Ianni, Michigan Assistant Attorney General.
February, 2009
7
Callies, B. Private e-mail correspondence with Karen Krzanowski from MDHC – Office of Public Health
Preparedness February 12, 2009
8
Skidmore S., Wall WT, Church JK Modular Emergency Medical System: Concept of Operations for the
Acute Care Center (ACC), Aberdeen Proving Ground, MD, May, 2003
Caring for the Community | preparing for an influenza pandemic
6

RNs (Registered Nurses), LPNs (Licensed Practical Nurses), RTs (Respiratory Therapists),
Paramedics, EMTs (Emergency Medical Technicians) and all other licensed personnel.
Presentation of the individual’s current professional license, picture identification (e.g. driver’s
license) and current CPR (cardiopulmonary resuscitation) card, if available, is typically sufficient
verification to practice in most states.
9
The Region 6 Hospital Mutual Aid Agreement reads:
The medical staff office or the designated department of the recipient hospital will be responsible
for providing a mechanism for emergency credentialing granting disaster privileges for physicians,
nurses and other licensed health care providers to provide service at the recipient hospital.
Credentialing volunteers (those not from Region 6 health care facilities) for use in a hospital or
ACS setting should be carried out by those hospital personnel already familiar with the process. All
hospitals have trained personnel to carry out the credentialing process. Assistance from law
enforcement or the State of Michigan may be required for criminal background checks for
volunteers present from states other than Michigan.
The Region 6 Hospital Mutual Aid Agreement supports the credentialing process. This agreement is
region-specific and thereby has limitations for inter-regional/inter-state support.
Staffing Models
Numerous sources were reviewed to gain an awareness of hospital/ACS/NEHC (Neighborhood
Emergency Help Center) staffing models. Determining an appropriate staffing model included
understanding the patient surge impact on hospitals.
The H1N1 pandemic outbreak of spring 2009 demonstrated that influenza strain virulence, intensity of
illness and case fatality rate play important roles in determining staffing needs. Most mass care staffing
models assume a higher level intensity of illness than was experienced during this outbreak.
Recommendations assume a “worst case” scenario to protect patients, staff and the community.
Hospitals
10
Rubinson, Hick, Hanfling, et al state “Hospitals cannot be expected to prepare for endless quantities of
critically ill patients.” Hospitals will not have the space, staff, or equipment to provide patient care services
to the number of expected ill during an influenza pandemic (beyond hospital capacity – surge). An acute
care site (ACS) would be necessary (e.g., school gymnasiums, armories, convention centers).
Rubinson, Hick, Hanfling, et al suggest that “Hospitals with ICUs should plan and prepare to provide EMCC
(emergency mass critical care) every day of the response for a total critically ill patient census of at least
triple usual ICU capacity.” From this suggestion, a modified critical care staffing model was deemed
appropriate when hospitals are at or above capacity with acutely ill patients.
9
Michigan Region 6 BioDefense Council Region 6 Hospitals Mutual Aid Memorandum of Understanding
August 2008
10
Rubinson L, Hick JL, Hanfling DG, Devereau AV, Dichter JR, Christian MD, Talmor D, Medina J, Curtis
JR, Geiling JA. Definitive Care for the Critically Ill During a Disaster: A Framework for Optimizing Critical
Care Surge Capacity. Chest 2008; 133; 18S-31S
Caring for the Community | preparing for an influenza pandemic
7
11
A critical care model, based on the Ontario Health Plan for Influenza Pandemic Working Group suggests
a core team, per ten acutely ill patients, of one critical care nurse supervising three to four nurses, working
in conjunction with one respiratory therapist and one physician. “The use of these types of care teams has
12,13
proven to be effective in past emergencies.”
Acute Care Site
If the influenza pandemic causes severe illness in large numbers of people, hospital capacity (beds and
staffing) will be overwhelmed. In that case, communities will need to provide care in ACS. No statutory
requirement for hospitals to establish an ACS was identified, although some accreditation agencies include
14
ACS in guidance documents. Expectations may differ between regions and/or states regarding hospitals
15
establishing and running an ACS. Local planning teams should investigate mandates for ACS
implementation and oversight within their state and local jurisdiction.
16
Recent best practices derived from local ACS exercises were discussed.
During the first ACS exercise, a hospital staffed all ACS Operations Center positions. During the
second ACS exercise (a repeat of the first), the ACS Operations Center was staffed by multiple
agencies, including: hospital staff from multiple area hospitals, host facility staff, Medical Reserve
Corps staff, Michigan State University Public Safety personnel, and EMS agency staff.
While strengths and areas for improvement were identified during both exercises, it was evident
that the multidisciplinary approach to ACS management was a better approach. This approach
allowed staff with applicable skill sets to fill appropriate roles. Additionally, this approach allowed
hospitals to focus on what they do best – provide patient care. In the end, it was determined that a
multidisciplinary approach was likely the only realistic approach to establishing a functional ACS
within the community.
A community-based approach is required to establish a functional ACS with effective staffing. For
example, hospitals may provide only medical oversight and clinical supervisory staff, while other roles may
be filled by additional community agencies/organizations. In order to minimize labor needs, an ACS would
be established at a facility that allowed for patient cohorting, such as a gym or civic center (as opposed to
individual rooms that require more labor to support patient care services).
Based on limited availability of staff, supplies, equipment and infrastructure a
palliative/symptomatic/supportive care model was deemed most appropriate for the ACS. This level of
care is generally provided by nursing homes; therefore a nursing home staffing model was chosen.
11
Christian MD, et al “Critical Care During a Pandemic: Final report of the Ontario Health Plan for an
Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge and Triage
Criteria. April, 2006 available at: http:
12
Cushman JG, Patcher HL, Beaton HL. Two New York City Hospitals’ surgical response to the
September 11, 2001, terrorist attack in New York City. J Trauma 2003; 54(1):147-154
13
Hick JL, Hanfling D, Burstein JL et al. Health care facility and community strategies for patient care surge
capacity. Ann Emerg Med 2004; 44(3):253-261
14
The Joint Commission. EM.02.01.01, EM.02.02.01-EP 13, EM.02.02.03-EP 9, EM.02.02.03-EP 10,
EM.02.02.11-EP3. 2008
15
Callies B. private e-mail correspondence ACC_from_MEMS_R2N. June, 2009
16
Callies B. Community ACS Model. Private communication Feb 2009
Caring for the Community | preparing for an influenza pandemic
8
The following documents were reviewed:
 Job descriptions for volunteer staffing based on pre-established job descriptions, including:
o Hospital Incident Command System
o Federal Emergency Management Agency (FEMA) responder credentialing
o Medical Reserve Corps
o Just-in-time job descriptions
 Department of Health and Human Services (DHHS) annotated review of literature for state-initiated
17
nursing home nurse staffing ratios.
 Staffing models for various locations and states
 Functional exercise after-action reports
 Current mutual aid limitations and guidelines
 Michigan volunteer registry roles and availability
 Citizen Corps roles and availability
Sources
The committee conducted a review to identify possible sources of clinical and non-clinical staffing to
support patient care needs throughout the region at hospitals and acute care sites. The committee
identified the following general and specific potential staffing sources (also see Surge Capacity Staffing
Resources document):
Non-Clinical Staff
ACS Site Owners/Managers/Workers
Hospitals (including the Veterans
Administration)
Temporary Staffing Agencies
Health Departments
Fire Departments
Emergency Medical Services (EMS)
Agencies
Police Departments
Sheriff’s Departments
National Guard Units
Military Reserve Units
Universities/Colleges
Medical Reserve Corps
Michigan Volunteer Organizations Active in
Disasters
National Volunteer Organizations Active in
Disasters (refer to VOAD attachment)
Citizen Corps
Americorps
Clergy
Family Members
17
Clinical Staff
Hospitals (including the Veterans
Administration)
Health Departments
Emergency Medical Services (EMS)
Agencies
National Guard Units
Military Reserve Units
Medical Reserve Corps
Medical/Pharmacy/Radiology/Nursing
Schools (including students)
Dentists
Veterinarians
American Red Cross
Federal Assets (Refer to the Federal
Assets attachment)
Family Members
May 2002 Available at: http://aspe.hhs.gov/daltcp/reports/ratiolit.htm
Caring for the Community | preparing for an influenza pandemic
9
Neighborhood Emergency Help Centers
18
The Neighborhood Emergency Help Center (NEHC) “serves the following purposes:
1. Direct casualties and “worried well” away from emergency departments (EDs), allowing hospitals
to continue to remain open in some capacity.
2. Render basic medical evaluation and triage, allowing medical providers to focus their efforts and
make efficient use of limited resources.
3. Provide limited treatment to people seeking aid, including stabilization care and distribution of
prophylactic medications and self-help information.
U.S. Army Soldier and Biological Chemical Command (SBCCOM) goes on to state “the MEMS strategy…
19
is one practical approach to managing a major non-communicable incident.” The NEHC model, as
proposed by the U.S. Army SBCCOM, was not designed for social distancing practices to minimize
disease transmission during an influenza pandemic. While the NEHC provides valuable support in a noncommunicable mass casualty care situation, the use of pre-established 2-1-1 or public health call centers
to provide telephone/remote triage and information to the public is a more responsible use of resources.
This limits public congregation while still providing essential public information.
A further option could include use of local primary care physicians to provide further triage (home care vs.
ACS care vs. acute hospital care) as well as provide locations for distribution of antibiotics, antiviral
medications or vaccines to the community. Using local health care providers requires the willing
cooperation of the practice and may not be feasible in smaller groups.
Supply Models
Hospital and ACS supply needs were evaluated using the following documents:
 FEMA 508-3 EMS Typed Resource Definitions
 FEMA 508-5 Health and Medical Typed Resource Definitions
 FEMA 508-8 Medical and Public Health Typed Resource Definitions
 InterAgency Board for Equipment Standardization and Interoperability (IAB) Standardized
Equipment List
 SBCCOM’s ACC (Acute Care Center) Concept of Operations
 Rocky Mountain Center of Excellence ACC supply models
 Regional resources
 Vendor supply lists
 Routine hospital supply inventories
 Strategic National Stockpile plans
Region 6 current hospital supply inventories were sampled. TJC recommends that hospitals maintain
adequate supplies to “stand alone” for 96 hours. The appendices E (equipment) and F (pharmaceuticals)
from SBCCOM’s ACC Concept of Operations contain a comprehensive list of supplies that can be used for
guidance for both hospitals and ACS.
18
U.S. Army Soldier and Biological Chemical Command. A Mass Casualty Care Strategy for Biological
Terrorism Incidents. Pg. 7. May, 2001. Available at:
http://bioterrorism.slu.edu/bt/key_ref/DOD/nehc_green_book.pdf
19
U.S. Army Soldier and Biological Chemical Command. Expanding Local Healthcare Structure in A Mass
Casualty Terrorism Incident. Pg. 16. June, 2002. Available at:
http://www.co.sanmateo.ca.us/vgn/images/portal/cit_609/23/32/844934287ECBC_mems_copper_book.pdf
Caring for the Community | preparing for an influenza pandemic
10
The supply list can be modified for the ACS to remove advanced airway and other non-palliative supplies.
Additional personal protective equipment (PPE) supplies (i.e., gloves, N-95 respirators, surgical
masks, gowns, goggles, splash shields, hand sanitizer, soap, etc.) for the both hospital and ACS will be
required.
Some points to consider when “determining minimal medical supplies and clinical support resources
needed to provide essential care to flu patients during a severity WHO Phase 5, eight-week pandemic
cycle” include:
 Pediatric-specific medical supplies and pharmaceuticals
 Specialty supplies for surgery; other specialty patients (burn units, dialysis units, etc)
 Hospice services, pain meds
 Mortuary supplies, storage areas
 Shelf life, potential duration of need
 Define current supply, rate of use, how long supplies will last
 Food supplies for the ACS
 Staff supply needs - food, water, shelter, shower facilities, sleeping facilities
Private vendors were consulted regarding ability to provide supplies in a state of emergency. As a result,
alternate sources for hospital and ACS supplies were identified. These sources include:
 Food Supplies: restaurants, local food suppliers, local food manufacturers, food supply chains,
wholesale warehouses, caterers, non-governmental organizations, universities, schools, churches
 Patient Care Supplies: retail chain pharmacies, pharmaceutical companies, home health supply
companies, alternative retailers (EMS supply companies, etc.)
 Hygiene Supplies: retail suppliers, hotels, churches
 Cleaning Supplies: retail outlets, wholesale warehouses, local manufacturers
 Medical Gas: pulmonary suppliers, truck and welding suppliers, dive shops
 Laundry: hotels, universities, laundromats, dry cleaners, uniform supply, commercial laundry
services
 Decontamination: car washes, health clubs, local swimming pools
 Trash: municipalities, local waste services
 Document Security: shredding companies, portable PODS
 PPE: pharmacies, retail outlets, chemical plants, farm/vet supply, food industry
Conclusion
To address “determine minimal staffing by licensed and non-licensed personnel types needed to deliver
essential services and care to flu patients during a severity WHO Phase 5 pandemic, eighth-week
pandemic cycle. “
Legal Issues - Credentialing
Credentialing personnel for use in hospital or MEMS settings should be carried out by hospital personnel
already familiar with the process. Assistance from law enforcement or the State of Michigan may be
required for criminal background checks if volunteers present from states other than Michigan
The Region 6 Hospital Mutual Aid Memorandum of Understanding supports the credentialing process but
is region-specific, thus limiting inter-regional/inter-state support. It also hinders stakeholders’ ability to
obtain staffing, supply, equipment, and/or facility support from local non-hospital health care entities, non-
Caring for the Community | preparing for an influenza pandemic
11
region hospitals and other health care entities. It is recommended that health care organizations expand
20
mutual aid capabilities by participating in the Health Care Mutual Aid Memorandum of Understanding.
Staffing
Hospital
21
Based on the Ontario Health Plan for Influenza Pandemic Working Group the following minimum
professional staffing for ten critical care-type patients in a hospital setting is recommended:
 Physician
1
 RN
1-2
 LPN/Tech/Aide 4
Also see attached Recommended Staffing Resources Guide for further recommendations on types and
sources of staffing.
ACS
A community-based approach is required to establish a functional ACS and its staffing. For example,
hospitals may provide only medical oversight and clinical supervisory staff, while other roles may be filled
by additional community agencies/organizations. In order to minimize labor needs, an ACS would be
established at a facility that allowed for patient cohorting, such as a gym or civic center (as opposed to
individual rooms that require more labor to support patient care services).
Based on limited availability of staff, supplies, equipment and infrastructure, a
palliative/symptomatic/supportive care model was deemed most appropriate for the ACS. This level of
care is generally provided by nursing homes; therefore a nursing home staffing model was chosen.
Staffing Categories
Physician
Physician extenders (PA/NP)
RNs or RNs/LPNs
Health technicians
Unit secretaries/coordinators
Respiratory Therapist
Case Manager
Social Worker
Housekeepers
Food Service
Chaplain/Pastoral/Interpreter
Engineering /Maintenance/BioMedical
Security
Patient transporters
Staffing Number per 12-Hour Shift
(50-Bed Unit)
1
1
6
4
2
1
1
1
2
2
1
0.25
1
1
20
(Note: Multiple health care organizations throughout Michigan already participate.) Available at:
http://www.irmc.org/body.cfm?id=1551
21
Christian MD, et al “Critical Care During a Pandemic: Final report of the Ontario Health Plan for an
Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge and Triage
Criteria. April, 2006 available at: http:
Caring for the Community | preparing for an influenza pandemic
12
NEHC
The NEHC model, as proposed by the U.S. Army SBCCOM, was not designed for social distancing
practices to minimize disease transmission during an influenza pandemic.
While the NEHC provides valuable support in a non-communicable mass casualty care situation, the use of
pre-established 211 or public health call centers to provide telephone/remote triage and information to the
public is a more responsible use of resources. This limits public congregation while still providing essential
public information.
A further option could include use of local primary care physicians to provide further triage (home care vs.
ACS care vs. acute hospital care) as well as provide locations for distribution of antibiotics, antiviral
medications or vaccines to the community. Using local health care providers requires the willing
cooperation of the practice and may not be feasible in smaller groups.
To address “Determine minimal medical supplies and clinical support resources needed to provide
essential care to flu patients during a severity WHO Phase 5 pandemic, eight-week pandemic cycle”
TJC recommends that hospitals maintain adequate supplies to “stand alone” for 96 hours. The appendices
E (equipment) and F (pharmaceuticals) from SBCCOM’s ACC Concept of Operations contain a
comprehensive list of supplies that can be used for guidance for both hospitals and ACS. Since the list is
based on a 50-bed unit, larger hospitals could safely increase their supply list by multiples of 50.
The supply list can be modified for the ACS to remove advanced airway and other non-palliative supplies.
Additional personal protective equipment (PPE) supplies (i.e., gloves, N-95 respirators, surgical
masks, gowns, goggles, splash shields, hand sanitizer, soap, etc.) for the both hospital and ACS will be
required. Most sources recommend increasing supplies to at least triple current PPE stockpiles.
Supplies not addressed on the above list (i.e., food supplies/sources for ACS patients, mortuary supplies,
body storage areas and staff supply needs, including food, water, shelter, shower facilities, sleeping
facilities) also need to be considered.
Caring for the Community | preparing for an influenza pandemic
13
Supporting Documents
Attachment A
Level A
Assumptions/
Situation
Description
Severity Matrix
Level B
Level C
911 communications
Level D
Level E
Pandemic outbreak
Pandemic
911
911
in North America;
outbreak identified and/or pre-hospital
communications
communications
human
in FEMA Region 5 response systems
and/or pre-hospital
and/or pre-hospital
transmissibility
or Michigan
and/or hospitals AT
response systems
response systems
demonstrated.
Region 6.
OR NEAR
and/or hospitals
and/or hospitals
CAPACITY.
BEYOND
AND SURGE
CAPACITY.
SYSTEMS
BEYOND
CAPACITY.
Hospital
Status
Standard
operating
procedures.
Standard
operating
procedures.
Begin
cancellation of
non-emergent
admissions and
elective
procedures.
Transfer patients
within region to
hospitals with
capacity.
Separate flu-like
illness patients
from other
hospital patients.
Acute (MI,
trauma, OB,
etc.) and critical
care in
hospitals.
Cohort patients
with similar
illness. Accept
patients in
hospital only if
modified flu
score is > 60.
Continuous
triage of flu-like
illness patients
using modified
flu score to
maximize use
of short
resources.
Accept
patients in
hospital only if
modified flu
score is > 60.
Staffing –
Hospital
Standard
staffing.
Standard
staffing.
Activate acute
care sites in
hospital setting
(banked beds,
same-day
surgery beds,
