King County Healthcare Coalition
IMPLEMENTATION FUNDAMENTALS


KEY FOCUS AREAS
The Coalition worked together to define key areas that would help the group focus and were defined by:

• Priorities raised by the broader membership and membership categories
• Priorities that would address regional surge capacity and capability
• Priorities that would address health sector surge capacity and capability
• Priorities that would address response gaps in the region
• Priorities that would address seamless communications and coordination

The following focus areas have been assigned an ongoing workgroup, special projects team or advising committee that oversees specific action items towards achieving specific objectives.

Alternate Care Facilities Project
Ambulatory Care Committee
Call Center Coordination Project
Critical Care Workgroup
Hospital Committee
Infectious Disease Workgroup
Legal Workgroup
Medical Director's Committee
Palliative Care and Hospice Workgroup
Pediatric Workgroup

Regular updates on focus areas and training and exercise opportunities are distributed to the Healthcare Coalition through a monthly Newsletter. Your health jurisdiction can review these Newsletter to see concrete examples of action items and focus area accomplishments.


ALTERNATE CARE FACILITIES PROJECT

The Alternate Care Facilities Project will work with experts and partners to establish emergency facilities that can provide triage, ambulatory care, observation, and palliative care. These facilities will be designed to supplement the regular health care system in the event of emergencies that generate demand that exceeds existing surge capacity, i.e. "super surge."

Definition:
An alternate care facility (ACF) is a non-medical building of convenience which is repurposed for delivery of healthcare services during a disaster.

Goals:

1. To provide non-complex, essential medical services which cannot be provided in a sufficient and timely manner by the usual healthcare system.
2. To provide non-complex medical care to patients with appropriate medical needs, so acute care facilities can concentrate on provision of medical care to more seriously ill patients.

Objectives:

1. Establish administrative structure for ACFs
2. Complete facilities plan (communications, layout, security, hygiene, etc.)
3. Establish policies and procedures regarding scope of care
4. Establish equipment lists appropriate for scope of care and procure essential equipment
5. Establish modular staffing model
6. Broaden coordination and communication with partnering agencies

Scope of Medical Care (dependent on situation):

1. Support for management of chronic medical conditions for medically high risk patients who require sheltering and are unable to be sheltered within traditional shelters due to medical needs
2. Non-life threatening urgent care
3. Provision of non-complex acute/chronic medical care needs for people transitioning from inpatient sector
4. End of life care
5. Post-event exposure screening
6. Countermeasure distribution
7. Prescription refill writing services

Events:

1. An acute surge in medical needs of community that places people with life-threatening conditions at risk of not receiving timely and sufficient medical care for an extended duration.
2. Reduction in healthcare infrastructure where essential medical services cannot be provided by the remaining functional healthcare entities and for which a medical collection point would be necessary prior to regional evacuation.
3. Reduction in healthcare infrastructure that places people with life-threatening conditions at risk of not receiving timely and sufficient medical care for an extended duration.

Capability:
Up to 3 ACFs will be established (one per fire zone) with a maximum capacity of 750 inpatients.

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AMBULATORY CARE COMMITTEE

The Ambulatory Care Committee approaches preparedness and response from four distinct perspectives: hospital-based clinics, safetynet providers, independent providers and procedure centers. The purpose of the committee is to develop coordinated operational strategies for each of these groups that will:

• Define essential services
• Define thresholds of continuity of business decisions
• Define procedures for the adaptation of service provision in support of the larger healthcare system
• Ensure adequate cross-institutional communications and support mechanisms

Objectives:

1. Develop strategies to increase ambulatory care surge capacity
2. Develop screening and triage strategies for the healthcare delivery system that will minimize inappropriate utilization of emergency rooms and other acute care facilities while preserving the safety net
3. Develop memoranda of understanding and mutual aid agreements to accomplish the above

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PUGET SOUND CALL CENTER COORDINATION PROJECT

The Puget Sounds Call Center Coordination Project will address call center capacity, medical phone advice and triage and will develop strategies to increase capacity.

Definition:
A consortium of call centers networked to provide medical phone triage as well as disseminate up-to-date public health information in King, Pierce, and Snohomish Counties.

