Biosecurity Briefing Subscribe | About | Current Issue | RSS | Archive California Releases Healthcare Surge Guidelines By Eric Toner, March 7, 2008 On February 19, 2008, the California Department of Public Health released its Standards and Guidelines for Healthcare Surge during Emergencies. The guidelines, comprising four volumes along with training materials and a reference manual, cover a multitude of difficult issues related to emergencies that overwhelm the healthcare system and solutions and tools for a number of these issues. In addition, a thorough listing and interpretation of the relevant laws and regulations that affect surge planning is included.1 The guidelines cover the following core areas: - Foundational Knowledge: This section includes descriptions of healthcare surge, California’s existing emergency response system, and the role of healthcare providers in that system. Importantly, this section articulates the need to change from individually-focused patient care to population-based care in a catastrophic health emergency.
- Volume I—Hospitals: This volume addresses emergency preparedness for hospitals, and includes guidance on increasing capacity and augmenting staffing during a mass casualty event.
- Volume II—Government-Authorized Alternate Care Sites: This volume covers planning considerations and specific guidance for site locations, staffing models, standards of care, administrative protocols, and federal and state reimbursement for government-authorized alternate care sites.
- Volume III—Payers: In addition to recommending what health plans must consider in planning for patient surge, this volume outlines changes to contract provisions that will simplify administrative and reimbursement requirements.
- Reference Manual: This reference manual provides an overview of relevant federal and state laws, regulations, and standards along with legal interpretations and implications for use during an emergency. Information is also included about the Hospital Incident Command System and funding sources that may be available during a declared healthcare emergency.1
Accompanying each volume is a training guide and training materials. For Volumes I (Hospitals) and II (Alternate Care Sites), there are Operational Tools Manuals that include forms, checklists, and templates to be used to implement recommendations outlined in the Standards and Guidelines Manuals.1 While a thorough description of this 1,900-page document is beyond the scope of this brief report, there are several aspects of the guidelines that are worth highlighting: - Among the topics detailed in the Foundational Knowledge document is that of allocation of scarce medical resources during an emergency, which is referred to as “transitioning from individual care to population-based care.” This section considers the ethical principles involved and reviews several relevant publications. In the Hospital manual, standard of care is addressed as well and a population-based standard of care is proposed.
- Volume I: Hospitals describes a number of surge capacity augmentation strategies such as cancellation of surgeries, early discharge, and cohorting patients to streamline demands on the workforce. In addition, it discusses strategies to augment the hospital workforce during a crisis and includes several credentialing and skills tracking tools. Strategies and tools to deal with anticipated shortages of supplies and pharmaceuticals are included as well. This section details most of the surge capacity augmentation strategies that have been proposed.
- Volume II: Alternate Care Sites addresses sites established by governmental agencies for patient care during an emergency involving significant patient surge. It does not address sites established by hospitals to expand their facilities or tents used by emergency medical services for field triage. The document recognizes that because resources may be limited, the level and type of care provided at an ACS will differ from that typically provided in a hospital. The manual includes criteria and tools for selecting an ACS and discusses how the ACS would fit within the incident command structure. Staffing, equipment and supplies, and administrative issues are discussed, as is reimbursement.1
According to a March 2, 2008, article in the Sacramento Bee, this $5 million plan was developed as part of Governor Arnold Schwarzenegger's 2006 healthcare surge initiative, a $172 million effort that “included the stockpiling of millions of doses of antiviral medications, thousands of ventilators, mobile field hospitals and extra hospital beds.” The article notes that the plan is “striking in its specificity and its frank focus on the need to suspend or flex established laws and to ration health care” and may serve as “as a model for the rest of the nation.” Jeff Levi, executive director of Trust for America's Health, told the Sacramento Bee "I don't know of any state that has taken it to this level of detail in outlining a surge plan for everyone who needs to respond to an emergency of this magnitude. It's exactly the kind of dialogue that has to happen."2 References - California Department of Public Health. Surge Standards and Guidelines. February 19, 2008. http://bepreparedcalifornia.ca.gov/EPO/CDPHPrograms/PublicHealthPrograms/ EmergencyPreparednessOffice/EPOProgramsServices/ Surge/SurgeStandardsGuidelines/.
- Griffith D. In a massive disaster, care will be scarce. March 2, 2008. Sacramento Bee. http://www.sacbee.com/111/story/753359.html. Accessed March 6, 2008.
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