etc.).
Begin
implementing
altered staffing
levels – 1 RN, 4
LPN/Aide for 10
patients.
Maintain
altered staffing
levels as long
as possible.
Supplies –
Hospital
Standard
supply
acquisition.
Standard
supply
acquisition.
As supply
resources
become
unavailable from
standard supply
sources, begin
implementation of
supply acquisition
from alternate
resources.
Obtain supplies
from any
available
resource.
Obtain
supplies from
any available
resource or
improvise.
Caring for the Community | preparing for an influenza pandemic
14
Level A
ACS Status
Level B
Level C
Level D
Level E
Palliative/
supportive/
symptomatic
care only.
Accept
patients only if
modified flu
score is ≥ 20 &
≤ 60.
NA
NA
NA
After
emergency
declaration,
with help of
local
emergency
management,
hospitals
establish ACS.
Palliative/
supportive/
symptomatic
care ONLY – no
advanced
airway. Accept
patients only if
modified flu
score is ≥ 20 &
≤ 60.
Staffing – ACS NA
NA
NA
ACS activation Maintain
and
minimum ACS
implementation, staffing levels.
after
emergency
declaration.
Supplies –
ACS
NA
NA
Local
emergency
management
resources,
Regional
resources,
alternate
hospital
resources.
NA
Caring for the Community | preparing for an influenza pandemic
Local
emergency
management
resources,
Regional
resources,
alternate
hospital
resources.
15
Supporting Documents
Attachment B
Recommended Staffing Resources Guide
Caring for the Community | preparing for an influenza pandemic
16
Caring for the Community | preparing for an influenza pandemic
17
Including a Staffing Resources List in emergency response plans is recommended to ensure that plans for
surge capacity are operational.
Hospital/ACS Staffing Resource Template
Position
Agency
Contact
Info
Staff
Type
Available
Physicians
(sample)
Medical
Reserve
Core
(MRC)
Jane
Doe,
State
EOC,
555‐1234
MD,
DO,
DVM,
DSS
#
of
Staff
Type
Available
5‐10
MD/DO
2
DVM,
1
DSS
Turn‐
around‐
time
48
hours
Procedures
for
working
w/agency
Hospitals
must
request
via
EOC
MOU
Insurance/
liability
issues
Not
required
MRC
handles
credentialing
PA/NP
Nurses
‐
RN
Nurses
‐
LPN
Aides
Clerks
Transporters
RT
Case
Manager
Social
Worker
Housekeepers
Other
Minimal Staffing Recommendations to Deliver Essential Services
to Patients during a Severe Influenza Pandemic
Hospital Staff for 10 Critical Care1
Type Patients
ACS Staff for 50 beds (12 hr shift)
Physician (1)
Physician (1)
RT (1)
Chaplin/Pastoral (1)
RN (1-2)
PA/NP (1)
Case Manager (1)
Engineering/Maintenance
(0.25)
LPN/aide (4)
RN/LPN (6)
Social Worker (1)
Security (1)
Other Additional Staff to
Consider: Lab, Radiology,
Pharmacy, Food Service,
Maintenance, Interpreters, Security,
Clergy
Aids (4)
Housekeepers (2)
Transporters (1)
Clerks (2)
Food Service (2)
2
Caring for the Community | preparing for an influenza pandemic
18
ACS & NEHC Recommendations
• ACS: Palliative/symptomatic/supportive care. MCA (Medical Control Authority) provides medical
oversight. Emergency Management provides logistical and planning oversight. Hospitals assist in
providing staff, equipment, and supplies.
• NEHC’s as defined by MEMS will not be set up. The functions of an NEHC will be carried out as
follows:
Prophylaxis & Community Education: Lead Agency - Local Public Health
Public health staffed sites supplemented by local physician offices and pharmacies. In addition,
public health agencies via call-in centers (e.g., 211,) media outlets, and websites will disseminate
community education.
Triage: Lead Agency - Local Public Health (hospitals to provide guidance)
Telephone/remote triage will be emphasized to promote social distancing. Local physician offices
may also be used.
1. Christian MD. et al. Critical Care During a Pandemic – Final Report of the Ontario Health Plan for an Influenza
Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge and Triage Criteria. April, 2006
2. Cantrill SV, Eisert SL, Pons P et al. Rocky Mountain Regional Care Model for Bioterrorist Events: Locate Alternate
Care Sites During an Emergency. AHRQ Publication No. 04-0075, August 2004. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/research/altsites/
Caring for the Community | preparing for an influenza pandemic
19
Supporting Documents
Attachment C
HEALTH
CARE
MUTUAL
AID
MEMORANDUM
OF
UNDERSTANDING
(“MOU”)
(Revision Date: 5.30.07)
I. RECITALS
WHEREAS, the health care entities are susceptible to disasters, both natural and man-made, that could
exceed the resources of any individual health care entity;
WHEREAS, a disaster could result from incidents generating an overwhelming number of patients, (e.g.,
major transportation accident, terrorism attack, etc.), from a smaller number of patients whose specialized
medical requirements exceed the resources of the impacted facility (e.g., hazmat injuries, pulmonary,
trauma surgery, exposure to biological or radiological agents, etc.), or from incidents such as building or
plant problems resulting in the need for partial or complete evacuation;
WHEREAS, this Memorandum of Understanding (MOU) is not a legally binding contract, but rather this
MOU signifies the belief and commitment of the Participating Health Care Entities that in the event of a
disaster, the medical needs of the citizenry will be best met if the Participating Health Care Entities
cooperate with each other and coordinate their response efforts;
WHEREAS, the Participating Health Care Entities desire to set forth the basic tenets of a cooperative and
coordinated response plan in the event of a disaster;
NOW, THEREFORE, in consideration of the above recitals, Participating Health Care
Entities agree as follows:
II. PURPOSE
This MOU is a voluntary agreement among Health Care Entities to electively provide mutual aid at the time
of a disaster in accordance with relevant emergency management/disaster preparedness plans. For
purposes of this MOU, a disaster is defined as an overwhelming incident that exceeds the effective
response capability of the impacted facility, whether through mass casualties, casualties with special
concerns such as contagious disease or radiological contamination, or severely impaired capabilities due
to impact on the facility (i.e., power outage, structural damage, etc.). The disaster may be an “external” or
“internal” event for health care entities and assumes that each Affected Health Care Entity’s emergency
management plan has been fully implemented. This MOU will not take effect until local, state, or federal
authorities have declared an emergency or disaster for the jurisdiction in which the Affected Hospital is
located.
This MOU also describes the relationships among health care entities and is intended to augment, not
replace, each facility's emergency management plan. By signing this MOU, each health care entity is
stating its intent to abide by the terms of the MOU in the event of a disaster. The terms of this MOU are to
be incorporated into the health care entity emergency management plan.
III. DEFINITIONS
“ACC” is an acronym for “Acute Care Center,” “Alternate Care Center,” “Alternative Care Center” or
“Ancillary Care Center.” The acronym reflects any non-hospital surge facility regardless of name, which
may vary between communities, regions, and states. An ACC is a recognized component of the Modular
Emergency Medical System (MEMS) concept and refers to a building or structure used to provide definitive
and supportive care for acutely ill patients from a mass casualty biological event or other mass casualty
incident that exceeds hospital capacity. The ACC will operate as a component of a community’s medical
surge plan.
Caring for the Community | preparing for an influenza pandemic
20
“ACC Incident Commander” means an individual assigned by a Lead Hospital who will be responsible for
command and control of the entire ACC.
“Affected Hospital” means a Participating Hospital that has initiated a request for assistance that may
include transferring patients to another health care entity or receiving personnel, pharmaceuticals, supplies
or equipment from another hospital.
“Assisting Health Care Entity” means a health care entity that receives transferred patients from or
sends personnel, pharmaceuticals, supplies or equipment to an Affected Hospital or ACC.
“Assisting Personnel” means personnel sent by an Assisting Health Care Entity and/or sent by local,
county, or state governmental mechanisms, to provide patient care at a Participating Health Care Entity or
ACC.
"Intermediary Coordinating Entity (ICE)" means any organizational structure that supports medical
coordination and control activities for a community, region or state. Such entities may include, but are not
limited to an Emergency Operations Center (EOC), a Medical Control Authority (MCA), a Medical
Coordination Center (MCC), Regional Hospital Resource Center (RHRC), or a Medical Command Center
(MCC). “Lead Hospital” means the hospital responsible for coordinating, in collaboration with the
jurisdictional emergency management agency and health department, staffing and management of the
clinical services provided through an ACC, including the assignment of an ACC Incident Commander.
“MEMS” means “Modular Emergency Medical System,” a concept developed by the Biological Weapons
Improved Response Program, under the Department of Defense Domestic Preparedness Program and
adapted by regions throughout the state of Michigan. MEMS includes the ACC concept and the
transportation system to support patient transfer to ACCs or other health care entities when hospitals have
maximized patient care surge capacity or to provide a facility to care for specific categories of patients (i.e.,
an isolation facility for infectious patients), or when hospital’s cannot support patient care due to facility
impact that impacts operational capability.
“Participating Health Care Entity” means a health care entity that has entered into this MOU.
"Surge Facility" means a non-hospital facility that is owned by a hospital that is used to support patient
surge capacity.
IV. MUTUAL AID RECEIVED BY OR PROVIDED TO A PARTICIPATING HOSPITAL
A. AUTHORITY AND COMMUNICATION
Only a senior hospital administrator or individual designated by a senior hospital administrator of an
Affected Hospital has the authority to initiate a request for assistance, which may include transfer of
patients or receipt of Assisting Personnel or material resources pursuant to this MOU. A request for
assistance should be made in accordance with the local, regional, or state medical surge/MEMS plan.
B. PERSONNEL
Personnel who are employed by, contracted with, act on behalf of, or are part of the staff of an Assisting
Health Care Entity who are dispatched to an Affected Hospital, Surge Facility or ACC shall be limited to
staff who are certified, licensed, privileged and/or credentialed at the Assisting Hospital, as appropriate,
given such staffs’ professional scope of practice unless the affected hospital, or intermediary coordinating
entity, specifically requests dispatch of additional unlicensed staff such as students and/or interns, in which
case the Assisting Hospital shall clearly communicate the identity of students/interns reporting to the
Intermediary Coordinating Entity, ACC, Surge Facility, or Affected Hospital. Assisting Health Care Entity
employees who are dispatched to an Affected Hospital, Surge Facility or ACC will act within their scope of
practice in the capacity of Assisting Personnel with respect to the Affected Hospital, Surge Facility or ACC
and for all purposes set forth herein will function as Assisting Personnel at the Affected Hospital, Surge
Facility or ACC, but nothing in this MOU shall be construed as creating an employee-employer relationship
between the Assisting Personnel and the Affected Hospital or Lead Hospital for purposes of worker’s
compensation coverage or other labor laws. The Assisting Health Care Entity’s senior administrator or
designee shall prepare and send to the Affected Hospital’s or ACC's command center or Intermediary
Coordinating Entity a list that includes the name, licensure category or other qualifications and any
specialty training of the Assisting Personnel who are being dispatched to the Affected Hospital, Surge
Facility or ACC. The Affected Hospital or Lead Hospital shall, if possible, then verify the identity of the
Assisting Personnel from the Assisting Health Care Entity based on a current picture identification badge
Caring for the Community | preparing for an influenza pandemic
21
issued by the Assisting Hospital, a disaster relief worker organization (i.e., American Red Cross, Medical
Reserve Corps, etc.), a state, federal or regulatory agency.
If possible, all Assisting Personnel shall report to the Affected Hospital, ACC, or designated community
disaster relief work registration site with one of the following:
• Current organizational identification card. If the organizational identification card does not have a picture,
then a valid government-issued identification card will be required;
• Current license to practice, if applicable;
• Identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT),
Federal Medical Surge (FMS), and/or other approved and verified response agency;
• Identification indicating that the individual has been granted authority to render patient care, treatment,
and services in disaster circumstances (such authority having been granted by a federal, state, or
municipal entity);
• Presentation by a current hospital or medical staff member(s) with personal knowledge regarding the
practitioner’s identity.
The Affected Hospital, Surge Facility or ACC may verify this information independently and in the event of
extraordinary circumstances (e.g., no means of communication or lack of resources) such verification may
occur after the emergency is determined to be under control, but must be done as soon as possible.
Participating Health Care Entities should follow relevant emergency credentialing standards.
In the case of Assisting Personnel deployed to an Affected Hospital or Surge Facility, the Affected Hospital
will identify where and to whom emergency Assisting Personnel are to report and who will direct and/or
supervise them.
This supervisor will brief the Assisting Personnel of the situation and their assignments.
In the case of Assisting Personnel deployed to an ACC, the Lead Hospital will identify where and to whom
emergency Assisting Personnel are to report and who will direct and/or supervise them. The Affected
Hospital and/or the Lead Hospital shall maintain records of the hours worked by the Assisting Personnel
and will provide and coordinate any necessary demobilization and post-event debriefing.
C. TRANSFER OF PHARMACEUTICALS, SUPPLIES OR EQUIPMENT
1. COMMUNICATION AND DOCUMENTATION
An Affected Hospital must communicate its need for assistance to a Participating Health Care Entity. The
Affected Hospital must specify the type(s) of resource that is needed. Minimally, information that must be
provided with any resource request includes:
• A point of contact name and phone number at the receiving site
• Resource type/kind
• Quantity needed
• When the resource is needed (date/time)
• Where the resource needs to be delivered:
• Site name
• Street address
• City
• State
• Additional location information, if necessary
• Special instructions, if any
To ensure appropriate reimbursement, an Assisting Health Care Entity sending pharmaceuticals, supplies
and/or equipment to an Affected Hospital, a Surge Facility, or an ACC will document in detail the delivery of
the requested materials.
Caring for the Community | preparing for an influenza pandemic
22
The Assisting Health Care Entity is responsible for tracking the borrowed inventory and requesting the
return of any non-disposable equipment, which shall be returned by the Affected Hospital, Surge Facility or
ACC in good condition, if possible.
The Affected Hospital and/or Lead Hospital is responsible for appropriately tracking the use and necessary
maintenance of all borrowed pharmaceuticals, supplies and equipment during the time such items are in
the custody of the Affected Hospital, Surge Facility or ACC in accordance with law.
An Affected Hospital/Lead Hospital will either replace or reimburse an Assisting Health Care Facility for any
consumable supplies, pharmaceuticals or damaged equipment at actual cost. Unused supplies may be
returned by the ACC, Surge Facility or Affected Hospital to the Assisting Health Care Facility provided that
they are unopened and in good and usable condition.
V. TRANSFER/EVACUATION OF PATIENTS
A. COMMUNICATION AND DOCUMENTATION
An Affected Hospital must communicate its need for assistance to a Participating Health Care Entity. The
Affected Hospital must specify:
• The number of patients needing to be transferred,
• The general nature of their illness or condition
• Any specialized services or placement required
An Affected Hospital is responsible for providing the Assisting Health Care Entity, Surge Facility, or Lead
Hospital/ACC with copies of the patient’s pertinent medical records, registration information and other
information necessary for care.
Participating Health Care Entities should utilize pre-established communication and documentation in
accordance with the Medical Surge/MEMS plan for the community/region. To help ensure effective
documentation, it is recommended that Participating Health Care Entities use the Hospital Incident
Command System Form 255 – Master Patient Evacuation Tracking Form and Hospital Incident Command
System Form 260 – Patient Evacuation Tracking Form. The forms are available at
http://www.hicscenter.org.
B. TRANSPORTING PATIENTS
In the case of an evacuation, the Affected Hospital is responsible for triage and transportation of patients
and any costs, not otherwise reimbursable by the patient, the patient’s third-party payer, or government
agency, incurred for their transportation. Extraordinary drugs or special equipment utilized by the patient, if
available, will be transported with the patient.
If feasible, the Affected Hospital should inventory the patient's personal effects and valuables transported
with the patient to the Assisting Health Care Entity, Surge Facility or the ACC. The Affected Hospital should
present the inventory list and the patient's valuables to the personnel transporting the patient, and receive
a receipt for such items. The Assisting Health Care Entity, Surge Facility or Lead Hospital should, in turn,
acknowledge and sign a receipt for the valuables delivered to it.
C. SUPERVISION
Once the patient arrives at the Assisting Health Care Entity, Surge Facility or ACC, the Assisting Health
Care Entity, Surge Facility or the Lead Hospital shall become responsible for the care of the patient. If
requested, the Assisting Health Care Entity, Surge Facility or Lead Hospital that assumes the care of the
transferred patient may grant temporary medical staff privileges or emergency privileges, in accordance
with its medical staff bylaws, to the patient’s original attending physician.
Caring for the Community | preparing for an influenza pandemic
23
D. NOTIFICATION
The Affected Hospital is responsible for notifying, and if applicable, obtaining transfer authorization from
the patient or the patient’s legal representative, as appropriate, and for notifying the patient’s attending
physician of the transfer and relocation of patient as soon as practical.
VI. MEDIA RELATIONS AND RELEASE OF INFORMATION
The Affected Hospital, typically via a Public Information Officer, will be responsible for working
cooperatively with the jurisdictional management agency and other organizations involved with disaster
response operations to educate the general public on the status of the emergency, including where and
when individuals who think they may be exposed, contaminated, ill, or injured should present. The Affected
Hospital or Lead Hospital, directly or via an Intermediary Coordinating Entity, will be responsible for
disseminating information to state and local public health departments, including patient names, diagnoses
and other identifying information as may be needed to prevent or control the spread of the contagion and to
avert imminent threats to health or safety of residents.
VII. MISCELLANEOUS PROVISIONS
A. TERM AND TERMINATION
The term of this MOU is open commencing for the Participating Hospital on the date of signature affixed to
this MOU document. Any Participating Health Care Entity may terminate its participation in this MOU at any
time by providing written notice to all other Participating Health Care Entities at least thirty days prior to the
effective date of such termination.
B. REVIEW AND AMENDMENT
This MOU shall be reviewed upon written request by a Participating Health Care Entity and may be
amended by the written consent of an authorized representative for each of the Participating Health Care
Entities. The MOU will be amended as necessary to comply with any new statutes, regulations, or
