Backgrounder: Virginia’s Healthcare Emergency Management Program

by James C. Sherlock

State emergency operations are personally meaningful to me. Preparation is key. Decisions have consequences. I want this one to go as well as possible.

I spent about a year while under contract to the Defense Advanced Research Projects Agency (DARPA) as director of operations for a program that offered advanced Department of Defense capabilities to the state of Louisiana to improve its real-time emergency voice and data exchange and GPS-enabled visualization capabilities with response agencies across the state. We operated out to the state Emergency Operations Center and performed several successful statewide multi-participant live demonstrations. The people were great. The post-action reviews were very favorable. We finished the demonstration series about eleven months before Katrina. DoD’s offer was never accepted.

So, any words I offer are informed by that tragedy and are well meant.

Virginia Healthcare Emergency Management Program

In an earlier column, we reviewed Virginia’s training and exercise program funded by the Federal Emergency Management Agency. There is a second one. The Virginia Healthcare Emergency Management Program is funded through an annual Hospital Preparedness Program (HPP) grant from the U.S. Department of Health & Human Services (HHS).

Since 2002 that grant has been awarded to the Virginia Department of Health (VDH). The program was created in Virginia through a partnership between VDH and the Virginia Hospital & Healthcare Association (VHHA). It was designed for Virginia hospitals and healthcare systems to enhance their capabilities to respond and recover from a wide range of public health and healthcare emergencies, including pandemic virus.

The regional structure consists of six healthcare coalitions (HCCs) – Northern, Eastern, Northwest, Central, Near Southwest and Far Southwest. HCC members are supposed to actively participate in HCC strategic planning, operational planning, information sharing, and resource coordination and management. Virginia’s HCCs coordinate regional training and exercise opportunities and support the ESF-8 during a response. (There is a free Health Care Coalitions Surge Test Tool[1] available).

Each HCC has a Regional Healthcare Coordinating Center (RHCC) designed to act as a hub in the event of a public health or healthcare emergency. RHCCs serve as the liaison between regions and the VDH Emergency Coordination Center. Each coalition defines the level of information exchange and scope of medical coordination authority granted to the RHCC. Some functions and responsibilities of the RHCC are:

  • Facilitate uniform situational awareness during response.
  • Provide central coordination of regional response activities and sharing of healthcare resources.
  • Disseminate information within the region at the request of VDH and VHHA.
  • Coordinate diversion status/patient distribution within the region.
  • Request needed assets from other regions, the state and federal governments.

One assumes they are carrying out those functions and responsibilities as I write this. An update on the current functioning of each of the six HCCs would be a worthwhile topic for the Governor’s daily briefing.

The Four Capabilities[2] of HCCs

The four health care preparedness and response capabilities and the goals defined under the HHS grant program are:

Capability 1: Foundation for Health Care and Medical Readiness

The community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.

Capability 2: Health Care and Medical Response Coordination

Health care organizations, the HCC, their jurisdiction(s), and VDH plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.

Capability 3: Continuity of Health Care Service Delivery

Health care organizations, with support from the HCC and VDH provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.

Capability 4: Medical Surge

Health care organizations—including hospitals, EMS, and out-of-hospital providers—deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with VDH, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

Those four capabilities were defined based on guidance provided in the 2012 Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness[3] document of January 2012. That document was part of a surge in federally directed and funded planning that was the impetus for the updates to the Virginia Emergency Operations Plan Hazard-Specific Annex #4 Pandemic Influenza Response (Non-Clinical)[4] and associated documents discussed in the previous column.

COVID-19 After Action Assessment

We all wish the HCCs and VDH the utmost success.  As discussed before, the success of all operations plans are dependent upon rigorous training and exercises. As with the FEMA-sponsored program, an after-action assessment of Virginia COVID-19 response must include a review of Virginia’s participation in the HHS-funded Hospital Preparedness Program (HPP) and the performance of the HCCs and VDH in COVID-19 operations.





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10 responses to “Backgrounder: Virginia’s Healthcare Emergency Management Program

  1. Did not know you were a DARPA guy. Very cool!

    I do not know if you saw Cuomo today but he spent some time discussing
    the current way that hospitals are organized … and used the word “fiefdoms” to describe efforts to coordinate.

  2. It is well and good to have this structure in place. There are two other major components that are necessary for its success –acceptance and implementation.

