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Rocky Mountain Regional Care Model for Bioterrorist Event

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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2. Methodology

The Working Group met 4 times during a 12-month period (November 2002 to October 2003) to address medical surge capacity issues/needs for Federal Region VIII (Colorado, Montana, North Dakota, South Dakota, Wyoming and Utah). During the first meeting the members of RMBT identified surge capacity issues that were considered important and where solution development was necessary. The members also provided the RMBT investigators and staff with documentation and resources during the weeks between the RMBT meetings. Through this collaboration and the extensive experience of the RMBT members, surge capacity products and tools were developed as part of this report.

The methodology used for profiling current regional medical resources capacity (Chapter 3) was primarily descriptive through data gathering. The data sources for this chapter include the American Hospital Association (AHA), HRSA State Health Workforce Profiles, AHA Physician Characteristics and Distribution in the U.S. and results from each of the 6 State HRSA hospital preparedness surveys. Where data was available, Region VIII resources were compared to the United States as a whole.

The development of additional resources to meet surge needs (Chapter 4) was based on information and experience from the RMBT working group. This included the US Army Soldier and Biological Chemical Command Concept of Operations for the Acute Care Center report (Skidmore et al., 2003) and other documents provided by the Department of Defense, RMBT members who had experience with planning for the Utah 2002 Summer Olympics, and members who had participated in Operation TOPOFF 2000. The alternative care site selection tool was created through collaboration with facility engineers at Denver Health and reviewed and edited by the RMBT working group.

Measures of preparedness (Chapter 5) were developed for hospital beds, equipment and infrastructure using the HRSA benchmarks as a measure of need and the data from the regional profile described above to measure current capacity. Hospital bed capacity was determined based on the average number of available beds in the region reported by participating hospitals to the National Disaster Medical System (NDMS). Staffing measures were created using the staffing requirements for a 50-bed alternative care site (Table 7) and compared to current excess/shortage of staffing capacity from the HRSA State Health Workforce Profiles. For instance, the HRSA benchmark for hospital beds is 500 additional beds needed per million population to address a surge. The staffing for a 50-bed unit was multiplied by the appropriate State population factor to meet each State's need based on this HRSA benchmark. Current hospital capacity for equipment and infrastructure was difficult to obtain from the HRSA Hospital Preparedness surveys. The HRSA benchmarks for need require actual estimates of equipment and infrastructure, while most States were only able to report summary data of having a capability.

Isolation and quarantine (Chapter 6) was discussed by a small sub-committee at the first Working Group meeting. This group shared information; a summary of their discussion and issue areas are presented. The Other Surge Capacity Issues (Chapter 7)—risk communication, vulnerable and rural populations, and a comparison of bioterrorism to an all-hazards approach—were each presented to the Working Group at the meetings. A topic expert from the Working Group was asked to prepare a presentation on the issue to facilitate discussion among the group. Working Group discussion regarding each topic area was then developed into a section for this report.

The example of a regional exercise (Chapter 8) was developed as a way to test one of the tools developed by the RMBT Working Group. An outside exercise expert from the Denver Office of Emergency Management was asked to facilitate this scoping exercise among the Working Group members. This exercise was developed by the Steering Committee to test hypothetical deployment of one of the caches across State lines. The alternative care site selection tool was also tested and validated as part of this orientation exercise.

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