SURGE CAPACITY HOSPITAL BED CAPACITY by xiuliliaofz

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									                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                           SURGE CAPACITY: HOSPITAL BED CAPACITY
    STANDARD                              ANALYSIS OF FINDINGS                                      ACTIONS                             TIMETABLE
 Critical Benchmark           The population of the Northeastern Region (NE            1. Develop work plan to further address          Xx Quarter 200x
        #2 - 1                Region) is approximately 438,000 (Census 2000).             benchmark for more accurate estimate
                              In order to support the surge described in CB 2-1,
Establish a system that       220 additional beds (i.e., beyond daily capacity) are    2. Considerations for analysis                   Xx Quarter 200x
allows the triage,            required. Due to limitations in the available data,        a. Collect additional data from hospitals
treatment and initial         the number of beds per facility beyond the staffed            on number of licensed beds available
stabilization of 500          bed capacity is not available; “licensed beds” are not        for use during surge
adult and pediatric           an accurate reflection of the number of beds               b. Further breakdown benchmark to
patients per 1,000,000        available beyond staffed beds.                                include separate levels for adult and
awardee jurisdictions                                                                       pediatric patients, based on sub-
(1:2000), above the           An estimate of the number of actual beds available            region populations of both age
current daily staffed         beyond the average daily census (i.e., average                groups
bed capacity                  number of populated beds) may be a more                    c. Take into account seasonal
                              reasonable approach to determining a facility’s               population variation (e.g., college
                              surge capacity. The number of staffed beds is a               campuses, tourists)
                              reasonable estimate of the maximum capacity at a           d. Provide training standards/guidance
                              given facility. Therefore, the region’s hospital bed          for facilities to follow for rapid triage
                              surge capacity has been defined as the combined               during an emergency
                              difference between the average daily census and
                              the number of staffed beds at each hospital (i.e.,
                              not including facilities other than hospitals).
                              The Maine Bureau of Health Assessment of
                              Regional Health System Capacity for Public Health
                              Emergency Response: Eastern Region survey (BOH
                              Survey) indicated that the NE Region had 1114
                              staffed beds and an average daily census of 787.
                              Therefore, the Hospital Bed Surge Capacity is 327
                              and the NE Region currently exceeds the benchmark
                              requirement of 220.




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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT




                                       SURGE CAPACITY: HOSPITAL BED CAPACITY cont.
             STANDARD                           ANALYSIS OF FINDINGS                              ACTIONS                       TIMETABLE

Minimum Level of Readiness

Number of beds which awardee is            NE Region Hospital Bed Surge Capacity:   1. Develop and implement sub-regional       Xx Quarter 200x
capable of surging beyond the              327                                         work plans to maximize economies
current staffed bed capacity in a                                                      of scale in planning for a public
24-hour period                                                                         health emergency event (e.g.
                                                                                       establishing mutual aid agreements or
                                                                                       MOUs).

                                                                                    2. Develop and implement a work plan        Xx Quarter 200x
                                                                                       to account for the operational and
                                                                                       physical needs of special populations;
                                                                                       notably people with physical
                                                                                       disabilities, geriatrics, and the
                                                                                       mentally ill to the extent possible.

                                                                                    3. Develop a plan to identify any           Xx Quarter 200x
                                                                                       unusual circumstance that will
                                                                                       require special procedures (such as
                                                                                       evacuation or equipment availability)
                                                                                       for specific remote geographic areas.

Additional priority concerns or
issues not captured in surveys




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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                               SURGE CAPACITY: ISOLATION CAPACITY
         STANDARD                                   ANALYSIS OF FINDINGS                                  ACTIONS                     TIMETABLE
  Critical Benchmark #2 - 2

1. Ensure that all                         1. For the purposes of this report, “the capacity 1. Continue development of NE            Xx Quarter 200x
   participating hospitals                    to maintain, in negative pressure, at least       Region and sub-region capacities to
   have the capacity to                       one suspected case…” has been defined as a        meet critical benchmark through
   maintain, in negative                      hospital having one fixed negative pressure       purchase and distribution of
   pressure isolation, at least               room OR a portable negative pressure setup        negative pressure isolation
   one suspected case of a                    (i.e., for converting a standard room/bed to      equipment
   highly infectious disease.                 negative pressure). According to the BOH
                                              Survey and the 2002 Maine Hospital
                                              Association Survey for Emergency
                                              Preparedness (MHA Survey), all hospitals
                                              within the region do not have this capacity.
                                              Fifteen of the 20 responding hospitals have
                                              negative pressure isolation capacity, while 5
                                              do not.