    Individuals participating in the preparedness plans have to take it seriously and understand their roles. I could give several personal examples of how this was not done, but I will limit myself to one. State agencies have “continuing operations plans” (COOPs) that spell out how the agency is supposed to operate if it has to quickly vacate its normal premises. At DPB, each section had a COOP coordinator who was supposed to take her copy of the COOP plan home and be responsible for using it to coordinate the section’s activities if the agency had to re-locate. I was my section’s COOP coordinator. I, like most of my colleagues, did not take the plan seriously. My copy of the plan was at home, but I would have had to search for it if it were needed. Furthermore, I never read the thing.

    Implementation–the organization (agency, state, etc) must implement the plan when needed. Do we know if Virginia has implemented the healthcare emergency management plan?

    • I have been passing my columns to the news departments of the RTD, Washington Post and Virginian-Pilot, the home papers of our three largest metro areas. In doing so I have pointed out the opportunities to do reporting to clarify for the public whether the Virginia’s excellent plans as a state component of the National Response Plan (NRP) have been executed. I have given them much the same background papers that I have given readers with the addition for the reporters of the names and contact information for those charged with executing each plan. I have thus far seen no reporting that I can trace directly to my news tips, but I may have missed one or two and others may be in preparation. The information I have provided is an investigative reporter’s dream background source.
      As example, Virginia’s six healthcare coalitions (HCCs) are under the Virginia plans should be in full operation and executing all four of the capabilities described in the plans. It is easy enough for a reporter to check as I gave each news organization the contact information for each HCC. If they are functioning, report it. If not, report it. Contact the member hospitals of each HCC and get their take on how the HCCs are doing. Contact the state EOC for their take. The story will draw much interest.

      • “As example, Virginia’s six healthcare coalitions (HCCs) are under the Virginia plans should be in full operation and executing all four of the capabilities described in the plans.”

        This is a primary reason why I have such skepticism for the overall plan. It key elements fail, the whole plan fails in significant part.

        So for example, if monopolistic organizations that for years have been paying off politicians to work against the public interest by limiting the public’s healthcare, and thus enrich themselves at public expense, do not change their corrupt ways overnight. Those corrupt ways and those people who perpetuate those corrupt practices that now have blood on their hands have to be rooted out root and branch. Whole rotten cultures have to be changed.

  3. Institutional change is very, very hard evidenced even in the private sector with companies like Kodak, even entire industries even when their very existence is threatened. In govt, “reorganization” is a typical way of attempts to change.

    Most of it is motivated by things like trying to be more efficient or accomplish a mission more effectively – but seldom is much of it premised on what has been called Disaster Planning and that gravitated to COOP.

    Almost always, it happens as the result of “lessons learned” AFTER some event and the folks in charge to a top-down process to re-examine and re-write a “plan”.

    Cuomo, in his long-winded, pontificate-about-much, press conferences has alluded to the problem of institutional reluctance to change, hospital systems operated like fiefdoms and how to accomplish critical things like sharing limited supplies of equipment, supplies, manpower, and hospital capacity when many of the hospitals do not operate according to a top level standard operating procedures – and as a result no real way to accomplish a coordinated function.

    It’s not just government, the private sector has similar issues – it’s human nature. People work to achieve success in an organization and once they achieve some level of success they fend off those who would change things or them. They build obstacles to change that protect their roles because no one likes to be demoted to a lesser role much less take part is that process for themselves.

    The military have an institutional way of dealing with this and I’d be curious to hear Mr. Sherlocks view of it. That process is that many in the military must change duty stations and sometimes roles – as a matter of the way the military fundamentally operated. Being a military brat, I lived through a bunch of moves and as an adult working at a military lab – saw leadership changes done on a regular basis as the base commander role and his subordinates changed on a regular basis.

    It’s a disruptive thing because each new guy had different ideas of how things should operate and everyone had to learn to dance to that new tune and Disaster Planning was one of those things that got new interest sometimes but have to say, I do not remember that we ever dealt with how a pandemic would work.

  4. “Tell me what to do, or tell me how to do it, but not both.” The phrase that made The Greatest Generation the greatest generation. It was unique in the fighting forces of WWII. Command really was diversified downward.

    • To a certain extent. “Do this” where you figure out how to do it but the “do it” itself is your orders.

      Field commanders typically don’t decide what the mission itself is – the goal – the objective, but they have they have great latitude in achieving it – with the proviso that the resources to do it – are allocated from the commands above.

      There is LOTS of opportunity for leadership – down the ranks – and that’s actually how leaders are identified and promoted – up the ranks.

      it’s the oppposite of de-centralized. It’s a top-down centralized hierarchy.

      Virtually every successful institution operates that way because if you’re part of an organization that is not coordinated – it’s often chaos. There has to be a Master Plan and there has to be a way to move resources around and elevate leaders to more responsibilities.

      Might be saying the same thing in different ways…

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