Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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Guidelines for Pediatric Hospital Responses to Increased Patient Volume
Activation of the surge
capacity plan should be performed either on hospital notification (from police,
emergency medical services control, public health officials, or another
established mechanism) that a mass casualty event has occurred, or once
clinicians in the emergency department (ED) have made the determination of need.
Activation of the Surge Capacity
Plan: The Hospital Incident Command System (HICS)—Hospital Command Group 6
The emergency physician who
activates the hospital surge capacity plan should contact hospital
telecommunications personnel ("operators") who must, in turn, notify essential
personnel. Hospital operators should also be responsible for notifying
personnel when the surge capacity plan is deactivated.
Once a surge capacity plan is
activated, a defined group of individuals known as the Hospital Command
Group (HCG) (Figure 1) should convene in a location identified as
the Hospital Command Center (HCC). The HCG typically receives valuable
input from the emergency department attending (serving as the Medical Technical
Specialist: Medical Staff Officer) and comprises the Administrator on Duty
(Incident Commander), Public Information Officer, Safety Officer, Liaison
Officer, as well as other members of hospital leadership. Although the exact
responsibilities of each member are unique to the specific disaster plans for
each health care facility, the HCG has responsibility to:
Activate the necessary HICS
Coordinate the institutional response
to the surge capacity plan.
Receive, interpret, and
communicate information from emergency medical services and public health
communication networks, including updates of the facility's bed capacity.
Coordinate hospital activities
during activation of the surge capacity plan.
Rapidly discharge inpatients
capable of outpatient or delayed management.
Monitor the flow of disaster
patients as they move through the hospital's systems.
Receive and communicate information
between hospital departments.
Ensure that elective admissions
are postponed, depending on the scope of the disaster.
Formulate plans for the next
Determine recovery strategies and
devolution of the surge capacity plan.
Each member should be clearly
identified by means such as a vest with the wearer's responsibility written on
it (e.g. Medical Technical Specialist: Medical Staff Officer). Each member
should also read his/her facility-specific HICS Job Action Sheets that
delineate individual responsibilities during the disaster. The ED Disaster Team
Leader (physician leadership based in the ED) should designate a predetermined
location in the ED as the ED Disaster Command Post. Here, the ED-based
strategies are formulated and management objectives are defined. These
strategies are shared with the HCC staff to better coordinate surge activities
outside of the ED. Once the surge capacity plan is activated, each member of
the HCG should immediately attend a status/action plan meeting in the HCC. Any
communication with patient families or the press must remain under the control
of the Public Information Officer who works with the Incident Commander and the
Medical Technical Specialist: Medical Staff Officer. Once convened, the HCG
priorities should include:
- Ensure that primary response
and support departments (nursing, critical care, radiology, respiratory
care, security, janitorial services, etc.) have received the alert and are
- Receive briefing from the
Situation Team Leader regarding patient census and bed status.
- Consider canceling elective
procedures and admissions.
- Ensure Logistics Section
Chief is able to deploy resources as needed.
- Ensure contact with senior
- Activate the Documentation
Team Leader individual to maintain the Incident Action Plan for
post-incident debrief notes.
The HCC should be stocked
with sufficient supplies to ensure operations of the HCG. Supplies should
include communication sets, clerical supplies, redundant communication systems,
mobile communication assets, HICS Incident Team Chart, hospital and city
emergency contact directories, WebEOC and State Bed Tracking site log-in
information, disaster related tracking forms, hospital charts, patient flow
board, and reference documents such as triage protocols, surge capacity plans,
patient reporting guidelines, HICS Job Action Sheets, area maps, copies of
vendor memoranda of understanding, and risk communication templates and
Communication sets should not
interfere with other networks used by the police, emergency medical services,
and fire departments. Tactical radio channels such as those used for local
communications have many different configurations. Some systems are dedicated emergency medical services (EMS) channels, some share channels with fire or police operations, and others have special
channels for on-scene operations. In a small event, such as a motor vehicle
crash, first response agencies may operate on a single channel. As operational
complexity increases, incident commanders should decide the point at which
communications transition from a single channel to a tactical (or "on-scene")
channel. The use of tactical channels prevents the overload of the primary EMS channel and prevents interference between agencies with different primary function. The
incident commander or Medical Technical Specialist: Medical Staff Officer from
the ED and other agencies should, however, communicate on a predesignated (mass
casualty incident) channel when needed.
communication nets should use multichannel portable radios that have talkaround
capacity, although these systems are susceptible to missed messages if a
dispatcher transmits over direct messages. Usually the portable radios used in
ED communications are relatively low power and therefore have a limited service
Several items can improve
communications efficiency. First, an adequate supply of batteries for portable
radios should be readily available to keep communications open as long as
necessary. Second, it is important to use plain English and avoid coded language.
This decreases the amount of radio traffic by eliminating phrases such as "at
this time" or "be advised" and greatly decreases the potential for
miscommunication. Third, radio users should remember to key the radio for a
full second before speaking to ensure the beginning of the message is not
Not all mass casualty
incidents demand a hospital-wide response. For example, incidents that involve
one or two clinical areas that can be handled with normal hospital staffing and
are resolved in less than 8 hours can be often be handled with improved
coordination between clinical services. In these limited cases, a Labor Pool
can be staffed with minimal personnel to assist the activated HICS members with
information management and to relieve workload on specific services (e.g.,
patient transport or radiology). Examples of these incidents include:
alteration of ED operations without immediate threat to life or property, one
or two operational areas involved (e.g., ED and radiology), considerable media
attention, or an initial response to an unconfirmed external emergency.
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