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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                            SURGE CAPACITY: ISOLATION CAPACITY cont.
        STANDARD                                    ANALYSIS OF FINDINGS                                     ACTIONS                     TIMETABLE
2. Awardee must identify at                2. For the purposes of this report, the capacity    2. Continue refinement of benchmark;      Xx Quarter 200x
   least one regional                         to “support initial evaluation and treatment        Collect additional data on isolation
   healthcare facility in each                of at least 10 adult and pediatric patients at      capacity needed to support analysis
   awardee hospital                           a time in negative pressure isolation” has          of refined benchmark; Develop
   preparedness region that is                been defined as a hospital having at least          purchase and distribution plan for
   able to support the initial                one fixed negative pressure isolation room          additional equipment where needed,
   evaluation and treatment                   or portable setup located in or adjacent to         at the sub-region level
   of a least 10 adult and                    the Emergency Department, in addition to a
   pediatric patients at a time               combination of 9 other fixed rooms and/or
   in negative pressure                       portable setups located in other areas of the
   isolation                                  hospital.

                                             Data from the BOH Survey indicate that The
                                             Aroostook Medical Center has a total of 10
                                             negative pressure rooms located throughout
                                             the hospital, and at least one portable setup.
                                             Data from the MHA Survey indicate that The
                                             Aroostook Medical Center has one negative
                                             pressure room in the Emergency Department.

                                             Data from the MHA Survey indicate that
                                             Eastern Maine Medical Center has a total of
                                             21 negative pressure rooms throughout the
                                             hospital, with one located in the Emergency
                                             Department.

                                             The NE Region currently meets this aspect of
                                             the benchmark for Isolation Capacity, since
                                             both the Aroostook Medical Center and
                                             Eastern Maine Medical Center meet the
                                             criteria as defined above.
Additional priority concerns or
issues not captured in surveys


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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                           SURGE CAPACITY: ISOLATION CAPACITY cont.
        STANDARD                                      ANALYSIS OF FINDINGS                               ACTIONS      TIMETABLE
  Minimum Level of Readiness                Fifteen of the 20 hospitals (75%) have the       No actions necessary     Xx Quarter 200x
                                            capacity to isolate one suspect case of highly
Seventy-five percent of                     infectious disease in negative pressure.
participating hospitals have the            Therefore, the NE Region meets the Minimum
capacity to maintain at least one           Level of Readiness.
suspect highly infectious disease
case in negative pressure isolation.
Additional priority concerns or
issues not captured in surveys
   Minimum Level of Readiness               Described in second section of benchmark         No actions necessary    Xx Quarter 200x
                                            narrative above
Seventy-five percent of awardee
regions will have identified and
upgraded (if needed) regional
healthcare facilities that can
support the initial evaluation and
treatment of at least 10 adult and
pediatric patients at a time in
negative pressure isolation
Additional priority concerns or
issues not captured in surveys




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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                           SURGE CAPACITY: HEALTH CARE PERSONNEL
           STANDARD                                   ANALYSIS OF FINDINGS                                  ACTIONS                     TIMETABLE
    Critical Benchmark # 2 - 3              The number of healthcare personnel needed to
                                            support the Benchmark Requirement for              1. Develop patient care ratios to       Xx Quarter 200x
Establish a response system that            additional beds for each sub-region are               allow for comprehensive
allows the immediate deployment             presented below. The calculations are based on        assessment
of additional health care personnel         HRSA guidance for acute care centers, which
in support of surge bed capacity            suggest 1 physician, 1 nurse                       2. Further refine benchmark to          Xx Quarter 200x
noted in CBM # 2-1                          practitioner/physician assistant, 6 registered        include required levels of
                                            nurses, 4 nursing support technicians, and one        respiratory therapists, patient
The number of health care                   social worker per 50-bed unit, on a rotating 12-      transporters, housekeepers, and
personnel must be linked to already         hour shift schedule.1 The guidance also               case managers
established patient care ratios noted       suggests staffing levels for respiratory
by the awardee’s Patient Care               therapists, patient transporters, housekeepers,
Practice Acts based on 24-hour              and case managers; these have not been             3. Collect additional data to support   Xx Quarter 200x
operations.                                 addressed in this analysis. Levels for                assessment that includes
                                            “physicians” and “nurse practitioner/physician        personnel categories defined in
                                            assistants” have been consolidated to a “medical      step 2
                                            staff” category, and “social worker” to a
                                            “behavioral health staff” category to allow for    4. Develop comprehensive sub-           Xx Quarter 200x
                                            comparison to data from the BOH Survey.               region analysis

                                            Number of additional staff persons needed to
                                            support the 220-bed surge for at least 24 hours:

                                            Registered Nurses: 57
                                            Nursing Support Technicians: 40
                                            Medical Staff: 16
                                            Behavioral Health Staff: 16



1
 US Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA). Bioterrorism Hospital Preparedness: Expanding
Local Healthcare Structure in a Mass Casualty Terrorism Incident. Prepared by the Department of Defense, January 1, 2002.
<http://www.hrsa.gov/bioterrorism/resources/MEMS_RedBook.htm>


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                                     SURGE CAPACITY: HEALTH CARE PERSONNEL cont.
        STANDARD                                    ANALYSIS OF FINDINGS                           ACTIONS           TIMETABLE
                                   The staffing levels that have been calculated represent the
                                   minimum number of staff persons needed to support daily
                                   emergency operations as recommended by HRSA guidance.
                                   They reflect a 12-hour rotating shift schedule (i.e., 2 FTEs
                                   per position category), which may be considered extreme.
                                   Additional staff would be required if reduction in hours per
                                   shift were to be considered, which almost certainly would be
                                   required if the surge continued over a long duration.

