Primary Care Center Generic Question Database
Planning
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When should key administrative staff be notified of the current situation? What actions should administration take, if any? When would the current situation trigger your center’s Emergency Management Plan? When would the current situation trigger your center’s Incident Command/Management System? Who would activate the center’s Emergency Management plan and how would the plan’s activation address the current situation?
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• Who would activate the center’s Incident Command/Management System and how would this activation address the current situation?
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How would staff be notified that the center’s emergency management plan has been activated? What are the core levels (or components) of your center’s Incident Command/Management System? How is your center’s Incident Command/Management System integrated with that of the regional (city, state, municipality) response system? How would your center meet the current demand for adult and pediatric outpatient care: staffing, supplies, etc.? Are there any specific activities for pediatric patients that you would consider or undertake? Please describe. How would your center plan to augment critically needed supplies? Do you think suppliers will be willing to travel into your area? Are emergency procurement procedures in place? What methods do you have to anticipate or respond to any special resource needs that might arise (e.g., specific types of personnel or expertise, personal protective equipment)? How would your center handle the increased demand for radiology, pharmacy, and laboratory services? Are there plans in place to increase their capacity in a timely manner?
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Communication
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What internal and external communications needs are required to communicate with your center’s staff? How would you handle any rumors circulating among center staff about the patient who was transferred to [your primary/secondary referral hospital(s)] and died, as well as worries circulating about new patients arriving with similar complaints? How would you effectively communicate with the appropriate departments/services at your primary/secondary referral hospital(s)? Who or which staff positions have the primary responsibility to communicate with the primary/secondary referral hospital(s)? When requested, what information would you share with the media concerning the several cases of severe, acute respiratory illness? Who would be designated as your center’s media spokesperson? How would you coordinate your public messages with your public health department and other appropriate governmental agencies?
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Security and Patient Flow Issues
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How would you ease the patient backlog in the waiting area? What are the primary safety and security issues, and how should they be addressed both in the short term and over a longer period of time? How should the patients waiting to be seen in your center be managed (e.g., cohort with similar patients, place in isolation, move to other areas of the center, etc.)?
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Response
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How do you plan to maintain staff attendance in light of the spread of the disease? What steps can be taken to augment staffing (clinical, non-clinical, support staff)? How will you keep your center operational? What steps could be taken to enhance outpatient treatment capacity?
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Do you think the need will arise to:
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Stay open for longer hours? Keep patients and consequently staff overnight?
If you answered “yes” to any or both of the points listed in the question above, what measures would your center need to take to achieve this?
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Can the center remain open to new admissions if it is being overwhelmed? Is there concern about nosocomial transmission? If necessary, how would you let center staff that are scheduled for the afternoon or evening shifts know that the center will be shut down? Does your center have an emergency credentialing and privileging procedure? If yes, how does this work? Who is responsible for this procedure?
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Infectious Disease Management
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What measures need to be taken to ensure the safety of center and medical staff, patients and visitors? Will you need to restrict visitors from entering the center? If so, who will be responsible for this activity? Please briefly describe your center’s screening (and patient isolation) protocols. At what point in the scenario, do you think that your center is experiencing an “outbreak”? How do you decide? Where would you go for help in answering this question? Are there any precautions that you would take? At what point would infection control personnel get involved in your center’s decision-making process? Who would contact infection control staff? What recommendations would your center’s infection control personnel make to administration regarding patient management? How will appropriate personal protective equipment training be accomplished? How will staff compliance be monitored? What resources or parts of your Incident Command/Management System would be employed to accomplish this ongoing activity? Who performs contact tracing procedures? How is this process done? Who is monitoring the index patient(s) and their family members? What do you tell them?
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Is decontamination of patients needed? How would your center make this decision? Which agency or authority would be consulted? If your center sought to implement decontamination procedures, how would you accomplish this task?
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What vendor agreements exist between your center and your major suppliers or contractors (e.g., medical supplies, personal protective equipment, security personnel, laundry, other)? Does your center have existing agreements, Memoranda of Understanding, or other arrangements with other primary care centers and/or hospitals for additional supplies, equipment, and personnel? If so, do you have any backup agreements in place in these areas? What criteria will you use to decide which patients need to be transferred to hospitals? To which hospitals would your center transfer patients, and does your center have MOUs? How would you transfer them?
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Access to Care
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What are the major clinical or patient care issues your center has to deal with and how should they be addressed? What procedures should be in place to handle the large influx of patients? Can the center’s normal standards of care be maintained under the circumstances presented in this scenario? At what point (e.g., amount of time, number of patients, other appropriate measure) would the center’s standards of care be impacted to a significant degree? What ethical issues would need to be considered over the course of this scenario? How would you seek to resolve these issues? Which issues would likely be the most difficult to resolve and/or require the input of external agencies?
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Mental Health Issues
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How would your center deal with the likely influx of asymptomatic, potentially exposed individuals (“worried well”) from the community? What measures would your center take to contain the spread of disease?
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Are any adult/child care services available to staff dependents? If not, what would your center attempt to do to allay people’s fears about their loved ones? What is the role of mental health, social services, psychiatric services, clergy (if applicable) or other similar staff positions in dealing with issues that are likely to arise during this scenario? How would they reduce some of the anxiety? Does your center have external social work/psychiatric/clergy (if applicable)/other services from other sources from which it could draw upon in the event of an emergency?
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Building/Facility Issues
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What role does the center’s administration and biomedical engineering play in this scenario? Please describe their role(s) and how these two sections of your center’s Incident Command/Management System interact. (If applicable) Are there special precautions required for housekeeping and laundry services? If so, how would your center decide when or whether to implement these precautions? Where would you go for help in answering questions of this nature? Should screening activities be set up at the entrance(s) to your facility to identify ill or potentially ill staff and visitors? If these activities are required, how will this be achieved and which staff positions would be involved?
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External/Interagency Relations
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At what point in the scenario would you contact your public health department? What assistance or information do you need from the public health department? What other agencies or organizations would you contact? Please outline any relationships that your center has with Community-Based Organizations or other community partners that could be called upon during this scenario – and what services or assistance they could provide. Does your center have agreements, Memoranda of Understanding, or other arrangements in place with local police or fire precincts?
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Post-Disaster Recovery
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How would your center handle the increase in recordkeeping and billing that would be required to be tracked in an unusual situation or emergency?