Step 1: Engage Local stakeholder planning workgroup

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The development of a community’s response to overwhelming medical surge begins by convening a local workgroup of key individuals*.

These key individuals are planners who have the responsibility for developing a community-based, collaborative and well-integrated response plan. This response plan, most appropriately, should be considered the health and medical annex or Emergency Support Function (ESF) 8 within the community’s or local jurisdiction’s emergency operations plan (EOP.) It is important to ensure that all health, medical and social service agencies and organizations responsible for assisting in an emergency are part of the plan development and are identified as key individuals.

• County Emergency Manager
• Health Emergency Response Coordinator-Hospital
• Planner or Response Coordinator-Primary Care Clinic or other medical facility
• Home Health Care Representative
• Nursing Home Representative
• Behavioral Health providers
• EMS Coordinator
• Non profit organizations that work with at-risk populations such as people with disabilities, the elderly
• Transportation providers
• Faith based organizations
• Other key stakeholders and response partners unique to an individual community
  
  

The awareness necessary for the planning workgroup include:

A community must develop a baseline understanding of what resources currently exist in order to plan for how to respond during a catastrophic event. By understanding what resources currently exist, what events existing resources and infrastructure can cover, a community can determine a threshold or trigger for activation of their Emergency Operations Plan including their Medical Surge Annex.

This baseline activity includes:
Complete a new or review any community hazard and vulnerability assessment including any organization assessments that have been completed (e.g. hospital, primary care.) The State of New Mexico All Hazard Plan also includes a hazard analysis by county which identifies the likelihood of specific hazards. Based on this information, counties may have conducted assessments. During the summer of 2008, each hospital in New Mexico may complete a vulnerability assessment with assistance from the New Mexico Department of Health.

Some communities and individual responding agencies and organizations may have already conducted planning for medical surge response. These existing local plans should be reviewed to gain knowledge about their response planning. For example, in April – August 2006, the NMDOH funded planning for counties to develop a Pandemic Influenza Response Plan. Planners should review the County’s Pandemic Influenza Response Plan developed during that project time so medical surge response plans build from existing decisions and planning that has already occurred. The development of a medical surge response plan should be a continuation of the decisions made during the development of the community’s Pandemic Influenza Plan. A Planning Guidebook was provided and included preliminary steps about utilizing NM MEMS. The planning guidebook is available at: http://www.health.state.nm.us/ohem/opibr/

Utilize the NM MEMS Planning Toolkit Questions for Consideration during Assessment and Planning located in the NM MEMS Planning Toolkit to prompt discussion about existing resources in the community.

Delivery of care during overwhelming patient or medical surge conditions (link here to section of Framework that describes Delivery of Care Under Overwhelming Patient Surge Conditions). is the language used to describe the provision of care during a catastrophic incident accompanied by a surge of patients that exceeds available resources and requires adjustments in normal resource management and triage. This surge of patients would overwhelm the health care system and will prompt the need to restructure existing resources or the places and way, possibly, health care is delivered to better accommodate the number of people seeking care. Key stakeholders will want to have discussions that further understanding of what it means legally and ethically to optimize the use of available resources and provide a reasonable level of care to those affected by the emergency. This could be called: “the greatest good for the greatest number.”

To further key stakeholder understanding of delivery of care during overwhelming medical surge conditions, communities are encouraged to participate in ethical decision making discussions before these critical decisions are required. Additional information about Ethics Guidance is available in the Pandemic Influenza Guidebook, May 2006 During a catastrophic incident, a public health emergency may be declared through the New Mexico Emergency Response Act (PHERA-link) that allows the Governor and state executive agencies to exercise “extraordinary powers” in response to an emergency, such as rationing health care supplies and how health care facilities are utilized. Decisions will need to be made locally related to limited and insufficient resources.

Planning for emergency preparedness at the local level is supported by planning that has been done at the State level. State agencies such as the New Mexico Department of Health (link) and Department of Homeland Security and Emergency Management (link) are key agencies addressing emergency preparedness on a daily basis.

The State of New Mexico All Hazard Plan is a core document to assist local governments in establishing priorities for action to reduce the risk from natural hazards. The NM DOH Emergency Operations Plan, Annex 5 Public Health, Medical, Mortuary recommends NM MEMS as the framework for medical surge response planning. The NM MEMS Manual (this website) provides guidance to local jurisdictions in New Mexico for local medical surge plan development.

Any NM MEMS-influenced plan or response annex would be managed according to the principles of the National Incident Management System (NIMS) and is operationalized locally through multi-agency coordination (MAC) of operations.

NM MEMS is also referenced and described in the NM Comprehensive Strategic Health Plan, 2008 in the Emergency Care Services Section.

d. Understand the NM MEMS functions or strategies that could be utilized or put into operation by communities in responding to medical surge;

The NM MEMS Framework is built around two core functions: Alternate Outpatient Care Areas (AOCA) and Alternate Inpatient Care Areas (AICA). Other key functions will be needed and to support the complex and connected activities necessary for an effective response to overwhelming patient surge.

e. Understand the effect that an overwhelming number of people seeking care would have on a community

“A catastrophic incident with public health ramifications, such as a pandemic, will occur. It is no longer if but rather a matter of when.” Alfredo Vigil, M.D., Secretary, NM Department of Health, October 2007.

Healthcare leaders and government officials believe communities must be prepared now for the catastrophic public health emergency in the future. Review of the figures provided by CDC through FluSurge software . Bring conservative projections of the numbers of people who could be sick or die in a community during a pandemic influenza. This is one example of an incident that would create a surge of people needing care. Check the CDC pandemic influenza figures estimated by hospital for New Mexico.

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