                                   An accurate method for estimating the region’s ability to
                                   meet these benchmark levels is to (1) assess staff levels
                                   needed to support standard (i.e., non-emergency) hospital
                                   daily operations and (2) assess actual staffing levels as
                                   reported by each hospital, which would lead to an estimate
                                   of excess staff which could be used to support the surge in
                                   an emergency. For example, if Hospital X has 100 nurses
                                   on staff, but only needs 90 to support daily operations, then
                                   10 could be used during an emergency to support the surge.
                                   The benchmark calls for “linking to already established
                                   patient care ratios” which essentially represent the staff
                                   needed to support daily operations. These ratios have not
                                   yet been established for the NE Region, therefore it is not
                                   possible to perform the analysis according to this method.
                                   Once ratios have been established, however, the assessment
                                   of this benchmark should be straightforward. The following
                                   staffing levels were reported by hospitals for the BOH
                                   Survey and may be used to complete the assessment of the
                                   benchmark once ratios are established:

                                   Registered Nurses: 2696
                                   Nursing Support Technicians: 1154
                                   Medical Staff: 962
                                   Behavioral Health Staff: 121



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                                    SURGE CAPACITY: HEALTH CARE PERSONNEL cont.
        STANDARD                                      ANALYSIS OF FINDINGS                                  ACTIONS                     TIMETABLE
  Minimum Level of Readiness               Available data suggest that the NE Region does     1    Develop a work plan that            Xx Quarter 200x
                                           not have an established system that allows the          incorporates availability of sub-
Awardees will have a response              immediate deployment of additional patient              regional health care personnel,
system that allows the immediate           care personnel. According to the BOH Survey,            supplies and other assets with
deployment of additional patient           a limited number of agencies in the region have         specific sub-region needs,
care personnel in support of surge         mutual aid agreements in place with other               geographies and populations.
bed capacity                               agencies for emergency situations, though these        a. Identify sub-regional
                                           agreements are not characterized (e.g.,                    healthcare worker skills and
                                           personnel, equipment, supplies). Mutual aid                assets
                                           agreements for personnel, as described in the          b. Develop work plan for
                                           analysis of Critical Benchmark 2-4, will be the            resource allocation intra and
                                           primary method by which the Minimum Level                  inter-sub-region
                                           of Readiness will be addressed. Mutual aid             c. Develop and implement sub-
                                           agreements among agencies/facilities can                   regional mutual aid
                                           facilitate getting additional support to a given           agreements
                                           facility during an emergency.                          d. Investigate a regional or state
                                                                                                      based resource management
                                           Data from the MHA Survey indicate that the                 system for use during an
                                           majority of hospitals in the region have                   emergency event
                                           emergency preparedness plans that “provide for
                                           the need for personnel augmentation during a
                                           large-scale emergency.” 90% of responding
                                           hospitals had plans that addressed physicians,
                                           86% of hospitals’ plans addressed nurses and
                                           pharmacists, and 55% addressed mental health
                                           professionals.

Additional priority concerns or
issues not captured in surveys




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                                    SURGE CAPACITY: HEALTH CARE PERSONNEL cont.
             STANDARD                                ANALYSIS OF FINDINGS                                    ACTIONS                     TIMETABLE
    Critical Benchmark # 2 - 4             The NE Region has not established an advance          1   Develop work plan that           Xx Quarter 200x
                                           registration and credentialing system. The NE             specifically addresses the
Develop a system that allows for           Region’s goal for addressing this benchmark               development of a computerized
the advance registration and               includes developing and maintaining a                     registration system, spearheaded
credentialing of clinicians needed         centralized practitioner registration system (i.e.,       by EMH, that works with the
to augment a hospital or other             computerized) whereby practitioners and their             state in order to maintain
medical facility to meet                   credentials may be registered to provide                  compatibility with any statewide
patient/victim care increased surge        agencies with real-time, convenient access to a           system being developed
capacity needs.                            comprehensive, secure, valid/current database              a. To include licensure status
                                           in the event of an emergency at a given facility.               of all licensed healthcare
                                                                                                           workers
                                           According to the MHA Survey, only 32% of the               b. To also include pre-
                                           responding NE Regional hospitals addressed                      registered volunteers
                                           “credentialing of clinicians not normally
                                           working at their facilities treating victims at
                                           their facilities” in their Emergency
                                           Preparedness plan.