Goals:

1. Accurately triage people with medical needs and direct them to the most appropriate venue.
   1. Reduce the number of outpatient visits so that services can be maintained for those who require face-to-face visits with clinicians.
   2. Reduce transmission of contagious diseases at outpatient healthcare sites by redirecting people away from those settings unless the benefit of the visit outweighs the potential risks to them and others.
2. Provide up-to-date information for the public regarding pertinent health issues and interventions during emergencies.

Objectives:

1. Engage potential call center partners from the business community
2. Establish MOUs/agreements
3. Commence cross-county collaboration regarding phone triage guidelines and scripting
4. Convene workgroup for review of software and technology
5. Develop activation/deactivation plan

Events:

1. An acute surge in medical needs of the community that places people with life-threatening conditions at risk of not receiving timely and sufficient medical care.
2. Reduction in healthcare infrastructure such that essential medical services may no longer be widely available within the region, and for which a medical collection point would be necessary prior to regional evacuation.

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CRITICAL CARE WORKGROUP

The Critical Care Workgroup will work with healthcare facility critical care unit directors and critical care specialists to accomplish the following objectives:

Objectives:

• Develop a set of hospital emergency mass critical care guidelines that could be implemented in the event that hospital critical care capacity is exceeded.
• Make recommendations to the Coalition related to critical care issues as needed during a health emergency and related to prioritization of critical care preparedness planning and capacity building.

HOSPITAL COMMITTEE

The Hospital Committee meets monthly to discuss a variety of hospital and healthcare emergency preparedness issues which includes surge capacity, evacuation planning, resource management, and training & exercises. Members include emergency management representation from all hospitals in King County as well as other health system partners. The hospital committee addresses the following objectives:

• Develop regional standards for emergency preparedness and response for hospitals and health system partners, which may include evacuation planning, cache development and management, communications, critical infrastructure, security and facilities, staffing, pharmaceuticals, training, and exercises
• Develop strategies to address identified gaps in emergency preparedness and response related to hospitals and health system partners
• Recommend regional funding priorities for hospitals and health system partners based on risk vulnerabilities
• Update King County ESF-8 and the regional hospital plan annex and associated appendices

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INFECTIOUS DISEASE WORKGROUP

The Infectious Disease Workgroup includes infectious disease specialists and representatives from the local Association of Professionals in Infection Control and Epidemiology (APIC), The Workgroup will address the following objectives:

• Provide consultation to Coalition Medical Directors to inform policy and guideline development.
• Develop guidance on clinical and infection control issues when needed and in the absence of other federal or authoritative guidance (i.e., triage and clinical management, hospital stockpiling and use of antiviral drugs, antimicrobial drugs and vaccine.)
• Provide guidance on infection control and personal protective measures for communicable diseases.
• Deliver training and education for clinicians and disseminate guidelines and recommendations within their healthcare systems and practice settings.
• Participate in facility-specific pandemic planning efforts.
• Serve as spokespersons to the public and leaders in their facilities during communicable disease emergencies.

LEGAL WORKGROUP

The Legal Workgroup includes attorneys representing hospitals and government entities in King County. The group will coordinate with state and federal attorneys as well. The workgroup will address the following objectives:

• Guide other Workgroups, Executive Council, and Steering Committee about current state and federal laws/rules that relate to public health emergencies.
• Clarify and/or enhance legal readiness for a public health emergency.
• Develop products and strategies for education of the legal community, including attorneys who advise Coalition members and members of the judiciary.

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MEDICAL DIRECTORS COMMITTEE

The Medical Directors Committee provides expertise and leadership for issues related to clinical care during any health emergency where large-scale emergency response and/or changes in routine healthcare delivery are necessary. The Medical Directors will review and develop clinical policies, protocols, practice standards, and plans that are relevant to emergency response. Members include medical directors and chief medical officers from hospitals and outpatient medical groups. The committee addresses the following objectives:

• Develop and/or review clinical care guidance related to health emergencies as necessary.
• Assure multi-disciplinary review from appropriate stakeholders at healthcare facilities on Coalition issues, guidelines and policies related to clinical practices.

PALLIATIVE CARE AND HOSPICE

This Toolkit is evolutionary in nature. We look forward to adding content and tools as our local planning advances.


PEDIATRIC WORKGROUP

This Toolkit is evolutionary in nature. We look forward to adding content and tools as our local planning advances.


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