The Role that Health Care Coalitions Play in Support of Mass Casualty Response

Abstract

We applaud the excellent depiction of hospital preparedness and response to a mass casualty event caused by terrorist bombing.1Gale S.C. Donovan C.M. Tinti M. et al.Organization and operations management at the health care facility.Ann Emerg Med. 2017; 69: S29-S35Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The authors do a fine job describing the response to a single mass casualty event affecting emergency medical services (EMS) and hospitals; however, the authors miss the context within which health care preparedness has evolved during the past decade, which we would like to briefly present here to add to the article’s important contributions. The US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response published the “2017-2022 Health Care Preparedness and Response Capabilities”2Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. 2017-2022 Health care preparedness and response capabilities. Available at: https://phe.gov/Preparedness/planning/hpp/reports/Documents/2017-2022-healthcare-pr-capablities.pdf. Accessed January 17, 2017.Google Scholar to portray the importance of both interdisciplinary and regional integration in disaster response. Large-scale emergencies, such as a terrorist bombing, would require a complex response across an entire region. Hospitals, in conjunction with EMS and public health and emergency management agencies, must work together under the rubric of a health care coalition to ensure collaboration, coordination, and consistency in a systems approach to disaster planning and response. The capabilities are defined around 4 broad themes: ensuring a strong foundation for health care and medical readiness (including strong administrative and financial backing for disaster planning efforts), ensuring health care and medical response coordination by understanding that each of the key participants in the health care coalition has a role to support one another in response, promoting continuity of health care service delivery (recognizing that disruptions in service delivery constitute failure), and planning for medical surge to ensure timely and efficient care to patients even when the demand for health care services exceeds available supply. Health care coalitions play a key role coordinating available resources across regions and are instrumental in leading the transition from conventional to contingency or crisis surge response, and return to conventional care, when ready.3Hick J.L. Hanfling D. Cantrill S.V. Allocating scarce resources in disasters: emergency department principles.Ann Emerg Med. 2012; 59: 177-187Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar, 4Hanfling D. Role of regional healthcare coalitions in managing and coordinating disaster response, invited white paper, National Academies of Science, Engineering and Medicine. Available at: http://www.nationalacademies.org/hmd/∼/media/Files/Activity%20Files/PublicHealth/MedPrep/2013-JAN-23/Role%20of%20Regional%20Healthcare%20Coalitions%20in%20Managing%20and%20Coordinating%20Disaster%20Response_FINAL_01_2013.pdf. Accessed January 17, 2017.Google Scholar The article makes recommendations in regard to mass casualty response that could be more easily brokered and supported by the health care coalition, rather than by any single health care organization alone. Sharing regional resources, distributing patients among hospitals, expediting hospital-to-hospital transfers, and procuring additional security elements to improve the security posture of the affected facilities are functions that lend themselves to health care coalition coordination, freeing hospital incident management leadership to focus on the clinical response required to support the victims. Patient tracking and the use of regional EMS disaster tags (which, as a best practice, could also be used to initiate patient charting in the emergency department, given the very real challenges of managing a mass casualty incident by using current electronic medical records systems) are also better suited to regional initiatives. Achieving these capabilities will take continued effort, given the many moving pieces that compose a medical response to a bombing event. Therefore, realistic disaster drills and exercises that test not only the “whole of hospital” but also the “whole of community” must be an integral part of all hazards planning lest they be forgotten during the stress and pressure of response to such events. Organization and Operations Management at the Health Care FacilityAnnals of Emergency MedicineVol. 69Issue 1PreviewHere we describe the organizational and operational considerations for pre-event planning and postevent implementation in a health care facility in regard to a mass casualty incident created by an explosion. Although a blast event is a specific subset of mass casualty incidents, from the hospital perspective, it is distinguished from other mass casualty events by the nature of the injuries and the uncertainty of secondary attacks, which have the potential to be perpetrated on the hospital itself. Full-Text PDF In reply:Annals of Emergency MedicineVol. 70Issue 1PreviewWe thank Ms. Harvey and Drs. Hunt, Hick, and Hanfling, who are all leaders in the field of national health care preparedness, for their valuable comments. We agree wholeheartedly. Full-Text PDF