                                                                                                 2   Develop and implement work         Xx Quarter 200x
                                                                                                     plan for establishing mutual aid
                                                                                                     agreements


Additional priority concerns or
issues not captured in surveys




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                                    SURGE CAPACITY: HEALTH CARE PERSONNEL cont.
             STANDARD                               ANALYSIS OF FINDINGS                                    ACTIONS                     TIMETABLE
                                           The NE Region has not developed a plan as             1. Develop and implement work         Xx Quarter 200x
Minimum Level of Readiness                 described in the Minimum Level of Readiness.             plan for establishing mutual aid
                                           As the Region works toward developing the                agreements
Awardees will have established a           centralized registration system, an interim plan
plan for their state-base systems          will be developed to allow for credentialing in
that allow qualified competent and         an emergency situation. This will primarily
licensed health care professional to       include (1) further developing the network of
work in an emergency situation             mutual aid agreements specific to personnel and
throughout the awardee jurisdiction        (2) developing a protocol for manually checking
                                           credentials of healthcare workers who volunteer
                                           or otherwise are involved in an emergency
                                           situation.

                                           Mutual aid agreements for personnel (i.e.,
                                           personnel registered and credentialed at a given
                                           facility) among facilities will help to address the
                                           issue of credentialing. For example, if Hospital
                                           X has a personnel mutual aid agreement with
                                           Hospital Y, and there is an emergency at
                                           Hospital X that creates a patient surge, workers
                                           from Hospital Y can be accepted at Hospital X
                                           in an expedited manner. The process of
                                           manually verifying the credentials of healthcare
                                           workers will likely be focused on physically
                                           checking workers’ licenses, etc.
                                                                                                 2. Develop plan for manually          Xx Quarter 200x
                                                                                                    checking credentials (e.g.,
                                                                                                    physical licenses) of volunteers
                                                                                                    and others who arrive on site
                                                                                                    during an emergency

Additional priority concerns or
issues not captured in surveys


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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT


                                       SURGE CAPACITY: PHARMACEUTICAL CACHES
           STANDARD                                  ANALYSIS OF FINDINGS                                  ACTIONS                     TIMETABLE
    Critical Benchmark # 2 - 5             As part of the statewide pharmaceutical cache    1      Assess feasibility of a            Xx Quarter 200x
                                           system, each hospital in the Region has received        computerized pharmaceutical
Establish regional plans that insure       a cache of pharmaceuticals that may be used to          cache registration/management
a sufficient supply of                     treat healthcare workers, their families, and           system
pharmaceuticals to provide                 others in the general community during a public
prophylaxis for 3 days to hospital         health event. Doses in the cache vary among      2      Identify adequate staffing and     Xx Quarter 200x
personnel (medical and ancillary           hospitals and although this information has been        flexible staffing patterns to
staff), emergency first responders         requested from the Maine Bureau of Health,              dispense antibiotic prophylaxis
and their families as well as for the      data are not available at this time.                    over 72 hours to cover region
general community—in the wake                                                                      and sub-regions and how it will
of a terrorist-induced outbreak of         The NE Region’s goal for this benchmark is to           integrate with operational plans
anthrax or other disease for which         (a) refine the benchmark to include specific
such countermeasures are                   agents (i.e., from specific terrorist/disaster      3   Develop comprehensive plan         Xx Quarter 200x
appropriate.                               scenarios), pharmaceuticals, assumptions for            that addresses other items
                                           number of family members per healthcare                 specific to refining and
                                           worker’s family, and determine/categorize the           reassessing the benchmark
                                           number of individuals in the general community          (described in last “analysis”
                                           that will receive treatment/prophylaxis, then (b)       paragraph)
                                           reassess the benchmark according to the refined          a. Plan to be organized into 3
                                           definition. The benchmark does address                       phases, as described below
                                           “anthrax,” however; it also calls for addressing             under “Minimum Level of
                                           “other diseases” as appropriate.                             Readiness”
                                           The NE Region will also explore creating a
                                           centralized, computer/web-based
                                           pharmaceutical cache reporting system whereby
                                           facilities could register and maintain details of
                                           their cache. This would allow facilities to
                                           manage their inventory conveniently, while
                                           officials at the regional level would have a
                                           collective inventory among all agencies in the
                                           region. This could provide an effective means
                                           of coordinating the pharmaceutical-related
                                           response in the event of an emergency.



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                                    SURGE CAPACITY: PHARMACEUTICAL CACHES cont.
             STANDARD                                 ANALYSIS OF FINDINGS                       ACTIONS             TIMETABLE
                                           Although a comprehensive assessment of
                                           pharmaceutical caches has not yet been
                                           completed for the entire NE Region, there is
                                           some information available on hospitals in
                                           Aroostook County. The Aroostook County
                                           Emergency Management Agency conducted the
                                           Aroostook County Hospital Emergency
                                           Preparedness Survey (Aroostook EMA Survey)
                                           in 2004, which addressed, among other issues,
                                           pharmaceuticals, in 4 hospitals (Cary Medical,
                                           TAMC, Houlton Regional, and Northern
                                           Regional). According to the survey, 2 of the 4
                                           facilities have identified emergency
                                           pharmaceutical supply systems (e.g., local
                                           pharmacy) and 1 has a protocol for distributing
                                           prophylaxis and treatment during a
                                           biological/chemical event. Levels of certain
                                           pharmaceuticals were reported, however,
                                           estimates are not reliable due to data quality
                                           issues.