standards promulgated by governmental entities or accrediting bodies, including but not limited to
standards promulgated by The Joint Commission or the American Osteopathic Association. Participating
Health Care Entities may convene a Review Committee to review and make MOU change
recommendations to Participating Health Care Entities. The Review Committee, at a minimum, will include
a representative sampling of Participating Health Care Entities.
C. CONFIDENTIALITY
Each Participating Health Care Entity shall maintain the confidentiality of all patient health information and
medical records in accordance with applicable state and federal laws, including, but not limited to, the
HIPAA privacy regulations.
D. REIMBURSEMENT
1. For Personnel, Supplies, Services and Equipment provided by an Assisting Health Care Entity to an
Affected Hospital or Surge Facility: Where personnel, services, equipment and/or pharmaceuticals are
provided to an Affected Hospital or Surge Facility, an invoice for expenses will be submitted by the
Assisting Health Care Entity to the Affected Hospital. The Affected Hospital shall make payment for
complete and reasonable invoices submitted within 120 days of receipt of such invoices.
2. For Personnel, Supplies, Services and/or Equipment provided by an Assisting Health Care Entity or a
Lead Hospital to an ACC: An Assisting Health Care Entity providing personnel, supplies, equipment and/or
pharmaceuticals to an ACC will submit invoices to the Lead Hospital/Agency who was responsible for
operating the ACC.
The Lead Hospital, directly or via the jurisdictional Emergency Operations Center, will be responsible for
tracking and documenting its expenses related to operating an ACC, including but not limited to expenses
related to additional staff, supplies, equipment and pharmaceuticals used at the ACC.
Caring for the Community | preparing for an influenza pandemic
24
The Lead Hospital, directly or via the jurisdictional Emergency Management Agency, will be responsible for
submitting all invoices and claims for services provided at an ACC to third party payers, CMS, private
insurance companies, and the county or state (for FEMA reimbursement) within 120 days of the last day of
operating an ACC and will use its best efforts to collect such funds. All claims submitted to third party
payers will be based on the level of care provided at the ACC as appropriate. When reimbursement is
obtained from all third party payers, including FEMA, the Lead Hospital, directly or via the jurisdictional
Emergency Management Agency, will be responsible for meeting with the state or county entity designated
to handle emergency reimbursement requests and any Assisting Health Care Entities to negotiate in good
faith regarding percentages of reimbursement to be allocated among the Lead Hospital and Assisting
Health Care Entities. Such allocation shall be determined based upon reasonableness of expenses and
compensation received from third party payers, including FEMA. It is the intent of the parties that the Lead
Hospital and the Assisting Health Care Entities shall share proportionally in losses related to
uncompensated care (e.g., if the Lead Hospital is compensated for 80% of its reasonable expenses, then
the Assisting Health Care Entity will also be compensated for 80% of its reasonable expenses). If a portion
of third party payments received by the Lead Hospital are necessary to proportionately compensate the
Assisting Health Care Entity(ies), such funds will be transferred to the recipient Assisting Health Care
Entity within 120 days of determination of allocation of reimbursement.
E. OCCUPATIONAL SAFETY AND HEALTH
Affected Hospitals and Lead Hospitals will provide appropriate Personal Protective Equipment (PPE) and
decontamination equipment as available and in compliance with the guidelines of the Occupational Safety
and Health Agency, or state OSHA if appropriate. Refer to OSHA’s “Best Practices for First Responders”
as needed.
F. STATE AND COUNTY CONTROL
When operating an ACC, the Lead Hospital agrees to defer to the MEMS/Medical Surge plan, to include
supporting documents, in the community/region where the ACC is located, for standing orders/protocol and
other instruction regarding the implementation of the Medical Surge/MEMS Plan. In the absence of any
predefined standing orders/protocols, the Lead Hospital is responsible for establishing medical care
protocols that will be implemented at the ACC.
G. INSUFFICIENT RESOURCES
If requested to provide support by an Affected Hospital, Participating Health Care Entities that lack the
resources to send personnel, supplies, or equipment because of the situation at their own facility must
inform the Affected Hospital.
H. ASSIGNMENT
A Participating Health Care Entity may not assign any part of its duties, obligations, or rights under this
Agreement.
I. AUTHORITY TO SIGN
Participating Health Care Entity representatives signing this Agreement attest that they have the authority
to sign and enter into this MOU on behalf of the Participating Health Care Entity.
J. SEVERABILITY
If any term or provision of this Agreement is determined to be illegal, unenforceable, or invalid in whole or
in part for any reason, such illegal, unenforceable or invalid provisions or part thereof shall be stricken from
this Agreement, and such provision shall not affect the legality, enforceability, or validity of the remainder of
this Agreement. If any provision or part thereof of this Agreement is stricken in accordance with the
provisions of this section, then this stricken provision shall be replaced, to the extent possible, with a legal,
enforceable, and valid provision that is as similar in tenor to the stricken provision as is legally possible.
Caring for the Community | preparing for an influenza pandemic
25
K. HEADINGS
The headings in this Agreement are included for convenience only and shall neither affect the construction
or interpretation of any provision in this Agreement nor affect any of the rights or obligations of the parties
to this Agreement.
L. JURISDICTION
This Agreement will be governed and construed in accordance with the laws of the state in which the
Participating Health Care Entity resides. The Parties agree that jurisdiction shall be in the state in which the
Affected Hospital resides.
M. ENTIRE AGREEMENT
This Agreement and any exhibits properly incorporated are the complete agreement between the
Participating Health Care Entities and may be modified only as set forth in this Agreement. I have read the
foregoing Health Care Mutual Aid Memorandum of Understanding and agree to the terms set forth therein.
Signature Date
Printed/Typed Name
Title
Health Care Entity
Phone Email
Caring for the Community | preparing for an influenza pandemic
26
Supporting Documents
Attachment C
Region
6
Hospitals
Mutual
Aid
Memorandum
of
Understanding
August 1, 2008
I. Introduction and Background
As in other parts of the nation, Region 6 is susceptible to disasters, both natural and man-made, that could
exceed the resources of any individual hospital. A disaster could result from incidents generating an
overwhelming number of patients, from a smaller number of patients whose specialized medical
requirements exceed the resources of the impacted facility (e.g., hazmat injuries, pulmonary, trauma
surgery, etc.), or from incidents such as building or plant problems resulting in the need for partial or
complete hospital evacuation.
II. Purpose of Mutual Aid Memorandum of Understanding
The mutual aid support concept is well established and is considered "standard of care" in most
emergency response disciplines. The purpose of this mutual aid support agreement is to aid hospitals in
their emergency management by authorizing the Hospital Mutual Aid System (HMAS). H-MAS addresses
the loan of medical personnel, pharmaceuticals, supplies, and equipment, or assistance with emergent
hospital evacuation, including accepting transferred patients.
This Mutual Aid Memorandum of Understanding (MOU) is a voluntary agreement among the hospital
members participating in the Region 6 coalition, for the purpose of providing mutual aid at the time of a
medical disaster. For purposes of this MOU, a disaster is defined as an overwhelming incident that
exceeds the effective response capability of the impacted health care facility or facilities. An incident of this
magnitude will almost always involve one of the Region 6 emergency management agencies or public
health departments. The disaster may be an “external” or “internal” event for hospitals and assumes that
each affected hospital’s emergency management plans have been fully implemented.
This document addresses the relationships between and among hospitals and is intended to augment, not
replace, each facility's disaster plan. The MOU also provides the framework for hospitals to coordinate as a
single H-MAS community in actions with any of the Region 6 emergency management agency, public
health department, and emergency medical services during planning and response. This document does
not replace but rather supplements the rules and procedures governing interaction with other organizations
during a disaster (e.g., law enforcement agencies, the local emergency medical services, local public
health department, fire departments, American Red Cross, etc).
By signing this Memorandum of Understanding each hospital is evidencing its intent to abide by the terms
of the MOU in the event of a medical disaster as described above. The terms of this MOU are to be
incorporated into the hospital's emergency management plans.
Caring for the Community | preparing for an influenza pandemic
27
III. Definition of Terms
The American Hospital Association is grateful to the District of Columbia Hospital Association, who
developed the original MOU from which this model is adapted.
Command Post
An area established in a hospital during an emergency that is the facility's
primary source of administrative authority and decision-making.
Clearinghouse
A communication and information center that has H-MARS network
capabilities allowing for the immediate determination of available hospital
resources at the time of a disaster. The clearinghouse must be operational
24 hours a day and requires daily maintenance. The clearinghouse does
not have any decision-making or supervisory authority but merely collects
and disseminates information, and performs regular radio checks of the HMARS system.
Donor Hospital
The hospital that provides personnel, pharmaceuticals, supplies, or
equipment to a facility experiencing a medical disaster. Also referred to as
the patient-receiving hospital when involving evacuating patients.
H-MAS
Hospital Mutual Aid System
H-MARS
Hospital Mutual Aid Radio System – The primary communication system
used by hospitals to communicate during an emergency (e.g. 800 MGz
radios)
Impacted Hospital
The hospital where the disaster occurred or disaster victims are being
treated. Referred to as the recipient hospital when pharmaceuticals,
supplies, or equipment are requested, or as the patient-transferring
hospital when the evacuation of patients is required.
Medical Disaster
An incident that exceeds a facility's effective response capability or that it
cannot appropriately resolve solely by using its own resources. Such
disasters will very likely involve the emergency management agency and
public health department and may involve loan of medical and support
personnel, pharmaceuticals, supplies, and equipment from another facility,
or, the emergent evacuation of patients.
Partner ("Buddy")
The designated facility that a hospital communicates with as its "first call
for help" during a medical disaster (developed through an optional
partnering arrangement).
Patient-Receiving
Hospital
The hospital that receives transferred patients from a
facility responding to a disaster. When patients are evacuated, the
receiving facility is referred to as the patient-receiving hospital. When
personnel or materials are involved, the providing hospital is referred to as
the donor hospital.
Caring for the Community | preparing for an influenza pandemic
28
Patient-Transferring
Hospital
An impacted facility. The hospital that evacuates
patients to a patient-receiving facility in response to a medical disaster.
Also referred to as the recipient hospital when personnel and materials are
moved to the facility
Participating
Hospitals
Health care facilities that have fully committed to
H-MAS.
Recipient Hospital
The impacted facility. The hospital where disaster patients are being
treated and has requested personnel or materials from another facility.
Also referred to as the patient-transferring hospital when
evacuating/transferring patients from the facility during a medical disaster.
IV. General Principles of Understanding
1. Participating Hospitals: Each hospital designates a representative to attend the Region 6 Hospital
Mutual Aid System meetings and to coordinate the mutual aid initiatives with the individual hospital’s
emergency management plans. Hospitals also commit to participating in H-MAS exercises and
maintaining their radio links to H-MARS.
2. Partner Hospital Concept: Each hospital has the option of linking to a designated partner or "buddy"
hospital as the hospital of 'first call for help' during a disaster. The hospitals comprising each partnernetwork should develop, prior to any medical disaster, methods for coordinating communication
between themselves, responding to the media, and identifying the locations to enter their buddy
hospital’s security perimeter.
3. Implementation of Mutual Aid Memorandum of Understanding: A health care facility becomes a
participating hospital when an authorized administrator signs the MOU. During a medical emergency,
only the authorized administrator (or designee) or command center at each hospital has the authority
to request or offer assistance through H-MAS. Communications between hospitals for formally
requesting and volunteering assistance should therefore occur among the senior administrators (or
designees) or respective command centers.
4. Command Center: The impacted facility's command center is responsible for informing the
clearinghouse of its situation and defining needs that cannot be accommodated by the hospital itself or
any existing partner hospital. The senior administrator/ designee or command center is responsible for
requesting personnel, pharmaceuticals, supplies, equipment, or authorizing the evacuation of patients.
The senior administrator/ designee or command center will coordinate both internally, and with the
donor/patient-accepting hospital, all of the logistics involved in implementing assistance under this
Mutual Aid MOU. Logistics include identifying the number and specific location where personnel,
pharmaceuticals, supplies, equipment, or patients should be sent, how to enter the security perimeter,
estimated time interval to arrival and estimated return date of borrowed supplies, etc.
5. Clearinghouse: Each hospital will participate in an annual H-MAS exercise that includes communicating
to the Clearinghouse a set of data elements or indicators describing the hospital's resource capacity
(see appendices). The Clearinghouse will serve as an information center for recording and
disseminating the type and amount of available resources at each hospital. During a disaster drill or
Caring for the Community | preparing for an influenza pandemic
29
emergency, each hospital will report to the Clearinghouse the current status of their indicators. (For a
more detailed account of the Clearinghouse's responsibilities, see "Clearinghouse Requirements.")
Hospitals also participate in weekly radio checks performed by the Clearinghouse.
6. Hospital Indicators: A set of hospital resource measures that are reported to the Communication Center
during a disaster drill or actual disaster. The indicators are designed to catalogue hospital resources
that could be available for other hospitals during a disaster.
7. Documentation: During a disaster, the recipient hospital will accept and honor the donor hospital's
standard requisition forms. Documentation should detail the items involved in the transaction, condition
of the material prior to the loan (if applicable), and the party responsible for the material.
8. Authorization: The recipient facility will have supervisory direction over the donor facility's staff,
borrowed equipment, etc., once they are received by the recipient hospital.
9. Financial and Legal Liability: The recipient hospital will assume responsibility for loss or damage to
equipment and supplies from the donor hospital during the time the equipment and supplies are at the
recipient hospital. The recipient hospital will reimburse the donor hospital, to the extent permitted by
federal law, for all of the donor hospital’s costs determined by the donor hospital’s regular rate. Costs
could include use, breakage, damage, replacement and return costs of borrowed materials. If the
donor hospital has insurance to cover equipment broken or damaged, coverage will come from the
donor hospital. Reimbursement will be made within 90 days following the receipt of an invoice. All
personnel, regardless of operational location, will remain employed by and responsible to their primary
employer.
10. Patient-accepting hospitals assume the legal and financial responsibility for transferred patients upon
arrival into the patient-accepting hospital.
11. Communications: Hospitals will collaborate on the H-MARS radio communication system to ensure a
dedicated and reliable method to communicate with the Clearinghouse and other hospitals. The backup conference call landline telephone system may be used as a semi-secure system for discussing
sensitive information.
12. Public Relations: Each hospital is responsible for developing and coordinating with other hospitals and
relevant organizations the media response to the disaster. Hospitals are encouraged to develop and
coordinate the outline of their response prior to any disaster. The partner hospitals should be familiar
with each other's mechanisms for addressing the media. The response should include reference to the
fact that the situation is being addressed in a manner agreed upon by a previously established mutual
aid protocol.
13. Emergency Management Committee Chairperson: Each hospital's Emergency Management
Committee Chairperson is responsible for disseminating the information regarding this MOU to relevant
hospital personnel, coordinating and evaluating the hospital’s participation in exercises of the mutual
aid system, and incorporating the MOU concepts into the hospital’s emergency management plan.
14. Hold Harmless Condition: The recipient hospital shall indemnify and hold harmless the donor hospital
for acts of negligence or omissions on the part of the donor hospital in their good faith response for
assistance during a disaster. The donor hospital, however, is responsible for appropriate credentialing
Caring for the Community | preparing for an influenza pandemic
30
of personnel and for the safety and integrity of the equipment and supplies provided for use at the
recipient hospital.
V. General Principles Governing Medical Operations, the Transfer of Pharmaceuticals,
Supplies or Equipment, or the Evacuation of Patients
1. Partner hospital concept: Each hospital has the option of designating a partner or buddy hospital that
serves as the hospital of "first call for help" (see lists under Clearinghouse Function). During a disaster,
the requesting hospital may first call its pre-arranged partner hospital for personnel or material
assistance or to request the evacuation of patients to the partner hospital. The donor hospital will
inform the requesting hospital of the degree and time frame in which it can meet the request.
2. Clearinghouse: The recipient hospital (patient-transferring hospital) is responsible for notifying and
informing the Clearinghouse of its personnel or material needs or its need to evacuate patients and the
degree to which its partner hospital is unable to meet these needs. Upon the request by the senior
administrator or designee of the impacted hospital, the Clearinghouse will contact the other
participating hospitals to determine the availability of additional personnel or material resources,
including the availability of beds, as required by the situation. The recipient hospital will be informed as
to which hospitals should be contacted directly for assistance that has been offered. The senior
administrator/ designee or command center of the recipient or patient-transferring hospital will
coordinate directly with the senior administrator/ designee or command center of the donor or patientaccepting hospital for this assistance.
3. Initiation of transfer of personnel, material resources, or patients: Only the senior administrator/
designee or command center at each hospital has the authority to initiate the transfer or receipt of
