Resources: The Emergency Manager’s Role in Healthcare and Public Health Readiness

We are seeing how well the Emergency Management Compact (EMAC) works in a regional disaster. Imagine a scenario where wildfires like the California fires were occurring in every city and in every state in America.  That’s the type of scenario we are in for during the next Pandemic.

A show, recently broadcast on The Science Channel, depicted how a pandemic might begin in Southeast Asia and then spread rapidly across all parts of the world infecting hundreds of millions of humans worldwide and leaving tens of millions dead in its wake. It was striking to see how empty the streets would be and how the normal hustle and bustle associated with everyday life would disappear. It was also alarming to think about the amount of trash that would be left behind as up to 60% of sanitary workers would be either at home with the flu or afraid to report to work because of the risk of becoming exposed to a deadly strain of influenza.

JVR Health Readiness, Inc. has been advocating a systems approach for pandemic preparation for a number of years (see table on page 5). Using this paradigm, the public health department would provide the majority of the “hands-on” care as part of the “Pandemic Community Surge.” This would ensure valuable hospital resources would be conserved for “the sickest of the sick” (those strong enough to pull through with intensive care equipment). Whether or not this paradigm is adopted by the Department of Health and Human Services (HHS), there is little doubt that materials management professionals will need to take leadership positions in healthcare readiness.  Healthcare materials managers can learn much from the Emergency Management Community.

Materials managers know that building huge stockpiles of medical supplies and equipment is unrealistic for a few reasons:

  1. “Just-in-time” supply systems function very well only as long as healthcare purchasing patterns reflect actual usage. When large inventories are built, the reorder point may reflect stockpile replenishment instead of actual usage.
  2. Financial constraints make investments in inventory untenable.
  3. Few healthcare organizations have the space to store massive quantities of food, medical supplies, pharmaceuticals, and ICU equipment even if federal money was available in the hundreds of millions of dollars that would be needed to fund the massive effort.

So what roles can the public Health officers, healthcare supply chain professionals and emergency mangers play in preparing their organization for a Pandemic? The answer is a true partnering role determined to preserve the community and its way of life, providing for the community’s minimum essential healthcare needs and protecting Public’s Health.  We cannot be successful if each disciple plays it’s traditional role and stays in its traditional “lanes.”

What many healthcare materials managers and some emergency managers may not know is that the HHS already offers modest financial help in the form of Hospital Preparedness Program (HPP) grants. HPP funds are intended to assist healthcare organizations better prepare for “medical surges” in patients associated with man-made and naturally occurring disasters like hurricanes, tornados, and yes, even a pandemic. In the past few years, the Centers for Disease Control and Prevention (CDC) has been funding state, territorial, and even a few major cities’ efforts to become better prepared for a pandemic through one of their major grant programs. Is some of that money available to hospitals as they prepare for surges in the patients and fatalities associated with a pandemic or even an outbreak of SARS? The answer is maybe. Do emergency managers, public health officers and healthcare share experiences, understand the gaps in each disciplines emergency management plans and share state and federal resources? For the survival of the Community, they better.  Pointing fingers at each other didn’t help the people who died in the 2005 hurricane season and finger pointing will not help America in a Pandemic.  So how can emergency managers facilitate a truly integrated community emergency management system?  The following are just some of the leadership steps emergency managers can play in community preparedness.