                                           Data from the MHA Survey suggest that 18% of
                                           hospitals surveyed in the NE Region have a
                                           plan for protecting clinicians that “provides for
                                           coordinating receipt and distribution of
                                           materials from the state/federal pharmaceutical
                                           stockpiles.” Only 18% had “made preparations
                                           to provide prophylaxis or vaccination for
                                           clinicians in the event of a biological
                                           emergency” at the time of the survey.




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                                    SURGE CAPACITY: PHARMACEUTICAL CACHES cont.
               STANDARD                                 ANALYSIS OF FINDINGS                              ACTIONS                 TIMETABLE
                                             This benchmark may be re-assessed over time as
                                             follows: (1) determining the cache level at each
                                             hospital; (2) determining the pharmaceuticals and
                                             doses needed to support healthcare workers
                                             (regional estimate available from BOH Survey),
                                             their families, and the community as defined in
                                             the benchmark; (3) comparing cache levels at the
                                             hospitals with levels needed to support levels
                                             determined in step 2 in order to assess additional
                                             need; and (4) developing a regional prophylaxis /
                                             immunization plan that includes distribution
                                             methods, prioritization, etc.
Additional priority concerns or issues
not captured in surveys

Minimum Level of Readiness                   The Minimum Level of Readiness will be               1. Develop 3-phase             Xx Quarter 200x
1. Seventy-five percent of                   addressed by organizing the benchmark                   pharmaceutical cache plan
    participating hospitals will have        reassessment into three phases: (1) developing a        so as to address the
    pharmaceutical caches sufficient to      plan and pharmaceutical cache focused on the first      Minimum Level of
    cover hospital personnel (medical        groups indicated in the Minimum Level of                Readiness (Phase 1 and 2)
    and ancillary), emergency first          Readiness (i.e., hospital personnel, emergency          as a priority, with
    responders and family members            first responders, and family members); and (2)          development of the
    associated with their facilities for a   developing state-compatible community-wide              comprehensive third phase
    72 hour time period.                     prophylaxis guidance for the region that will be        as a secondary priority
2. Fifty percent of awardee                  adopted at the sub-region level, and (3)
    jurisdictions or regions as defined      developing a more comprehensive plan that takes      2. Develop work plan to
    in the FY 2003 application will          other issues (e.g., developing a computerized           address specific            Xx Quarter 200x
    have established community wide          system), into consideration. All planning will          components of the plan
    prophylaxis plans that are               take into consideration the 72-hour temporal
    compatible with other existing           component, distribution methods including
    state immunization or prophylaxis        personnel category prioritization, etc.
    plans.
Additional priority concerns or issues
not captured in surveys


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                 SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION
           STANDARD                                  ANALYSIS OF FINDINGS                                  ACTIONS              TIMETABLE
    Critical Benchmark #2 - 6              As in benchmark 2-5, the NE Region’s goal          Actions for addressing the PPE
                                           related to this benchmark is to further refine     benchmark are outlined under
Each awardee must ensure                   PPE-related issues that are addressed in the       “analysis of findings”
adequate personal protective               benchmark as it exists. The following describes
equipment (PPE) per awardee                components of the NE Region’s plan for fully
defined regions, to protect current        addressing this benchmark:
and additional health care                   Development of PPE standards, including                                          Xx Quarter 200x
personnel, during a chemical,                 o Strategy and protocol for its use and
biological, radiological or nuclear               distribution
incident. This benchmark is tied                 Fordecontamination/response
directly to the number of health                     personnel
care personnel the awardee must                  For healthcare staff with direct patient
provide (CBM # 2-3) to support                       contact
surge capacity for beds (CBM # 2-                For agency support staff with no direct
1).                                                  patient contact
                                              o Type of equipment and number needed
                                                  for each category of user
                                              o Methods for training and tracking
                                                  competency levels (i.e., completion of
                                                  training) among users
                                              o Methods for its management and
                                                  maintenance at each facility
                                             Developing methods for assessing the                                             Xx Quarter 200x
                                                region’s Level of Readiness and degree to
                                                which the region meets the Benchmark,
                                                including
                                              o Level needed to support Daily Capacity
                                                  personnel
                                              o Level needed to support Surge personnel
                                             Developing a plan for establishing the                                           Xx Quarter 200x
                                                required levels of PPE in an emergency if a
                                                given sub-region does not/will not have the
                                                required levels on-hand



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             SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION cont.
             STANDARD                                ANALYSIS OF FINDINGS                        ACTIONS             TIMETABLE
                                           Once a comprehensive PPE plan is developed
                                           and regional assessment completed, the region
                                           will be able to develop a plan for purchasing
                                           and distributing PPE in order to meet the
                                           refined standards. The plan will address the
                                           need to support the protection of the personnel
                                           surge levels as indicated in CB 2-3 (at least 129
                                           additional healthcare workers).
Additional priority concerns or
issues not captured in surveys




