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Area and Regional Medical Coordination -

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Area and Regional Medical Coordination
Developed by NCW HERCPresented by Robbie Deede
Thank you to the “Regional Medical Coordination Planning” Team for all their work and effort in cumulating member input and development of this document.
Outline Area & Regional Med Coord in concept and realityIdentify the"Purpose"of Area & Regional Med CoordHighlight"Triggers"in activating AMC & RMCWalkthroughInitiating FacilityAssumptions, Considerations and ChecksWalkthroughReceiving/Assisting FacilityAssumptions, Considerations and Checks
Plan intended to provide concepts for advisory purposesNot replace or contradict internal plansNo requirement to useMembers are ultimately responsible for their facilityThis is intended to be a living document, within the NCW HERC Response Plan, with continued revisions and updates as identified
These are concepts you and your colleagues have identified as best practice to NCW HERC over the past year.
Background & Intent of the System
Event happens ---> Incident Command is openedEvents happen that become larger than we can handle by ourselvesTiered Coordination Structure1. Local/Internal 2. Area (NCW HERC) 3. Regional 4. Intrastate 5. Interstate 6. FederalArea and Regional Medical Coordination"Centers"Designated site or entity, pre-determined coordinate movement and informationArea: a county or twoRegional: all twelve counties
Issues in Reality
Designed from a different modelReal-life events and exercises have never indicated passing of responsibilityPre-determination can be dangerousArea and Region lines blur very quickly. You must reach further to get needed resultAll facilities need to be ready to be coordinating entity
Aid overwhelmed facilitiesProvide a system to coordinate transportation and patientsProvide a single point of contact during the eventCentralize, enhance and expedite the flow of informationIdentify and prioritize the use of available resourcesSupport normal referral process overwhelmed in an event
Scope & Authority
Does not replace a county EOC, but ensure continuity until one can opened or in event EOC will not be openedBuilds upon concepts of Hospital Mutual AidNo rules, statutes or codes that require participation
Triggers to Activate
Resource needs will exceed the responding facility’s capacity (Facility Dependent)An event that overwhelms resourcesNumber of expected patients to exceed normal response or mutual aid resources (MCI incident)Healthcare facility’s ability to care for patients has been compromised (Hospital Evacuation or nursing home evacuation)Multi-jurisdictional infectious disease event (Epidemic/Pandemic Event)
Initiating Facility Considerations and Assumptions
STOP ALL CURRENT TRANSFERS!Bring in Finance immediatelyProvide additional staff to your “Call Centers”Engage EMS Medical Director (patient support)Pre-identify multiple staging points for evacuation based on patient acuityContact NCW HERC
Assumptions and Considerations Cont'd
A physician will be designated as the referring physicianEnsure patients being discharged or transferred with 24 hours of medicationsIncident command will remain at the facility where the incident is occurring until that facility requests another facility to assume incident command(Core ICS concept)An initiating facility can request another facility to assume incident command should the event no longer be manageable internally.Ensuring “closed-loop communication” is essential
Assumptions and Consideration Cont'd
Alternative standards of care considerationsOnly essential proceduresMaximize ability for transportSend medical staff with assigned patientsReport after safe transport, at receiving locationEnsure the ED is able to accept patients presenting“On Diversion” statusAlternate siteStabilize patients presenting to ED and add to overall count
Initiating Facility Checklist
Determine immediate need, activate internal incident command and notify essential internal partners.(CO-S-TR Guide for Initial Incident Actions) (see appendix A)Broadcast on WISCOM and WITRAC to alert of need: MCI capacity, bed availability, other intel PRN and establish common operational pictureNotify essential external partners: NCW HERC, Regulating Agency, County Dispatch to notify Emergency Management, Emergency Medical Services (EMS), Public HealthCancel elective and non-essential procedures
Initiating Facility Checklist
If transfer is needed:Contact "Call Center"Triage patients to:DischargeTransport to skilled nursing facilityLow Acuity HospitalHigh Acuity HospitalReceive initial response from Responding Facilities and identify resources to activateCommunicate resource needs and identified resource availability to "Call Centers" to coordinate approval for transfer/activationInform responding facilities where resources are planned to be engagedimmediately (closed-loop)
Receiving/Assisting Facility Considerations & Assumptions
Bring in Finance immediatelyAccept 75% of current availability to prevent being overwhelmedConsider discharging patientsCancel elective and non-required procedures
Receiving/Assisting Facility Considerations & Assumptions Cont'd
Designate a physician, likely Emergency Department physician, as accepting physician for all incoming transfersReady to provide all resources identified as available (WITRAC)Ready to assume incident command at the initiating facility’s requestReady internal medical staff to assist medical surge staff
Receiving/Assisting Facility Checklist
Receive WITRAC or WISCOM notification from Initiating HospitalConsider activating internal incident commandIdentify resource availability based on resource request and relay back to initiating facilityReceive verification of resource engagementBegin process of staging/fulfilling need or request
Questions?Input?Critical elements missing?How would you like this formatted?How can you plug this into your evac or surg plan?





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Area and Regional Medical Coordination -