  1. “Be the Leader.” No other profession better understands the critical capabilities a community needs better than the Emergency Manager. Getting all community providers of critical goods and services together in one room and flesh out the “Who provides what goods and services” types of questions. Expect an overabundance of astonishment and “We can’t do that!” types of reactions at this type of meeting.  The reality is planning for any disaster is going to take place. The only question is when it will take place. Then “when it takes place’ answer is what dictates the disaster outcome as evidenced by the stark contrasts between hurricane Katrina in Louisiana and this year’s wild fires in California.
  2. “Be the Communicator.”  Remember that we don’t know ….what we don’t know.  For example, a Public Health Officer may not know that when healthcare organizations are overcome during a Pandemic, it is the Public Health Officer’s job to provide Public healthcare until the community’s Private Sector’s Healthcare System can recover.  Ask how the Public Health Officer plans to protect the Public’s Health and “care” for the folks in the Community during a Pandemic or in any other event where health services are lost or over-capacity? In other words ask all the tough questions and lead the process of answering the questions.
  3. “Be the Subject Matter Expert”.  Emergency managers know emergency management better than anyone else in the Community and can play the pivotal leadership role in its Readiness.  The Emergency Manger is also has the “Big Picture” and understands Federal and State grant programs better than most if not all other community leaders. The 21st Century challenge to the Emergency Manger will be in erasing the grant lines in a way that harmonizes the capabilities of all Community goods and services providers, be they Private Sector or Public Sector entities.
  4. “Be the troubleshooter.” Help Public Health Officers and Healthcare executives review their capabilities and work with them at closing the gap between “Requirements” and “Capabilities.” Evaluate their assumptions relating to the availability of goods and services that have been built into each organization’s emergency management plan (EMP). Consider whether these assumptions are likely to be valid during peak demands for materials and services during a pandemic. For example, if your organization’s EMP assumes that federal supplies and equipment will be available to sustain hospital operating functions during all phases of a pandemic, your EMP is currently incorrect.
  5. Understand the phases/waves associated with a pandemic and evaluate the demand for medical and non-medical supplies, equipment, pharmaceuticals, food, and all contractual services during each pandemic phase.
  6. Provide supply, equipment, and services subject matter expertise at emergency management planning committees, exercises, and other hospital and community pandemic preparedness meetings and events.
  7. Accompany the Disaster Coordinator to local disaster coordination meetings sponsored by the State Public Health Department's Bioterrorism Coordinator (BT Coordinator), especially pre-proposal federal grant meetings. You can then assist the EMP in writing the Hospital Preparedness Program (HPP) grant proposal for submission to the state public health department. Once HPP funds are approved, it is important for the materials management teams to order and obligate HPP funds in the most expeditious manner possible. State health departments as well as federal grant program project officers track the obligation of grant dollars. Rapid obligation of grant dollars may not assure better funding considerations in future years, but tardiness in obligating funds may hurt.
  8. Use AHRMM‘s disaster readiness information as a basis to help plan for events depicted in the community HVA ( <> ) and use AHRMM’s Disaster Preparedness Manual for Healthcare Materials Management Professionals to receive greater detail and “how-to” assistance on the 10 functional areas listed in this article.
  9. Be the leader in your organization for developing requirements lists for disaster-related goods and services (a sample requirements worksheet is also included in AHRMM’s Disaster Preparedness Manual for Healthcare Materials Management Professionals). The earlier requirements are developed the better. Consider healthcare infrastructure requirements such as back-up generator fuel, water re-supply services, and regulated medical waste challenges associated with a pandemic. During an emergency the jurisdiction’s Public Health Officer in coordination with the Governor’s office may order quarantine. Special convoy arrangements may help ensure vital resources get through to the hospital.

    Regulated Medical Waste (RMW) stored in and around the healthcare organization for long periods of time can pose a significant health risk for staff, patients, and the community. Onsite treatment systems backed up with emergency power may be the best option for normal RMW treatment operations and during a pandemic.  While federal grant programs will not provide onsite RMW units for normal RMW operations, “add on” units or autoclaves may be funded through the pandemic or HPP grant programs. These will facilitate the treatment of RMW surges associated with a pandemic or any other disaster that generate large quantities of RMW.
  10. Fortify your organization’s supply chain management program. Work closely with prime vendors and suppliers to plan for surges in demand for medical products. Consider national distribution centers and how suppliers can harmonize their supply chain with the phases/waves of a pandemic as it crosses America. Here, your competence, experience, and resourcefulness as a materials manager will shine through.
  11. Become an advocate for healthcare preparedness at local, state, and regional materials management planning work groups and at AHRMM state chapter meetings. Share the strategies you learn with your colleagues and other materials management professionals.
  12. Develop memoranda of agreements with DOD active duty and reserve organizations within the state/territory for logistics support during disasters. Local DOD elements may be able to offer helicopter or fixed wing transportation services for supplies and equipment from distributors to hospitals when roads are impassable. The same agreements should be explored with air taxis within the jurisdiction or region and where feasible with law enforcement agencies for supply convoy escorts.

Every materials management professional has the opportunity to make a phenomenal impact on how their organization will effectively function during a possible future pandemic and other disasters and public health emergencies. Those who take an active leadership role in developing requirements and establishing new or broader contractual arrangements with suppliers and community resources will be providing an invaluable service to their patients, and their communities. Today’s healthcare organizations are making decisions now on whether or not to organize for an emergency well in advance. In the event of a disaster, the buck will more than likely stop with the materials manager, so we better be ready.

(c) JVR Health Readiness, Inc. 2008

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