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             SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION cont.
           STANDARD                                  ANALYSIS OF FINDINGS                                 ACTIONS                   TIMETABLE
    Critical Benchmark #2 - 7              The NE Region plans to address this benchmark      1. Develop sub-regional              Xx Quarter 200x
                                           by (a) better addressing the capacity of fixed        procedures that address
Ensure that adequate portable or           decontamination facilities within hospitals; (b)      mobilization of decontamination
fixed decontamination systems              standardizing decontamination procedures              equipment within a specific
exist for managing adult and               across the Region; (c) providing guidance to          timeframe of event.
pediatric patients as well as health       help facilities coordinate training for use of     2. Investigate coordination and
care personnel who have been               equipment, etc.; then (d) assessing the need for      management of PPE and
exposed in a chemical, biological,         additional decontamination equipment by               decontamination resources
radiological, nuclear, or explosive        comparing current capacity (i.e., through more        within the region.
incident in accordance with the            comprehensive data) to the capacity needs as
numbers associated with CBM # 2-           indicated in the benchmark (i.e., maximum of 3
1 & # 2-3. All decontamination             hours to decontaminate the patient and
assets must be based on how many           healthcare worker surges as indicated in CB 2-1
patients/providers can be                  and CB 2-3 respectively).
decontaminated on an hourly basis.
The awardee should plan to be able         In terms of the Region’s current status
to decontaminate all patients and          regarding this benchmark, calculations based on
providers within 3 hours from the          equipment inventories and other factors are
onset of the event                         presented under Minimum Level of Readiness.
Additional priority concerns or
issues not captured in surveys




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             SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION cont.
             STANDARD                                ANALYSIS OF FINDINGS                                  ACTIONS                    TIMETABLE
                                           1. Possession of Actual PPE. In 2002, the
  Minimum Level of Readiness               Maine Emergency Management Agency                   1. Develop a work plan between        Xx Quarter 200x
                                           (MEMA) distributed Personal Protection Kits to         the 3 state regions to provide
1. Awardees will possess                   40 Maine hospitals to support their efforts to         sharing PPE as necessary (i.e.,
   sufficient numbers of PPE to            protect workers during a biological or chemical        contingency plans) to meet
   protect both the current and            event. Nineteen hospitals (i.e., all hospitals         additional short-term needs;
   additional healthcare personnel         other than the mental health hospitals) in the NE      Determine the number of PPE
   expected to be deployed in              Region each received six kits, each kit                kits still unused at hospitals,
   support of a bio-terrorism              containing a Tyvek suit, gloves, boots, Powered        and then expand cache of PPE
   event.                                  Air Purifying Respirator (PAPR) with                   kits in order to meet short-term
2. Awardees will possess                   rechargeable battery, and battery charger.             needs (i.e., at least enough for
   contingency plans to establish          These kits provide protection for a range of           the healthcare worker level
   sufficient numbers of PPE to            agents, though this range has not been clearly         indicated in CB 2-3).
   protect both the current and            characterized. Considering all kits distributed
   additional health care                  throughout the region for purposes of               2. Develop sub-regional             Xx Quarter 200x
   personnel expected to be                addressing the Minimum Level of Readiness,             procedures that address
   deployed in support of a                114 individuals can be protected, although it is       mobilization of
   chemical and radiological               assumed that some of these kits may have               decontamination equipment
   event.                                  already been used for training purposes.               within a specific timeframe of
3. Awardees will possess                   Regardless, the level falls short of the               event.
   sufficient numbers of fixed             conservative estimate of 129 additional                a. Investigate coordination
   and/or portable                         healthcare workers from CB 2-3.                            and management of PPE
   decontamination facilities for                                                                     and decontamination
   managing adult and pediatric            2. Possession of Contingency Plans. Overall,               resources within the region.
   victims as well as health care          available data do not address (a) whether the
   personnel, who have been                Region has specifically developed a standard        3. No actions necessary to address    Xx Quarter 200x
   exposed during a chemical,              contingency plan/guidance that facilities within       third Minimum Level of
   radiological, nuclear or                the region may be able to follow; or (b) whether       Readiness item
   biological incident                     facilities have developed their own contingency
                                           plans specific to PPE.




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             SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION cont.
             STANDARD                                ANALYSIS OF FINDINGS                         ACTIONS            TIMETABLE
                                           Data from the MHA Survey indicate that 55%
                                           of responding hospitals in the NE Region have
                                           “personal protective equipment such as N-95
                                           masks available for clinicians in an
                                           emergency.” Data from the Aroostook EMA
                                           survey indicate that 2 of 4 hospitals have
                                           “chemical cartridge air purifying respirators”
                                           and all hospitals have “HEPA masks” on hand.


                                           3. According to the BOH Survey, the NE
                                           Region is able to decontaminate 11 individuals
                                           per hour using fixed units/facilities. The
                                           capacity is specifically for fixed
                                           decontamination systems; portable
                                           decontamination systems were not included in
                                           the survey. Also, several hospitals did not
                                           respond to this question, which suggests that the
                                           decontamination rate is inaccurate.