personnel, material resources, or patients. The senior administrator/ designee or command center and
medical director, in conjunction with the directors of the affected services, will make a determination as
to whether medical staff and other personnel from another facility will be required at the impacted
hospital to assist in patient care activities. Personnel offered by donor hospitals should be limited to
staff that are fully accredited or credentialed in the donor institution. No resident physicians,
medical/nursing students, or in-training persons should be volunteered. In the event of the evacuation
of patients, the command center of the patient-transferring hospital will also notify its local fire
department of its situation and seek assistance, if necessary, from the emergency medical services.
The local fire department will be requested to notify the local emergency management agency and if
appropriate, the local public health department.
VI. Specific Principles of Understanding
A. Medical Operations/Loaning Personnel
1. Communication of request: The request for the transfer of personnel initially can be made verbally.
The request, however, must be followed up with written documentation. This should ideally occur
prior to the arrival of personnel at the recipient hospital. The recipient hospital will identify to the
donor hospital the following:
a.
b.
c.
d.
The type and number of requested personnel.
An estimate of how quickly the request is needed.
The location where they are to report.
An estimate of how long the personnel will be needed.
Caring for the Community | preparing for an influenza pandemic
31
2. Documentation: The arriving donated personnel will be required to present their donor hospital
picture identification badge (ID) at the site designated by the recipient hospital's command center.
The recipient hospital will be responsible for the following:
a.
b.
c.
Meeting the arriving donated personnel (usually by the recipient hospital's security department
or designated employee).
Confirming the donated personnel's picture ID badge with the list of personnel provided by the
donor hospital.
Providing additional identification, e.g., "visiting personnel" badge, to the arriving donated
personnel. The recipient hospital will accept the professional credentialing determination of
the donor hospital but only for those services for which the personnel are credentialed at the
donor hospital.
3. Supervision: The recipient hospital's senior administrator/ designee or command center identifies
where and to whom the donated personnel are to report, and professional staff of the recipient
hospital supervise the donated personnel. The supervisor or designee will meet the donated
personnel at the point of entry of the facility and brief the donated personnel of the situation and
their assignments. If appropriate, the "emergency staffing" rules of the recipient hospital will govern
assigned shifts. The donated personnel's shift, however, should not be longer than the customary
length practiced at the donor hospital.
4. Legal and financial liability: Each party shall, throughout the term of this Memorandum of
Understanding, maintain comprehensive general liability insurance, workers’ compensation
insurance, property insurance and professional liability insurance to cover their activities. Upon
request, each party will provide evidence of insurance. Professional liability claims will be the
responsibility of the treating facility. Disability and worker compensation claims will be the
responsibility of the primary employer. General liability and property claims will be evaluated to
determine who is responsible. The recipient hospital will reimburse the donor hospital for the
salaries of the donated personnel at the staff’s current rate as established by the donor hospital.
The salary reimbursement will not include the cost of benefits. The medical staff office or the
designated department of the recipient hospital will be responsible for providing a mechanism for
emergency credentialing granting disaster privileges for physicians, nurses and other licensed
health care providers to provide service at the recipient hospital.
5. Demobilization procedures: The recipient hospital will provide and coordinate any necessary
demobilization procedures and post-event stress debriefing. The recipient hospital is responsible
for providing the donated personnel transportation necessary for their return to the donor hospital.
B. Transfer of Pharmaceuticals, Supplies or Equipment
1. Communication of Request: The request for the transfer of pharmaceuticals, supplies, or equipment
initially can be made verbally. The request, however, must be followed up with a written
communication. This should ideally occur prior to the receipt of any material resources at the
recipient hospital. The recipient hospital will identify to the donor hospital the following:
a.
b.
c.
The quantity and exact type of requested items.
An estimate of how quickly the request is needed.
Time period for which the supplies will be needed.
Caring for the Community | preparing for an influenza pandemic
32
d.
Location to which the supplies should be delivered.
The donor hospital will identify how long it will take them to fulfill the request. Since response time is a
central component during a disaster response, decision and implementation should occur quickly.
2. Documentation: The recipient hospital will honor the donor hospital's standard order requisition form
as documentation of the request and receipt of the materials. The recipient hospital's security office
or designee will confirm the receipt of the material resources. The documentation will detail the
following:
a. The items involved.
b. The condition of the equipment prior to the loan (if applicable).
c. The responsible parties for the borrowed material.
The donor hospital is responsible for tracking the borrowed inventory through their standard requisition
forms. Upon the return of the equipment, etc., the original invoice will be co-signed by the senior
administrator/ designee or incident commander of the recipient hospital recording the condition of the
borrowed equipment.
3. Transporting of pharmaceuticals, supplies, or equipment: The recipient hospital is responsible for
coordinating the transportation of materials both to and from the donor hospital. This coordination
may involve government and/or private organizations, and the donor hospital may also offer
transport. Upon request, the receiving hospital must return and pay the transportation fees for
returning or replacing all borrowed material.
4. Supervision: The recipient hospital is responsible for appropriate use and maintenance of all
borrowed pharmaceuticals, supplies, or equipment.
5. Financial and legal liability: The recipient hospital, to the extent permitted by federal law, is
responsible for costs arising from the use, damage, or loss of borrowed pharmaceuticals, supplies,
or equipment. Liability claims arising from the use of borrowed supplies and equipment will be the
responsibility of the recipient hospital. The donor will not provide equipment to the recipient
hospital if it is in need of preventive maintenance or repair.
6. Demobilization procedures: The recipient hospital is responsible for the rehabilitation and prompt
return of the borrowed equipment to the donor hospital.
C. Transfer/Evacuation of Patients
1. Communication of request: The request for the transfer of patients initially can be made verbally.
The request, however, must be followed up with a written communication prior to the actual
transferring of any patients. The patient-transferring hospital will identify to the patient-accepting
hospital:
a.
b.
c.
The number of patients needed to be transferred.
The general nature of their illness or condition.
Any type of specialized services required, e.g., ICU bed, burn bed, trauma care, etc.
2. Documentation: The patient-transferring hospital is responsible for providing the patient-receiving
hospital with the patient's complete medical records, insurance information and other patient
Caring for the Community | preparing for an influenza pandemic
33
information necessary for the care of the transferred patient. The patient-transferring hospital is
responsible for tracking the destination of all patients transferred out.
3. Transporting of patients: The patient-transferring hospital is responsible for coordinating and
financing the transportation of patients to the patient-receiving hospital. The point of entry will be
designated by the patient-receiving hospital's senior administrator/ designee or command center.
Once admitted, that patient becomes the patient-receiving hospital's patient and under care of the
patient-receiving hospital's admitting physician until discharged, transferred or reassigned. The
patient-transferring hospital is responsible for transferring of extraordinary drugs or other special
patient needs (e.g., equipment, blood products) along with the patient if requested by the patientreceiving hospital.
4. Supervision: The patient-receiving hospital will designate the patient's admitting service, the
admitting physician for each patient, and, if requested, will provide at least temporary courtesy
privileges to the patient's original attending physician.
5. Financial and Legal Liability: Upon admission, the patient-receiving hospital is responsible for liability
claims originating from the time the patient is admitted to the patient-accepting hospital.
Reimbursement for care should be negotiated with each hospital's insurer under the conditions for
admissions without pre-certification requirements in the event of emergencies.
6. Notification: The patient-transferring hospital is responsible for notifying both the patient's family or
guardian and the patient's attending or personal physician of the situation. The patient-receiving
hospital may assist in notifying the patient's family and personal physician.
D. Clearinghouse Function
The H-MARS provides the means for the hospitals to coordinate among themselves, and as a unit to
integrate with any Region 6 emergency management agency or public health department, police, and
emergency medical services during a disaster event.
The Clearinghouse serves as the data center for collecting and disseminating current information about
equipment, bed capacity and other hospital resources during a disaster (see appendices). The information
collected by the Communication Center is to be used only for disaster preparedness and response.
In the event of a disaster or during a disaster drill, hospitals will be prepared to provide the communication
center the following information:
1. The total number of injury victims your emergency department can accept, and if possible, the
number of victims with minor and major injuries.
2. Total number of operating beds currently available to accept patients in the following units:
a. general medical (adult)
b. general surgical (adult)
c. general medical (pediatric)
d. general surgical (pediatric)
e. obstetrics
f. cardiac intensive care
g. neonatal intensive care
Caring for the Community | preparing for an influenza pandemic
34
h. pediatric intensive care
i. burn
j. psychiatric
k. subacute care
l. skilled care beds
m. operating suites
3. The number of items currently available for loan or donation to another hospital:
a. respirators
b. IV infusion pumps
c. dialysis machines
d. hazmat decontamination equipment
e. MRI
f. CT scanner
g. hyperbaric chamber
h. ventilators
i. external pacemakers
j. atropine
k. kefzol
4. The following number of personnel currently available for loan to another hospital:
a. Physicians
. Anesthesiologists
. Emergency Medicine
. General Surgeon
. OB-GYN
. Pediatricians
. Trauma Surgeons
b. Registered Nurses
. Emergency
. Critical Care
. Operating Room
. Pediatrics
c. Personnel
. Maintenance Workers
. Mental Health Workers
. Respiratory Therapists
. Plant Engineers
. Security Workers
. Social Workers
. Others as indicated
E. Partner Hospital Concept (Optional)
Each "paired" hospital should standardize a set of contacts to facilitate communications during a disaster.
The procedural steps in the event of a disaster are as follows:
1. Determine the total number of patients the emergency department and hospital can accept, and if
possible, the total number of patients with major and minor injuries.
Caring for the Community | preparing for an influenza pandemic
35
2. Impacted hospital contacts partner hospital to determine availability of beds, equipment, supplies,
and personnel. (Contacts secondary partner hospital if primary hospital is unable to meet needs.)
3. Impacted hospital contacts the Clearinghouse and notifies the center of its needs, how they are
being met, and any unmet needs.
4. At the request of the impacted hospital, the Clearinghouse will contact other hospitals to alert them
to the situation and to begin an inventory for any possible or actual unmet needs.
Caring for the Community | preparing for an influenza pandemic
36
Appendix 1: PRIMARY DATA COLLECTION FORM
In the event of an emergency, record the time of communication, the total number of injury victims the
receiving hospital can accept, and, if possible, the number of major* and minor** injury victims the hospital
can accept.
Date: _________________
Page #: ________________
Hospitals
(list abbreviated name
of each member
hospital)
Time
Total Number of
Patients
Minor Injuries
Major Injuries
Comments
* Major injury victims: Those expected to require admission and/or significant medical/ hospital resources
(operating room, critical care, extensive orthopedics intervention, etc.)
** Minor injury victims: Those expected to be treated and released or require very little medical/ hospital
resources.
Caring for the Community | preparing for an influenza pandemic
37
Appendix 2a: SECONDARY DATA COLLECTION FORM*
If time or need permits, request the following information from the donating hospital.
Hospital Name:
Person completing form:
Date: _______________
Number of Open/Available Beds
General medical (adult)
General surgical (adult)
General medical (pediatric)
General surgical (pediatric)
Obstetrics
Cardiac ICU
NICU
PICU
Burn
Psychiatric
Trauma
OR Suites
Skilled Nursing & Subacute Care
Time: ______________
Total Available to Donate
Respirators
IV Infusion Pumps
Dialysis Machines
Hazmat Decontamination Equipment
MRIs
CT Scanners
Hyperbaric Chamber
Ventilators
External pacemakers
Atropine
Kefzol
* During an actual disaster or disaster drill, hospitals should complete the above form with the most current
information available and have this information ready for dissemination to the local emergency
management agency, fire department, requesting hospitals, and the H-MARS Clearinghouse.
Caring for the Community | preparing for an influenza pandemic
38
Appendix 2b: SECONDARY DATA COLLECTION FORM*
Hospital Name:
Person completing form:
Date: _______________
Time: ______________
Number of Personnel
Currently Available to
Loan/Donate to Partner
Hospital*
Physician
Anesthesiology
Emergency Medicine
General Surgeon
General Medicine
OB-GYN
Pediatrician
Trauma Surgeon
Other as indicated
Registered Nurses
Emergency
Critical Care
Operating Room
Pediatrics
Other as indicated
Other Personnel
Maintenance Workers
Mental Health Workers
Respiratory Therapists
Plant Engineers
Security Personnel
Social Workers
Other as indicated
Caring for the Community | preparing for an influenza pandemic
* During an actual disaster or
disaster drill, hospitals should
complete the above form with the
most current information available
and have this information ready
for dissemination to the local
emergency management agency,
fire department, requesting
hospitals, and the
H-MARS Clearinghouse.
39
Supporting Documents
Attachment E
APPENDIX
E
Medical
Equipment
List22
Item Description
Calculations
of Quantities
Total Item
Count
Unit Of
Issue
Total UOIs
Required
All supplies are based on the needs of one (1) 50 bed subunit; two, 12 hour
shifts per 24-hour day and approximately 6 staff providing direct patient care
per shift.
IV Supplies (approximately 50% or 25 patients/day estimated to require IVs) 50
pts first day, then 10 new pts/day for 6 remaining days = approx. 110 different
pts/wk (88 adults; 22 peds)
Alcohol pads (multiple
2-4 boxes per
14-28
Box
widespread use)
24 hrs
boxes/week
Catheters, intraosseous
6-7/wk of 1
module blue (pediatric
May use 1/day standard
use)
max.
size
Ea
7
50 pts initially
Intermittent IV access
(first day) then
device (lock)
250/wk
50/Box
5
10% turnover qday
IV catheters, 18g with
40% of pts req 150/wk
50/Box
3
protectocath guard
IVs
IV catheters, 20g with
40% of pts req 150/wk
50/Box
3
protectocath guard
IVs
IV catheters, 22g with
10% of pts req 25/wk
50/Box
0.5
protectocath guard
IVs
IV catheters, 24g with
10% of pts req 25/wk
50/Box
0.5
protectocath guard
IVs
IV fluid bags, NS, 1000cc (50% of
315 L/wk
12/case 18 cases
(required by 60% of
pts(25)/day x
patients)
3L/pt) x
IV fluid bags, D5 1/2NS,
(50% of
210 L/wk
12/case 18 cases
1000cc (required by 40% pts(25)/day x
of patients)l
3L/pt) x
same # as
intermittent
IV start kits
access device 60
25/box
2.5 boxes
IV tubing w/ Buretrol drip 10% peds/wk
25/wk
20 per
1.25 cases
set for peds
case
IV tubing w/ standard
same # as
250/wk
48/case 5 cases
macrodrip for adults
intermittent
access
22
U.S. Army Soldier and Biological Chemical Command. A Mass Casualty Care Strategy for Biological
Terrorism – Acute Care Center. Available at: http://www.disasterhelp.net/resources/acc_blue_book.pdf
Caring for the Community | preparing for an influenza pandemic
40
Needles, Butterfly, 23g
Needles, Butterfly, 25g
Needles, sterile 18g
Needles, sterile 21g
Needles, sterile 25g
Saline for injection 10cc
bottle
Patient Care Supplies
ABD bandage pads,
sterile
BandAids
Basins, bath
Bathing supply,
prepackaged (e.g., Bath
in a Bag (TM))
Bedpans - regular
Blankets
10% peds/wk
10% peds/wk
1 box/day
1 box/day
1 box/day
50 bottles/day
10%of pts/day
=5 pads/day =
35 pads/wk
1 box/day
20 pts/day
50 pts every
day
40 pts/day
initially then
10%
50 pts/day;
changed daily
Caring for the Community | preparing for an influenza pandemic
25/wk
25/wk
7 boxes/wk
7 boxes/wk
7 boxes/wk
350
bottles/wk
50/box
50/box
100/box
100/box
100/box
24/box
0.5 boxes
0.5 boxes
7 boxes
7 boxes
7 boxes
14.5 boxes
35 pads/wk
7 boxes/wk
140/wk
350/wk
16/box
2 boxes
50/box
7 boxes
100/case 1.5 cases
350
65/wk
50/case
1.25 cases
50/day or
350/wk
41
Item Description
Sanitary pads (OB pads)
Sharps disposal containers -2
gallon
Sheets, disposable, paper, for
stretchers & cots
Syringes, 10cc, luer lock
Syringes, 3cc, luer lock, w/
21g 1.5" needle
Syringes, catheter tip 60cc
Syringes, Insulin
Syringes, TB
Tape, silk -1 inch
Tape, silk -2 inch
Toilet tissue
Appendix E E-1
Total
Calculations of
Item
Quantities
Count
2 women/wk;
20
10pads/day
pads/wk
2-4 /wk/sub-unit 2-4/wk
Urinals
Washcloths, disposable
Water, bottled 1 liter (for
mixing ORT)
Water container, 1 gallon
potable
Diagnostic Supplies
Glucometer
12
pads/box
20/case
Total
UOIs
Required
2 boxes
0.25
cases
100/day
700/wk
4 boxes/wk
(100 ct box)
200/day
400/wk
100/box
4 boxes
1400/wk
100/box
14 boxes
25/wk
28/wk
50/box
100/box
4/day
2/day
12/day
6/day
25 rolls/day
Tongue depressor
Tubex [TM] pre-filled syringe
holders
Unit Of
Issue
1 per staff
member plus
extras
10/pt/day
1/patient
Glucometer test strips
Probe covers for
4 boxes/day
thermometers
Protocol unit (or other brand), 02 sat monitor,
thermometer, BP, HR
Protocol unit, disposable
200/day
plastic BP covers
Single Use Shielded Lancets
25/day
Stethoscopes
Caring for the Community | preparing for an influenza pandemic
14/day
96/wk
42/wk
175
rolls/wk
2
boxes/wk
12/subunit
50/wk
3500/wk
200/wk
0.5 boxes
0.25
boxes
100/box
0.4 boxes
12rolls/box 8 boxes
12rolls/box 3.5 boxes
175 rolls
500/box
2 boxes
50/case
.25 cases
50/case
1 case
3500
125/wk
125
1per subunit
2
bottles/wk
28
boxes/wk
4 per
sub-unit
1400/wk
Ea
175/wk
12/subunit
200/box
Ea
50
strips/vile
20/box
2 vials
28 boxes
Ea
1 box
12
42
Item Description
Housekeeping and Misc.
Supplies
Backboard, plastic
Bleach
Microwave oven
Total
Calculations of
Item
Quantities
Count
1 gal/day
Refrigerator
Stretcher, EMS (rolling)
Towels, paper
Trash cans with pop lids
(biologic), large
Trash liners, red plastic (large)
25 rolls/day
6 changes/day
x 6 trash cans
Wheelchair
Unit Of
Issue
1
7 gal/wk
1 per
sub-unit
3 per
sub-unit
2/sub-unit
175
rolls/wk
6 per
sub-unit
252/wk
Ea
10/subunit min
Ea
Total
UOIs
Required
1
7gallons
1
3
Ea
2
175 rolls
Ea
6
100/roll
2.5 rolls
10
In addition to the items listed above, which only address medical supplies for one 50-bed nursing subunit,
planners should also provide supplies and equipment for the other sections of the ACS. Those
requirements are found in the description of each section (see Appendix B). General supplies common to
all sections are not included in the lists but must be considered. Some of these common items include but
are not limited to:


