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 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 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 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) 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.