                                           At the time MEMA distributed PPE kits as
                                           described in CB 2-6, portable decontamination
                                           equipment was also distributed to the same 19
                                           hospitals. Each portable decontamination setup
                                           consisted of a tent, heaters, water heaters, lights,
                                           decontamination spray hardware, and absorbent
                                           clean-up material; each hospital received one
                                           setup. Each portable unit is able to allow for
                                           the decontamination of approximately 8
                                           individuals per hour.




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             SURGE CAPACITY: PERSONAL PROTECTION AND DECONTAMINATION cont.
             STANDARD                                ANALYSIS OF FINDINGS                        ACTIONS             TIMETABLE
                                           Considering the 19 portable units across the
                                           Region, the NE Region is theoretically able to
                                           decontaminate 152 persons/hr. Considering the
                                           additional fixed capacity as indicated in the
                                           BOH Survey data as well as the portable
                                           equipment, the theoretical total is 163/hr. These
                                           calculations do not include time for equipment
                                           setup, recruitment of operators and time for
                                           operation crew changes, whether the crew has
                                           sufficient PPE, and other issues. Without
                                           strongly considering these issues, for the
                                           purposes of addressing the Minimum Level of
                                           Readiness, available data indicate that the NE
                                           Region currently has sufficient equipment to
                                           decontaminate the patient and healthcare
                                           worker surges of 329 persons (i.e., the total of
                                           the levels indicated in CB 2-1 and 2-3). Also,
                                           according to the MHA Survey, 82% of the
                                           responding hospitals indicated that they had
                                           fully or partially addressed “how
                                           decontamination activities will occur” during an
                                           emergency, which suggests that most hospitals
                                           have at least addressed the issue of
                                           decontamination procedures during emergency
                                           event planning.
Additional priority concerns or
issues not captured in surveys




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                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



                                              SURGE CAPACITY: MENTAL HEALTH
          STANDARD                                   ANALYSIS OF FINDINGS                                  ACTIONS          TIMETABLE
Critical Benchmark #2 - 8                  The region’s ability to manage care associated      See “actions” below under
                                           with behavioral health issues that arise during     Minimum Level of Readiness
Enhance the networking capacity            an emergency has not yet been fully assessed.
and training of health care                The benchmark is focused on developing the
professionals to be able to                (related) behavioral health skills of the general
recognize, treat and coordinate care       health care professional workforce for a given
related to the behavioral health           event. In order to fully address the benchmark,
consequences of bioterrorism or            standardized trainings and competency levels
other public health emergencies            need to be established for all health care
                                           professionals based on their roles in an
                                           emergency. The Region’s goal related to this
                                           benchmark includes (a) developing behavioral
                                           health training for healthcare workers that
                                           encompasses all aspects of the support needs
                                           associated with the different types of public
                                           health emergencies; (b) providing guidance for
                                           allowing facilities to track workers’ competency
                                           levels; (c) designating roles for behavioral
                                           health providers during an emergency (e.g., a
                                           certain level of social workers available for
                                           counseling); (d) developing a plan for setting up
                                           a hotline and/or web-based tool that specifically
                                           addresses behavioral health issues (e.g., where
                                           to go to receive services/medication) for the
                                           community during an emergency.
Additional priority concerns or
issues not captured in surveys




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                                             SURGE CAPACITY: MENTAL HEALTH cont.
            STANDARD                                   ANALYSIS OF FINDINGS                                     ACTIONS                    TIMETABLE
                                           Behavioral health training standards and                1   Develop a work plan that           Xx Quarter 200x
Minimum Level of Readiness                 competencies for healthcare workers practicing              addresses working with existing
                                           and/or responding to an emergency event have not            Behavioral Health partners, task
Awardees will identify the                 yet been established in the NE Region. Data from            forces and workgroups to
minimum behavioral health                  the BOH Survey indicate that 7 of the 21 hospitals          provide information that will
training competencies for health           (including psychiatric hospitals) have “trained staff       increase basic competence in
care professionals responding to           available to provide outreach crisis counseling for         responding to the behavioral
bioterrorism or other public health        emotional and mental health services” and a total of        health needs of adults,
emergencies                                27 agency staff and 23 licensed behavioral health           pediatrics and health care
                                           workers available to provide these services. A total        personnel.
                                           of 342 agency staff and 191 licensed behavioral              a. Develop training plan
                                           health workers were indicated as available across all
                                           responding facilities in the region to provide these    2   Develop work plan to address       Xx Quarter 200x
                                           services. 43% of hospitals indicated having a               behavioral health issues related
                                           “written plan for emotional and mental health               to quarantine, evacuation,
                                           needs” specifically for victims, while 57% reported         anxiety among patients and
                                           having plans to address hospital staff behavioral           families, family support in
                                           needs.                                                      hospital settings, risk
                                           Data from the MHA Survey indicate that 59% of               communication, etc.
                                           hospitals have full “plans in place to address
                                           emotional and mental health impacts of an
                                           emergency incident on staff, patients, and family
                                           members” while 14% of remaining hospitals have
                                           partial plans. None of the hospitals responding to
                                           the Aroostook EMA Survey indicated having
                                           “training programs that include preparation for the
                                           emotional and mental health impacts of a terrorist
                                           event for staff, patients, or family members;
                                           however, 3 of 4 hospitals have “Critical Incident
                                           Stress Debriefing Team (CISD) or CISD
                                           capability.”
Additional priority concerns or
issues not captured in surveys