Personal Protective Equipment (PPE) – The exact PPE requirements will be dependent upon the
disease. Likely PPE will include:
o Gloves
o Surgical Masks
o N95 Respirators
o Gowns
o Paper
o Pens/Pencils
Food supplies for 50 patients – 3 meals daily and snacks
Caring for the Community | preparing for an influenza pandemic
43
Supporting Documents
Attachment F
APPENDIX
F:
Pharmaceutical
Supplies23
1. Selected Pharmaceuticals.
The list of stock medications that should be available in the ACS was determined by identifying the most
likely symptoms the majority of patients would present with, regardless of the agent, as well as each drug’s
flexibility in action, treatment applications, and use across all age populations. An estimate was made
regarding the percentage of patients on a 50-bed unit who might require that medication. Under most
circumstances, the total quantity of medication required was based on the maximum allowable daily adult
dosage. Pediatric dosing is provided where appropriate. All dosing is on an as-needed basis (PRN) except
for antibiotics. The chart below is calculated for one 50-bed subunit with 80 percent adults and 20 percent
pediatrics at full capacity for one day and for one month. (Note: A legend of all abbreviations used in the
following table is included at the end of this document.)
Drugs
Antibiotic CDC push pack
Promethazine
(Phenergan)Dosing: 12.5–25
mg q4–6hr (IV/IM/PR)
Maximum dose: 200 mg/day
Pediatrics: 0.25–0.5 mg/kg/dose
q6h 25 mg/vial; 50
mg/suppository
Digoxin (Lanoxin)
Maintenance dose: 0.25 mg/day
Loading dose: 1 mg/day divided
QID (assume 1 pt requires
loading dose & 4 pts require
maintenance dose per day) 0.25
mg/tablet
23
% of pts
requiring drug
100%
100% 60%
10%
1 day
1 week
50 daily doses
medication for all 50
patients
320 vials (8 vials/pt/day x
40 pts) 40
suppositories(4
suppositories/day x 10 pts)
350 daily doses
8 tablets (1 loading dose
of 4 tablets + 4
maintenance doses)
56 tablets
2,240 vials 210
suppositories
U.S. Army Soldier and Biological Chemical Command. A Mass Casualty Care Strategy for Biological
Terrorism – Acute Care Center. Available at: http://www.disasterhelp.net/resources/acc_blue_book.pdf
Caring for the Community | preparing for an influenza pandemic
44
Furosemide (Lasix)(Assume 4
pts/day require maintenance
dose of 40 mg PO BID & 1
pt/day requires acute therapy of
100 mg IV BID) 40 mg tablets
100 mg/vial
20%
8 tablets 2 vials
56 tablets 14 vials
Diphenhydramine (Benadryl)
Dosing: 25–50 mg IV/IM/PO
q6h Pediatrics: 1 mg/kg
IV/IM/PO q6h 50 mg/vial 12.5
mg/5 cc
75%
80 vials (4 vials/pt/day x
20 pts) 400 cc or 14 fluid
ounces (80 cc/pt/day x 5
pts)
560 vials 100 fluid
ounces
1 day
1 week
48 vials (4 vials/pt/day x
12 pts)
336 vials
Drugs
Lorazepam (Ativan) Dosing: 2
mg IV/IM q6hr Pediatrics: 0.05
mg/kg/dose q6h 2 mg/vial
% of pts
requiring drug
70% 75% for all
Nitroglycerin SL 0.4 mg
Dosing: 1 tab SL q5 min
Insulin NPH & Reg Dosing:
individualized (Assume 30
units/pt/day of NPH, 70/30 &
Regular) 10 cc vials (100
units/cc)
Albuterol MDI Dosing: 6 puffs
QID with spacer Nebulizer: 1 u
dose QID Multidose dispenser
Unit dose for nebulizer
10%
1 bottle
1 bottle
6%
1 vial of NPH & Regular
1 vial of NPH &
Regular
40%
12 MDI
12 MDI
Aspirin 325 mg Dosing: 325
mg/day for platelet inhibition
(cardiac & TIA)
Naloxone (Narcan)Dosing: 0.4
mg–2 mg IV/IM/SC q 3 min,
PRN 1.0 mg/ml prefilled syringe
(box of 10)
10%
1 bottle
1 bottle
1%
1 box
1 box
Morphine Sulfate Dosing
(titrate to effect): 5 mg IV/IM/SC
q4h (0.1 mg/kg in 2-4 mg
increments) Pediatrics: 0.1
mg/kg/dose 10 mg/vial
50%
100 vials (4 mg or 10 mg)
(4 vials/pt/day x 25 pts)
700 vials
Caring for the Community | preparing for an influenza pandemic
45
IV Fluids Dosing: 4 liters/pt/day
Normal saline or D5W .45% NS
1 liter bags
Dump out half the IV bag for
peds or use volutrols
50% (assumes
the other 50%
would use oral
rehydration
therapy)
100 liter bags60 liters of
NS 40 liters of D5W.45%
Acetaminophen Dosing: 1 g
q4h Pediatric: 15 mg/kg q4h
(elixir volume based on a 32 kg
child) 500 mg/tablet 160 mg/5
cc
100%
480 tablets (12
tablets/pt/day x 40 pts) 60
ounces of elixir (3 oz/day
x 20 pts)
3,360 tablets 420
ounces of elixir
Spacers for Albuterol MDI 1
per pt
40%
12 spacers
84 spacers
Oral rehydration packets Oral
50%
100 packets(4
liters/pt/day x 25 pts)
700 packets
700 liter bags(Assume 60%
of pts are given NS and
40%of pts are given D5W
.45% NS; therefore, need
420 bags NS and 280 bags
D5W .45% NS)
rehydration therapy (ORT) is a primary
mode of treatment for dehydration in
mass casualty situations. One packet
makes 1 liter
Legend





