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                                           SURGE CAPACITY: TRAUMA AND BURN CARE
           STANDARD                                    ANALYSIS OF FINDINGS                                 ACTIONS          TIMETABLE
    Critical Benchmark #2 - 9               The NE Region recognizes that the benchmark         See “actions” below under
                                            related to trauma and burn care needs to be         Minimum Level of Readiness
Enhance statewide trauma and burn           refined. A comprehensive assessment of the
care capacity to be able to respond         trauma and burn care capacity for the region
to a mass casualty incident due to          will be completed and include: (a) specific
terrorism. This plan should ensure          population levels for adult and pediatric
the capability of providing trauma          patients; (b) definition of “providing trauma and
care to at least 50 severely injured        burn care” and “severely injured” (e.g.,
adult and pediatric patients per            equipment and levels of equipment needed to
million of population                       support trauma/burn care); (c) an assessment of
                                            capacity according to the refined benchmark
                                            that will involve additional data collection via
                                            survey; and (d) an assessment of need (e.g.,
                                            equipment).
Additional priority concerns or
issues not captured in surveys




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                                     SURGE CAPACITY: TRAUMA AND BURN CARE cont.
             STANDARD                           ANALYSIS OF FINDINGS                                       ACTIONS                        TIMETABLE
                                      According to the BOH Survey, the Region has             1   Identify burn and trauma               Xx Quarter 200x
Minimum Level of Readiness            the capacity to care for 219 acutely injured adult          capacities within each sub-
                                      and pediatric patients at a time. Although this             region.
Awardees will have the capability     does not fully address the issues addressed in
of providing trauma and burn care     the benchmark (e.g., no clear definition of             2   Develop a work plan that               Xx Quarter 200x
to at least 50 severely injured adult “trauma and burn care” etc.), and the survey                addresses triage of less critically
and pediatric patients per million of question calls for rather arbitrary estimates, it is        ill patients and the diversion and
population due to a mass casualty     the best available measure at the time of this              transport to other facilities (intra
incident due to terrorism             report. According to the benchmark, using the               and extra regional).
                                      50 patients per million ratio, the Region must be
                                      able to provide trauma and burn care to
                                      approximately 22 people. According to the
                                      BOH Survey data as described above, the
                                      Region appears to meet the Minimum Level of
                                      Readiness.

                                           Data from the Aroostook EMA Survey suggests
                                           that 3 of the 4 hospitals have multiple trauma
                                           beds, while none of the hospitals indicated that
                                           they had “burn unit beds.” Also, Eastern Maine
                                           Medical Center is recognized by Maine
                                           Emergency Medical Services (EMS) as one of
                                           the three statewide regional trauma centers (the
                                           others, Central Maine Medical Center and
                                           Maine Medical Center, are outside of the NE
                                           Region) which also provides some insight into
                                           the region’s advanced trauma care capacity.
Additional priority concerns or
issues not captured in surveys




5ba2d826-ee88-49e7-adb9-96f43d53a695.doc                                  7/28/2011                                                               Page 23 of 24
                                   ASSESSMENT OF NORTHEASTERN REGIONAL HEALTH SYSTEM CAPACITY – PRELIMINARY REPORT



             SURGE CAPACITY: COMMUNICATIONS AND INFORMATION TECHNOLOGY
           STANDARD                                   ANALYSIS OF FINDINGS                                   ACTIONS                     TIMETABLE
    Critical Benchmark #2 - 10             The Critical Benchmark suggests that the region     1   Identify all current sub-region      Xx Quarter 200x
                                           should have a secure and redundant system               communications capabilities in
Establish a secure and redundant           encompassing all agencies that would be                 hospitals, clinics, EMS systems,
communications system that                 involved in an emergency event, including               etc. to address compatibility and
ensures connectivity during a              neighboring jurisdictions and federal officials.        capacity.
terrorist incident or other public         No criteria for security or redundancy have
health emergency between health            been suggested, however. The Maine BOH              2   Identify information technology      Xx Quarter 200x
care facilities and state and local        survey required responders to report attributes         back up (contingency) systems
health departments, emergency              of connectivity to the internet, as well as the         available for use in the event the
medical services, emergency                different types of communication devices                primary systems fail.
management agencies, public                agencies have available for use. All hospitals
safety agencies, neighboring               reported having continuous access to the
jurisdictions and federal public           internet, while some rural health centers and
health officials                           other facilities reported having either no access
                                           or only dial-up access. 18 of the 20 responding
                                           hospitals and psychiatric hospitals reported
                                           having access to a satellite telephone, and the
                                           same number reported having access to a
                                           cellular telephone. The MHA Survey data
                                           suggest that 64% of reporting hospitals have
                                           full plans for “emergency communication
                                           systems including appropriate backup systems,”
                                           while 18% reported partially addressing this
                                           issue.
Additional priority concerns or
issues not captured in surveys




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