BID twice-a-day dosing
cc cubic centimeters
d day(s)
D5W 5% dextrose and water
h hour(s)
IM intramuscular
IV intravenous
g gram(s)
kg kilograms
mg milligrams
mL milliliters
MDI metered dose inhaler
min minute
NPH isophane insulin
NS normal saline
ORT oral rehydration therapy
oz ounce(s)
PCN Penicillin
PO per os (orally)
PR per rectum
PRN as necessary
pt (pts) patient (patients)
q every (e.g., q6h = every 6 hours)
QID four times daily
Rx treatment or prescription
SC subcutaneous
SL sublingual
TIA transient ischemic attack
u unit(s)
Caring for the Community | preparing for an influenza pandemic
46
2. Rationale for Selected Drugs












Promethazine (Phenergan): This drug is safe for both adults and pediatrics and has multiple uses
in the clinical setting. It may be used as an anti-emetic, as an adjunct to narcotics to potentiate
their effect and thus decrease the amount of narcotic used, and as a sedative to promote rest and
calm agitated patients.
Digoxin (Lanoxin): Given the expected mass casualty situation, it is likely that many patients would
present with comorbidities including cardiovascular disease. Digoxin is versatile enough to treat
arrhythmias as well as heart failure.
Furosemide (Lasix): Most patients requiring diuresis respond to this diuretic or are on it for
maintenance. It is stable, readily available, and inexpensive.
Diphenhydramine (Benadryl): A very versatile drug to have on hand to treat allergic (drug)
reactions, nausea, and insomnia.
Lorazepam (Ativan): This drug provides effective treatment for both anxiety and insomnia. It is
relatively safe with few side effects or contraindications and may be given IV or IM. Its rapid onset
and short half-life make it a useful addition to the basic drug inventory.
Nitroglycerin Sublingual: Provides a safe and effective treatment for congestive heart failure (CHF)
and anginal pain. Use of this drug combined with aspirin may stabilize a patient long enough for
transfer to a hospital if bed space is available. This combination may also be used for advanced
cardiac care, or it may prevent the patient from further suffering.
Insulin (Regular and NPH): Insulin was included in the basic drug inventory because approximately
6 percent of the general population are diabetic. In persons 65 years and older, the prevalence
increases to more than 18 percent. Because the elderly are more susceptible to illness in general,
it can be surmised that at any given time, the census of the ACS will lean towards more elderly
than middle-aged patients and therefore a higher percentage of diabetics. Although regular insulin
will be used more than NPH, some portion of the diabetic population will require both.
Albuterol Meter Dose Inhaler (MDI): Albuterol is the bronchodilator of choice, when combined with
a spacer, because of its ease of administration and rapid onset of action. It is assumed that the
need for bronchodilators will be widespread since the respiratory tract will be the primary site of
infection
Aspirin: This antiplatelet drug was included in the formulary to help treat cardiac or stroke
(including transient ischemic attacks) comorbidity that may present to the ACC.
Naloxone (Narcan): This drug prevents or reverses the adverse effects of narcotics, including
respiratory depression, hypotension, and sedation. Because many patients will presumably
receive morphine for pain and respiratory distress, it is imperative to have Narcan to reverse
accidental overdoses.
Morphine: Morphine is the preferred pain medicine because of its use in easing respiratory distress
and decreasing cardiac oxygen consumption.
Oral Rehydration Therapy (ORT): Many patients suffering from the effects of bioterrorist agents will
present with dehydration from fever, emesis, or diarrhea. Rehydration may be accomplished by
either ORT or intravenous routes. ORT may be used safely for patients with altered mental status
(especially pediatric) and may be administered by family members with minimal instruction. It is
the mainstay of disaster/epidemic relief worldwide.
Caring for the Community | preparing for an influenza pandemic
47
Supporting Documents
Attachment G
National VOAD Members Resource Directory - 200924
The following lists each National VOAD member organizations and the types of services provided during
emergencies and disasters. This is not a guarantee of services nor does it list every possible service
provided. Much is dependent upon the type of disaster, services provided by other coordinating nonprofits,
and local resources.
Agency
National Voluntary
Organizations
Active in Disaster
Function
•
•
•
•
Adventist
Community
Services (ACS)
American Baptist
Men/USA
American Radio
Relay League
(ARRL) – Amateur
Radio Emergency
Services (ARES)
•
•
•
•
•
•
•
•
•
•
American Red
Cross
•
•
•
24
Facilitates and encourage collaboration, communication, cooperation, and
coordination, and builds relationships among members while groups plan and
prepare for emergencies and disaster incidents.
Assists in communicating to the government and the public the services provided by
its national member organizations.
Facilitates information sharing during planning, and preparedness, response, and
recovery after a disaster incident.
Provides members with information pertaining to the severity of the disaster, needs
identified, and actions of volunteers throughout the response, relief, and recovery
process.
Distributes relief items such as: drinking water, groceries, clothing and more.
Provides warehousing and other donation coordination services such as Points of
Distribution centers (PODs).
Operates volunteer centers where community members can volunteer during
disaster response.
Provides victims with emotional and spiritual counseling.
Provides cleanup, repair and initial rebuilding. Short-term volunteers work
cooperatively with Church World Service.
Provides financial assistance to victims during both the relief and recovery stages.
Operates volunteer centers to serve as clearinghouses for relief teams.
Operators setup and run organized communication networks locally for
governmental and emergency officials, as well as non-commercial communication
for private citizens affected by the disaster. They activate after disasters damage
regular lines of communications due to power outages and destruction of telephone,
cellular and other infrastructure-dependent systems.
ARRL volunteers act as communications volunteers with local public safety
organizations. In addition, in some disasters, radio frequencies are not coordinated
among relief officials and amateur radio operators (hams) step in to coordinate
communication when radio towers and other elements in the communication
infrastructure are damaged.
At the local level, hams may participate in local emergency organizations, or
organize local “traffic nets.”
Provides Mass Care operations such as: shelter, fixed and mobile feeding services
for disaster victims and emergency workers in the affected area, and the distribution
of supplies and commodities.
Provides emergency and preventive health services to people affected by disaster.
Provides individual assistance at service delivery sites and through outreach, by
referral to government and/or voluntary agencies through distribution or financial
assistance.
National Voluntary Organizations Active in Disaster. Members Resource Directory 2009. Available at
http://www.nvoad.org/Portals/0/Resource%20Directory%202009.doc
Caring for the Community | preparing for an influenza pandemic
48
•
•
•
Provides services leading to reunification of family members in the affected area.
Performs damage assessments.
Provides emergency and preventive mental health services.
Ananda Marga
Universal Relief
Team (AMURT)
Billy Graham Rapid
Response Team
Provides food and clothing, shelters, counseling; it also renders emergency medical
services, sanitation, short-term case management.
Brethren Disaster
Ministries
•
•
•
•
•
•
Provides emotional and spiritual care
National database of more than 3,200 crisis-trained chaplains and ministry
volunteers
Engages a network of volunteers to repair or rebuild homes for disaster survivors
who lack sufficient resources to hire paid labor, focusing on vulnerable communities.
Trained, skilled project leaders supervise volunteers.
BDM cooperates with the local disaster recovery organization to enhance the longterm recovery of the community.
Provides Maryland-based warehousing and distribution services through the Church
of the Brethren’s Material Resources center.
Children’s Disaster Services (CDS) alleviates disaster-related anxiety in children
through specially trained and certified volunteers.
Provides children a safe, secure and comforting environment in shelters and
assistance centers.
Offers specialized care for children experiencing grief and trauma.
Educates parents and caregivers on how to help children cope.
Provides assistance including direct financial assistance to communities in
addressing the crisis and recovery needs of local families.
Performs initial damage assessments.
Provides ongoing and long-term recovery services for individuals and families,
including temporary and permanent housing assistance for low income families,
counseling programs for children and the elderly, and special counseling for disaster
relief workers.
Provides relief stage services including shelter and emergency food.
Fully equipped and trained Rapid Response teams for clean up, chain saw and
mucking out
Trained volunteer managers assist local community in the formation and operation
of long term recovery organizations.
Provides community wide unmet needs assessments for long-term recovery
organizations.
Provide construction estimating services using skilled volunteers
Provide accounting services for long term recovery and VOAD organizations using
volunteer CPA’s
Provide skilled teams for long term housing repair and construction.
Chaplaincy services.
Community Development consultants after the recovery.
Assists relief crews in providing food and water.
Emotional and spiritual care.
Church World
Service
•
•
•
•
•
Provides advocacy services for survivors.
Provides case management for low income and marginalized groups.
Provides emotional and spiritual care as well as physical rebuilding programs.
Assists in long-term recovery of those in need.
Restores and build community relationships.
City Team
Ministries
•
•
•
Supports first responders during rescue phase.
Provides food, water and shelter during the relief phase.
Provides emotional and spiritual care and case management to assess the needs of
victims.
Is committed to the effort of rebuilding homes and communities.
•
•
•
•
•
•
•
Catholic Charities,
USA
Christian Reformed
World Relief
Committee
(CRWRC)
•
•
•
•
•
•
•
•
•
•
•
Churches of
Scientology
Disaster Response
•
Caring for the Community | preparing for an influenza pandemic
49
Convoy of Hope
Episcopal Relief
and Development
Feeding America
Feed the Children
Habitat for
Humanity
International
HOPE Coalition
America (Operation
Hope)
Facilitates relief efforts between churches and other organizations to help best serve the
needs of survivors. With our fleet of trucks, 300,000 square foot warehouse, Mobile
Command Center, and utilizing the first response P.O.D. (Points of Distribution) model,
USDR has become an active and efficient disaster relief organization, providing
resources and help to victims in the first days of a disaster.
•
Sends immediate relief grants for such basics as food, water, medical assistance,
and financial aid within the first 90 days following a disaster.
•
Provides on-going recovery activities through rehabilitation grants, which offer the
means to rebuild, replant ruined crops, and counsel those in trauma.
•
Delivers relief kits and other emergency supplies and food to emergency shelters &
camps.
•
Works primarily through Church World Service in providing its disaster-related
services.
•
Does rebuilding for individual homes damaged during disasters.
•
Helps residents restore the social and economic fabric of their communities by
providing economic and educational opportunities and improving access to legal
services and home ownership.
•
Trains and equips local denominations to prepare for and respond to disasters that
devastate their communities.
•
Collects, transports, warehouses, and distributes donated food and grocery
products for other agencies involved in both feeding operations and distribution of
relief supplies through its national network of food banks.
•
Processes food products collected in food drives by communities wishing to help
another disaster-affected community.
•
Develops, certifies, and supports their food banks.
•
Positions frequently used emergency food products and personal care items in
strategic locations and regularly cycles inventories to ensure usage by survivors
immediately following a disaster.
•
Serves as a liaison between the food banks and the donors.
•
Educates the public about the problems and solutions of hunger.
•
Specializes in disaster training for its network, and continually improves standard
operating procedures that enable member food banks to develop seamless,
coordinated approaches to delivering disaster assistance.
•
Provides help to survivors of natural disasters occurring in the United States and
around the world.
•
Provides food, water, blankets, cleaning supplies or other relief supplies to
individuals and families affected.
•
Through a subsidiary, picks up in-kind contributions from corporate warehouses and
individual donors, to any of its six regional distribution centers for either bulk
distribution or directly to individual relief boxes for families.
Conducts community housing assessments for long-term recovery.
Works with partner families to build or rehabilitate simple, decent, and affordable
homes after a disaster.
•
Offers construction and development technical assistance to communities.
•
Facilitates community involvement and support during the long-term recovery
process.
•
Introduces alternative construction technologies (modular, panelized/SIP housing,
etc.) to communities to speed up the delivery of permanent housing solutions.
Supports disaster survivors by assisting with budgeting and developing financial
recovery plans:
•
Pre-disaster preparedness seminar.
•
Emergency budget counseling.
•
Emergency Credit Management.
•
Assistance with working with creditors.
•
Referrals to government and private agencies.
•
Assistance with obtaining copies of destroyed financial documents.
•
Insurance claim assistance.
•
•
Caring for the Community | preparing for an influenza pandemic
50
Humane Society of
the United States
International Critical
Incident Stress
Foundation
International Relief
& Development
Provides assistance with animal rescue, handling and transport in a timely and humane
way:
•
Assessment of animal related needs..
•
Establishment and management of temporary emergency animal shelters.
•
Evacuation support.
•
Veterinary evaluation of animals.
•
Relocation and support of disaster affected animal facilities.
•
Transition of support to local resources during the recovery phase.
•
Donations and volunteer management including emergent volunteers.
•
Serves as resource for individuals, animal-related organizations, and others
concerned about the urgent needs of animals before, during and after disasters.
Emotional and spiritual care:

Pre- and post-incident training.

Risk and crisis communication.

Crisis planning and intervention with communities and organizations.

Spiritual assessment and care.
•
•
•
•
Distributes food and critical relief supplies.
Helps communities develop effective social services through collaborative efforts to
improve roads, renovate schools, rebuild utilities: water and sewage systems, and
establish health facilities.
Collaborates with other organizations to provide shelter and necessary tools such as
financial counseling to disaster victims.
Performs needs assessment and mapping.
International Relief
Friendship
Foundation
Provides needs assessment, case management, distribution of designated relief
supplies, and spiritual care and counseling.
Latter-Day Saint
Charities
Provides food and other emergency supplies and kits during response.
Lutheran Disaster
Response
•
Mennonite Disaster
Services
Mercy Medical
Airlift (Angel Flight)
Provides response efforts through a pre-selected group of Lutheran social service
agencies with established standing in the affected communities.
•
Provides spiritual and emotional counseling for affected persons.
•
Helps in coordinating volunteer teams for cleaning-up and rebuilding disaster
affected homes.
•
Provides case management services for long-term recovery.
•
Provides training and expertise on volunteer coordination, case management, longterm recovery, construction, and database management.
Assists disaster victims by providing volunteer personnel to clean up and remove debris
from damaged and destroyed homes and personal property.
Repairs or rebuilds under-insured primary residence homeowners with emphasis on
assisting with the special needs of the vulnerable populations such as the elderly and
people with disabilities.
Homeland Security Emergency Air Transportation System (HSEATS):
•
Transport into disaster response areas of small high-priority non-hazardous cargo
(including blood) up to 300-400 pounds (boxed) when commercial ground or air not
available.
•
Aerial reconnaissance of disaster area.
•
Air transport of disaster response personnel and evacuees into/from/within disaster
area when commercial ground or air not available.
•
Relocation of special populations including special "surge services" using
commercial air ambulance services (by pre-arranged MOU only).
•
Coordination of available corporate jet aircraft for disaster response in cooperation
with NBAA.
•
Management of large-scale airline provided relocation movements in support of
FEMA, Red Cross, etc.
Caring for the Community | preparing for an influenza pandemic
51
National
Association of
Jewish Chaplains
(NAJC)
National Emergency
Response Team
(NERT)
National
Organization for
Victim Assistance
(NOVA)
Nazarene Disaster
Response (NDR)
Noah’s Wish
Operation Blessing
Points of Light
Institute/Hands On
Network
Presbyterian
Disaster Assistance
(PDA)
REACT
International
Provides spiritual crisis counseling, short term pastoral care and long term pastoral
counseling through its board certified chaplains and professionally trained
chaplains.
•
Provides education and training in disaster spiritual care.
•
Helps organize volunteer disaster chaplains, through its association with American
Red Cross' Critical Response Team and other professional chaplaincy
organizations who wish to provide immediate disaster spiritual care services in the
aftermath of disasters.
•
Provides coordinated emergency services with federal, state and local government
agencies and non-profit agencies.
•
Transports food and other disaster goods through trailer units.
•
Provides communication services through trailers equipped with ham radios,
scanners etc.
•
Provides direct financial aid to victims.
•
Home repair services for special needs group (elderly).
Provides social and mental health services for individuals and families who experience
major trauma after disaster, including: psychological first aid, crisis intervention, crime
victim resources, crisis management consultation.
•
Provides clean-up and rebuilding assistance, especially to the elderly, persons with
disabilities, the widowed, and those least able to help themselves.
•
Works in the recovery phase by assisting with the emotional needs of disaster
victims.
The mission of Noah’s Wish is to save animals during disasters by providing:
•
Rapid deployment of disaster response teams.
•
Operation of temporary animal shelters.
•
Rescue and evacuation assistance.
•
Veterinary care for disaster related injuries or illness.
•
Short- and long-term foster care for animals.
•
Permanent placement for all unclaimed or surrendered animals.
•
Coordination and distribution of donated supplies and food.
•
Transports food and emergency supplies to disaster survivors.
Assists in disaster medical relief.
Provides direct financial assistance to victims.
Creates innovative, actionable models for citizen-centered problem solving, and
direct, tangible tools and opportunities for people and organizations to apply their
interests and passions to make a difference.
•
Serves 83% of the American population and 12 international communities in nine
countries through hundreds of affiliates — places where people can get connected,
get involved and make change happen in their communities.
•
Focuses on helping people plug into volunteer opportunities in their local
community, helping non-profits manage volunteer resources and developing the
leadership capacity of volunteers.
•
Works primarily through Church World Service in providing volunteers to serve as
disaster consultants.
•
Funding for local recovery projects that meet certain guidelines.
•
Provides trained volunteers who participate in the Cooperative Disaster Child Care
program.
•
Provides volunteer labor and material assistance at the local level.
•
Supports volunteer base camps for volunteer groups assisting with the rebuilding
efforts.
Provides emergency communication facilities for other agencies through its national
network of Citizen Band radio operators and volunteer teams.
•
•
•
•
Caring for the Community | preparing for an influenza pandemic
52
•
Provides emergency assistance including mass and mobile feeding, temporary
shelter, counseling, missing person services, medical assistance.
Provides warehousing services including the distribution of donated goods including
food, clothing, and household items.
Provides referrals to government and private agencies for special services.
Does individual and family counseling.
Recruits, trains, houses, and transports volunteers.
Coordinates economic reconstruction efforts.
Provides financial assistance to victims through case management to include:
housing needs, disaster related medical & funeral expenses.
Provides emotional and spiritual care.
Samaritan’s Purse
•
•
•
Emotional and spiritual care.
Provides cleanup assistance.
Emergency home repairs.
Save the Children
•
Provides disaster relief services for children in shelters including food, clothing,
diapers, evacuation backpacks.
Also provides supervision in designated areas within shelters.
Provides social services to individuals and families, and collects and distributes
donated goods.
Makes store merchandise available to disaster victims. Operates retail stores,
homeless shelters, and feeding facilities that are similar to those run by the
Salvation Army.
Provides warehousing facilities for storing and sorting donated merchandise during
the emergency period.
The Salvation Army
•
•
•
•
•
•
•
Society of St.
Vincent De Paul
•
•
•
•
Southern Baptist
Disaster
Relief/North
American Mission
Board
Tzu Chi Foundation
United Church of
Christ
Provides mobile feeding units staffed by volunteers who prepare and distribute
thousands of meals a day.
•
Provides disaster childcare – mobile units transport equipment and supplies to a
facility where trained workers provide safe and secure care for children.
•
Provides units and trained volunteers to assist with clean-up activities, temporary
repairs, reconstruction, chaplains, command/communication, and bilingual services.
•
Provides water purification, shower and laundry units and trained volunteers for
disaster responses.
•
Emotional and spiritual care.
•
Provides medical and financial assistance.
Coordinators help to organize volunteers for clean-up and rebuilding efforts; as well as
participate in response and long-term recovery efforts in communities affected by natural
disasters.
•
United Jewish
Communities (UJC)
•
United Methodist
Committee on Relief
(UMCOR)
•
•
•
•
•
United Way of
America
•
•
•
•
Organizes direct assistance, such as financial and social services, to Jewish and
general communities in the U.S. following disaster.
Provides rebuilding services to neighborhoods and enters into long-term recovery
partnerships with residents.
Raises and distributes funds equitably to the most vulnerable populations in affected
communities.
Provides case management services and related training for the long-term recovery
of victims.
Coordinates shipments of disaster relief supplies and kits, including cleanup
supplies.
Provides spiritual and emotional care to disaster victims and long-term care of
children impacted by disaster.
Offers training in support of volunteer activities in disaster recovery.
Provides experience, expertise, and resources to local United Ways facing local,
regional, state or national emergencies.
Gives direct grants to support disaster recovery, such as: home repairs, food
vouchers, counseling.
Acts as a resource and information guide for survivors, through its 211 call centers.
Caring for the Community | preparing for an influenza pandemic
53
World Hope
International (WHI)
World Vision
•
•
•
•
•
•
Coordinates with churches and pastors in the disaster areas to establish distribution
sites and housing facilities for volunteers.
Highly skilled volunteers help clean up, gut houses or rebuild homes.
Provides relief kits and tool resources for disaster response.
Trains and mobilizes community-based volunteers in major response and recovery
activities.
Provides consultant services to local unaffiliated churches and Christian charities
involved in locally-designed recovery projects.
Collects, manages, and organizes community based distribution for donated goods.
Caring for the Community | preparing for an influenza pandemic
54
Supporting Documents
Attachment H
Federal agencies with defined capabilities that may be
able to provide staffing support
Organization
1. The National Disaster
Medical System (NDMS)
2. The National Disaster
Medical Assistance Teams
(DMATs)
Role/Capabilities
NDMS is activated through the Federal Response Plan, works within ESF-8,
and is designed to fulfill three primary functions:
 To provide supplemental health and medical assistance in domestic
disasters at the request of state and local authorities.
 To evacuate patients who cannot be cared for in the disaster area to
designated locations elsewhere in the nation.
 To provide hospitalization in a nationwide network of hospitals to care for
the victims of domestic disaster or military contingency that exceeds the
medical care capability of the affected local, state, or federal medical
system.
A DMAT is a group of professional and paraprofessional medical personnel
(supported by a cadre of logistical and administrative staff) designed to provide
emergency medical care during a disaster or other event.
Each team has a sponsoring organization, such as a major medical center,
public health or safety agency, non-profit, public, or private organization that
signs a Memorandum of Understanding (MOU) with the USPHS. The DMAT
sponsor organizes the team and recruits members, arranges training, and
coordinates the dispatch of the team.
DMATs are designed to be a rapid-response element to supplement local
medical care until other federal or contract resources can be mobilized, or the
situation is resolved.
DMAT members are required to maintain appropriate certifications and
licensure within their discipline. When members are activated as federal
employees, all states recognize licensure and certification. Additionally, DMAT
members are paid while serving as part-time federal employees and have the
protection of the Federal Tort Claims Act in which the Federal Government
becomes the defendant in the event of a malpractice claim. DMATs are
principally a community resource available to support local, regional, and state
requirements. However, as a national resource they can be federalized to
provide interstate aid.
3. Commissioned Corps
Readiness Force (CCRF)
DMATs may provide primary health care and/or may serve to augment
overloaded local health care staffs. Under the rare circumstance that disaster
victims are evacuated to a different locale to receive definitive medical care,
DMATs may be activated to support patient reception and patient disposition at
hospitals.
The U.S. Surgeon General created the CCRF in 1994 to improve the DHHS
capability to respond to public health emergencies. HHS/OEP implements the
Caring for the Community | preparing for an influenza pandemic
55
Organization
4. Veterinary Medical
Assistance Teams
(VMATs)
Role/Capabilities
responses and manages the system. CCRF consists of a cadre of USPHS
officers uniquely qualified to mobilize in times of extraordinary need in
response to domestic or international requests and to provide public health
leadership and expertise.
Capabilities include: “hands-on” care, technical assistance liaison support to
OEP, FBI, FEMA, regional staff assistance, augmenting NDMS teams and
responding to non-federally declared disasters, emergencies, or special events.
Professional categories include: physicians, dentists, nurses, engineers,
scientists, environmental health officers, veterinarians, pharmacists, dieticians,
therapeutics, and health science officers. The CCRF membership is listed as
1,372 individuals.
The Federal Response Plan tasks the National Disaster Medical System
(NDMS) under Emergency Support Function #8 (ESF-8) to provide assistance
in assessing the extent of disruption and need for veterinary services following
major disasters or emergencies. These responsibilities include the following:







Assessment of clinical needs of animals
Animal care and handling
Animal sheltering and evacuation
Animal inspection and disease surveillance
Technical assistance
Hazard mitigation
Care and shelter of companion pets
In order to accomplish this mission, NDMS entered into a Memorandum of
Understanding with the American Veterinary Medical Association (AVMA), a
nonprofit organization, to develop Veterinary Medical Assistance Teams
(VMATs). VMATs are composed of private citizens who are called upon in the
event of a disaster.
VMAT members are required to maintain appropriate certifications and
licensure within their discipline. When members are activated, all states
recognize licensure and certification, and the Federal Government
compensates the team members for their duty time as temporary federal
employees. During an emergency response, VMATs work under the guidance
of local authorities by providing technical assistance and veterinary services.
5. American Red Cross
The National Disaster Medical System in conjunction with the Coordinator of
Emergency Preparedness directs the VMATs for the AVMA. Teams are
composed of clinical veterinarians, veterinary pathologists, animal health
technicians (veterinary technicians), microbiologist/virologists, epidemiologists,
toxicologists, and various scientific and support personnel.
The American Red Cross (ARC) is a humanitarian organization, led by
volunteers, which provides relief to victims of disasters and helps people
prevent, prepare for, and respond to emergencies. Its primary lines of service
are: disaster services, armed forces emergency services, biomedical services,
health and safety services, international services, and volunteer services. It is
the only non-governmental organization signatory to the Federal Response
Plan for ESF-6 (Mass Care).
Caring for the Community | preparing for an influenza pandemic
56
Organization
6. Weapons of Mass
Destruction (WMD) Civil
Support Teams (CST)
Role/Capabilities
The American Red Cross is a first responder that provides assistance in
sheltering and feeding, individual/family assistance, health/mental health
assistance. In addition, ARC assists with contacting families in disaster areas.
Services that will be of value following a BWI are health services, mental health
services, disaster welfare inquiry, family services, and mass care. The national
headquarters has 238 Emergency Response Vehicles (ERVs), 11
Communications Vehicles, 10 Supply ERVs, 10 Logistical ERVs, 10
warehouses strategically placed in the U.S. and an Air Team, which can
respond to mass casualty events.
The WMD Civil Support Teams were established to provide rapid assistance to
a local incident commander in determining the nature and extent of an attack or
incident. They were also established to provide expert technical advice on
WMD response operations and help identify and support the arrival of follow-on
state and federal military response assets. Each team consists of 22 highly
skilled, full-time members of the Army and Air National Guard.
The WMD Civil Support Teams are unique because of their federal-state
relationship. They are federally resourced, federally trained, and federally
evaluated, and they operate under federal doctrine. But they will perform their
mission primarily under the command and control of the governors of the states
in which they are located. They will be, first and foremost, state assets. Unless
federalized, they fall under the command and control of the adjutants general of
those states. As a result, they will be available to respond to an incident as part
of a state response well before federal response assets would be called upon
to provide assistance.
st
7. Centers for Disease
Control and Prevention
(CDC)
8. National Medical
Response Team –
The closest operational team is the 51 WMD-CST from Battle Creek,
Michigan.
The Centers for Disease Control and Prevention (CDC) is recognized as the
lead federal agency for protecting the health and safety of people at home and
abroad, providing credible information to enhance health decisions, and
promoting health through strong partnerships. CDC serves as the national
focus for developing and applying disease prevention and control,
environmental health, and health promotion and education activities designed
to improve the health of the people of the United States.
The CDC, located in Atlanta, Georgia, USA, is an agency of the Department of
Health and Human Services. One of the CDC’s missions is to protect
individuals against emerging infectious diseases including bioterrorism as
defined in the following statement. CDC will continue to fight against infectious
diseases, with particular emphasis on emerging and antimicrobial-resistant
infectious diseases. We will reinforce international work to reduce and eliminate
re-emergent infectious diseases. We will continue to strengthen local, state,
and national public health capacity to respond to growing threats from
biological and chemical terrorism.
The NMRT is a specialized response force designed to provide medical care
following a nuclear, biological, and/or chemical (NBC) incident. This unit is
Caring for the Community | preparing for an influenza pandemic
57
Organization
Weapons of Mass
Destruction (NMRTWMD)
Role/Capabilities
capable of providing mass casualty decontamination, medical triage, and
primary and secondary care to stabilize NBC victims for transportation to
tertiary care facilities. There are four NMRTs in the NDMS program. Unlike its
counterparts, it is a static force that may only be deployed by the President of
the United States.
An NMRT consists of approximately 50 members. The teams are self-sufficient
in regard to their medical and decontamination operations, with the exception
of the water used for decontamination purposes. Each team is equipped with
its own chemical and biological monitors and detectors, which are used
primarily for personnel and victim safety. Additionally, each team carries
medical supplies and medications, including antidotes, to manage 1,000
victims of a chemical incident.
9. Department of Defense
(DoD)
The NMRT is equipped and trained to perform the following specific functions:

Provide mass or standard decontamination

Collect samples for laboratory analysis

Provide medical care to contaminated victims

Provide technical assistance to local EMS

Assist in triage and medical care of NBC events before and after
decontamination

Provide technical assistance, decontamination, and medical care
at a medical facility

Provide medical care to Federal responders on site

Provide conventional medical care to victims of a non-NBC event
The Department of Defense’s official role in consequence management is to
support FEMA, the lead federal agency. The Secretary of the Army directs
DoD efforts to provide a wide variety of support services, ranging from
laboratory assessments to specialized teams trained and equipped to detect,
neutralize, and respond to incidents involving biological agents. These
specialized teams include the Army’s Technical Escort Units (TEU) and the
Navy’s Defense Technical Response Group (DTRG). For biological incidents,
response teams and laboratories at the U.S. Army Medical Research Institute
of Infectious Diseases (USAMRIID) and the U.S. Naval Medical Research
Institute can help identify biological agents and administer appropriate
antidotes and vaccines. USAMRIID can also deploy Aeromedical Isolation
Teams consisting of physicians, nurses, medical assistants, and laboratory
technicians who are specially trained to provide care for and transport patients
with diseases caused by biological agents or infectious diseases requiring high
containment. The Mobile Analytical Response System, a part of the Edgewood
Research Development and Engineering Center, is capable of providing
assessments of biological contamination at incident sites.
In addition, Public Law 104-201, Section 1414 et seq., mandates the
Department of Defense to organize a Chemical and Biological Rapid Response
Team (CB-RRT) that will be a joint organization to provide chemical and
biological defense support to civil authorities. The mission of the CB-RRT is to,
on order, deploy and establish a robust and integrated capability to coordinate
and synchronize DoD’s technical assistance (medical and non-medical) to
Caring for the Community | preparing for an influenza pandemic
58
Organization
Role/Capabilities
support the Lead Federal Agency in both the Crisis and Consequence
Management of a WMD incident or designated National Security Special Event.
The CB-RRT is self-sustaining for 72 hours.
The Marine Corps also established the Chemical Biological Incident Response
Force (CBIRF) in July 1996 as a consequence management tool capable of
rapid response to chemical and biological attacks. CBIRF consists of a 350man self-sustaining force that can assemble within 4 hours to respond to an
incident involving biological or chemical weapons. CBIRF’s response elements
include reconnaissance, detection, decontamination, medical, security, and
service support. Specifically, CBIRF has the ability to provide command and
control support to a civilian incident commander, conduct detection in a
contaminated environment, and insert Navy doctors into an infected zone for
triage and decontamination. The force is supported by an “electronic
reachback” group of scientific and medical consultants. With these assets
contained in one deployable unit, CBIRF may have the extended support
structure capable of helping local communities respond to a crisis situation.
Caring for the Community | preparing for an influenza pandemic
59
References
1. Agency for Healthcare Research and Quality (AHRQ). Mass Medical Care with Scarce Resources:
A Community Planning Guide. AHRQ Publication No. 07-001, February, 2007. Rockville, MD
http://www.ahrq.gov/research/mce/ (accessed June 12, 2009)
2. AHRQ interactive Hospital Surge Model
http://hospitalsurgemodel.ahrq.gov/
3. Benjamin G., Maves M., AMA/APHA Linkages Leadership Summit Report – Improving Health
System Preparedness for Terrorism and Mass Casualty Events – Recommendations for Action.
American Medical Association in cooperation with American Public Health Association. July, 2007
4. Black K., Ormond B. and Tilly J. State-Initiated Nursing Home Nurse Staffing Ratios: Annotated
Review of Literature. Urban Institute, May, 2003 http://aspe.hhs.gov/daltcp/reports/ratiolit.htm/
(accessed June 4, 2009)
5. Callies B. Community ACS Model. Private communication.February 2009
6. Callies B. private e-mail correspondence. February 12, 2009
7. Callies B. private e-mail correspondence ACC_from_MEMS_R2N. June, 2009
8. Cantrill S., Bonnett C., Hanfling D, Pons P. Chapter 6. Alternative Care Sites in Mass Medical
Care with Scarce Resources: A Community Planning Guide. AHRQ Publication No. 07-0001,
February, 2007. Rockville, MD (http://www.ahrq.gov/research/mce/ , accessed June 12, 2009)
9. Center for Health Policy, Columbia University School of Nursing. Adapting Standards of Care
under Extreme Conditions – Guidance for Professionals During Disasters, Pandemics and Other
Extreme Emergencies. American Nurses Association. March, 2008
10. Centers for Disease Control and Prevention. CDC Interim Guidance for Infection Control for Care
of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare
Setting. Available at: http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
11. Centers for Disease Control and Prevention. CDC Interim Public Health Guidance for the Use of
Facemasks and Respirators in Non-Occupational Community Settings during an Influenza
Pandemic. Available at: http://www.cdc.gov/h1n1flu/masks
12. Centers for Disease Control and Prevention. FluSurge2.0. Available at:
http://www.cdc.gov/flu/excel/FluSurge2.0.xls
13. Centers for Disease Control and Prevention. Pandemic Influenza Update. May, 2007. Available
through CDC’s Priority Communication system (http://www.pandemicflu.gov)
14. Cheng, M “WHO Handbook for Journalists: Influenza Pandemic” World Health Organization,
December, 2005 available at
http://www.who.int/csr/don/Handbook_influenza_pandemic_dec05.pdf
Caring for the Community | preparing for an influenza pandemic
60
15. Christian MD, et al “Critical Care During a Pandemic: Final report of the Ontario Health Plan for an
Influenza Pandemic (OHPIP) Working Group on Adult Critical Care Admission, Discharge and
Triage Criteria. April, 2006
16. CIDRAP News. Hospital pandemic drill reveals major supply challenges. Nov 25, 2008. Available
at: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov_2508ppe-jw.html/,
accessed January 19, 2009
17. County of Santa Clara Public Health Department, National Association of City and County Health
Officials, Advanced Practice Center. Mass Medical Care During an Influenza Pandemic/ Guide and
Tool Kit for Establishing Influenza Care Centers. May 31, 2007.
(http://www.sccphd.org/SCC/docs/Public%20Health%20Department%20(DEP)/attachments/APC_I
CC_FINAL.pdf/ accessed June 12, 2009)
18. Cushman JG, Patcher HL, Beaton HL. Two New York City Hospitals’ surgical response to the
September 11, 2001, terrorist attack in New York City. J Trauma 2003; 54(1):147-154
19. HCPro. Plan Ahead for Pandemic Prevention. Briefings on Infection Control. HCPro. January,
2007
20. Health Systems Research, Inc. Altered Standards of Care in Mass Casualty Events. AHRQ
Publication no. 05-0043. April, 2005
21. Hick JL, Hanfling D, Burstein JL et al. Health care facility and community strategies for patient care
surge capacity. Ann Emerg Med 2004; 44(3):253-261
22. HICS National Workgroup. Pandemic Influenza Planning and Response Guide. HICS Center for
Education & Training. Available at: http://www.hicscenter.org
23. Ingham Regional Medical Center. Healthcare Mutual Aid MOU. May, 2007. Available at:
http://www.irmc.org/body.cfm?id=1551
24. Lessons Learned Information Sharing. Infection Control: Cohorting Ill Patients in a Single Hospital
Unit. Available at: http://www.llis.gov
25. Lessons Learned Information Sharing. Infectious Disease Outbreaks: Creating Hospital Staffing
Surge Plans. Available at: http://www.llis.gov
26. Michigan Department of Agriculture. Michigan Agriculture Products (Commodities).
(http://www.michigan.gov/mda/0,1607,7-125-1570_2468_2471-183622--,00.html, accessed April
21, 2009
27. Michigan Department of Community Health. Pandemic Influenza Plan. March, 2006. (2006 version
not available on-line due to 2008 update)
28. Michigan Department of Community Health, Office of Public Health Preparedness. Modular
Emergency Medical System (MEMS) Planning Tools. November, 2007
29. Michigan Emergency Management Act 390 of 1976, Sec. 5
Caring for the Community | preparing for an influenza pandemic
61
30. Michigan Legislature Service Bureau. A bill to amend 1978 PA 368, entitled “Public health code,”
by amending sections 16184 and 16185 (MCL 333.16184 and 333.16185), section 16184 as
amended by 2006 PA 591 and section 16185 as added by 2006 PA 25.
31. Michigan Region 6 Biodefense Council. Region 6 Hospitals Mutual Aid Memorandum of
Understanding.V4; Private correspondence. 2009
32. Michigan State Pandemic Influenza Operational Response Plan, Appendix __: Legal Authorities
33. Nap RE., Andriessen MPHM, Meessen NEL, Miranda DdR, van der Werf TS. Pandemic Influenza
and Excess Intensive Care Workload. Emerging Infectious Diseases, Vol. 14, No. 10. October,
2008. Available at: http://www.cdc.gov/eid
34. National Voluntary Organizations Active in Disaster. Members Resource Directory 2009. Available
at http://www.nvoad.org/Portals/0/Resource%20Directory%202009.doc
35. Private communication. “Hall Triage Matrix” Spectrum Health CDC Grant Project. February, 2009
36. Private correspondence 1.22.09 “FY07-08 Region 6 PM Response Sheet-total.qpw” Region 6
Biodefense Council
37. Reuters. Some Health Staff Wouldn’t Work During a Pandemic. May 22, 2007
38. Rocky Mountain Regional Care Model for Bioterrorist Events. October 2003 Available at:
http://www.ahrq.gov/research/altsites/
39. Rocky Mountain Regional Center of Excellence for Biodefense and Emerging Infectious Diseases
Research (http://www.rmrce.colostate.edu/, accessed June 12, 2009)
40. Rubinson L, Hick JL, Hanfling DG, Devereau AV, Dichter JR, Christian MD, Talmor D, Medina J,
Curtis JR, Geiling JA. Definitive Care for the Critically Ill During a Disaster: A Framework for
Optimizing Critical Care Surge Capacity. Chest 2008; 133; 18S-31S
41. Skidmore S., Wall WT, Church JK Modular Emergency Medical System: Concept of Operations for
the Acute Care Center (ACC), Aberdeen Proving Ground, MD, May, 2003
42. State of Delaware Department of Health and Social Services, Division of Public Health.
Neighborhood Emergency Help Center Plan. Document Control # 35-05-20/-8-05-13B. July, 2008
(http://www.dhss.delaware.gov/dhss/dph/php/files/nehcplan.pdf, accessed April 21, 2009)
43. Stopford B., Jevitt L., Ledgerwood M., Singleton C., Stolmack M. Development of Models for
Emergency Preparedness – Personal protective equipment, decontamination, isolation/quarantine
and laboratory capacity. Agency for Healthcare Research and Quality. Publication No. 05-0099.
August, 2005
44. U.S. Army Soldier and Biological Chemical Command. A Mass Casualty Care Strategy for
Biological Terrorism – Acute Care Center. Available at:
http://www.disasterhelp.net/resources/acc_blue_book.pdf
Caring for the Community | preparing for an influenza pandemic
62
U.S. Army Soldier and Biological Chemical Command. A Mass Casualty Care Strategy for Biological
Terrorism Incidents – Neighborhood Emergency Help Center. Pg. 7. May, 2001. Available at:
http://bioterrorism.slu.edu/bt/key_ref/DOD/nehc_green_book.pdf
1.
U.S. Army Soldier and Biological Chemical Command. Expanding Local Healthcare Structure in A
Mass Casualty Terrorism Incident. Pg. 16. June, 2002. Available at:
http://www.co.sanmateo.ca.us/vgn/images/portal/cit_609/23/32/844934287ECBC_mems_copper_
book.pdf
2. U.S Department of Health and Human Services. Pandemic Influenza Plan Supplement 3
Healthcare Planning. Available at: http://www.hhs.gov/pandemicflu/plan/sup3.html
3. U.S Department of Homeland Security Federal Emergency Management Agency (FEMA). National
Emergency Responder Credentialing Job Titles. FEMA 509-3. July 2007
(http://www.fema.gov/pdf/emergency/nims/ems_jobtitle_112906.pdf, accessed June 12, 2009)
4. U.S. Department of Homeland Security Homeland Security Council. National Strategy for
Pandemic Influenza Implementation Plan. May 2006. Available at:
http://www.pandemicflu.gov/plan/federal/pandemic-influenza.pdf
5. U.S. Department of Homeland Security. Pandemic Influenza Preparedness, Response, and
Recovery Guide for Critical Infrastructure and Key Resources. September 2006. Available at:
http://www.pandemicflu.gov/plan/pdf/cikrpandemicinfluezaguide.pdf
6. U.S. Department of Labor Occupational Safety and Health Administration (OSHA). Best Practices
for Hospital-based First Receivers of Victims from Mass Casualty Incidents Involving the Release
of Hazardous Substances. January 2005. Available at:
http://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html
7. U.S. Department of Labor Occupational Safety and Health Administration (OSHA). Pandemic
Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare
Employers. OSHA publication 3328-05 2007. Available at: http://www.osha.gov/
8. Utah Hospitals and Health Systems Association. Utah Pandemic Influenza Hospital and ICU
Triage Guidelines. Draft 2007. http://www.pandemicflu.utah.gov/plan/med_triage120707.pdf,
accessed April 21, 2009
9. World Health Organization. Global Pandemic Phases.
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html, accessed prior to changes in
May 2009
Caring for the Community | preparing for an influenza pandemic
63