ED managers should interface with community

While health care facility surge capacity is the prime concern of ED managers, it is also important for them to interface with community officials — both before and after a major disastrous event.

"I think ED management really needs to know how the hospital is going to coordinate and integrate with the community at large," advises Dan Hanfling, MD, FACEP, director of emergency management and disaster medicine at Inova Health System in Falls Church, VA.

The ED is the front door, he says. "Oftentimes, we’re the first stop for patients who have medical concerns," Hanfling continues. "We need to know what is out there beyond our ambulance deck and the walkway."

The public health community, fire departments, and police have been given lead responsibility for helping develop a large-scale disaster response effort, he says, but ED managers much know how to coordinate their services as part of a larger response, as they may receive patients from outside the normal EMS route.

"At this point in time, if the chief of nursing and chairman of emergency medicine haven’t at least made contact with their local health department staff, now’s the time to do it," Hanfling advises.

Issues on which you should focus include: how the public health department can establish community-based facilities and how the EMS will interact with those facilities; pharmaceutical cache management and delivery for first responders, the health care community, and the community at large; and what vaccination and medical distribution plans will look like. "The other big issue is, how we are going to share information and manage it, because that affects all of us," Hanfling notes.

ED managers should communicate beyond their department to the hospital at large, and then to the greater community, says John L. Hick, MD, medical director for emergency preparedness at Hennepin County Medical Center in Minneapolis. "The ED manager needs to get with administration and say, What happens when we get overwhelmed? Who do we call when we literally have 100 people in an ED with a capacity of 20? How can we get some of these walking wounded out of our ED, and what’s going on in the rest of the community?’" he adds.

Once local hospitals are beyond their limits, surge capacity extends to the public health and community-based levels, where off-site facilities may be employed, Hick notes. "There is tremendous opportunity for [ED] leadership there, because ED managers tend to be proactive," he says. "They can give valuable input in terms of off-site care planning — what will realistically work, and what will not."

Hick’s own facility has a nurse supervisor who has contracted for 0.2% of her time for off-site planning, he notes. "This has involved establishing a memorandum of understanding’ with the facility and public health, developing an operational plan for the facility, looking at staffing and supply issues, as well as operational issues such as interpreter services and communication," Hick explains. "She chairs the workgroup that is designated to develop the full plan, which meets monthly to work on operational details."

Sources and Resource

For more information on surge capacity, contact:

  • Dan Hanfling, MD, FACEP, Director of Emergency Management and Disaster Medicine, Inova Health System, Falls Church, VA. Phone: (703) 776-3002.
  • John L. Hick, MD, Medical Director for Emergency Preparedness, Hennepin County Medical Center, 701 Park Ave. S., Minneapolis, MN 55415. Phone: (612) 873-3020. Fax: (612) 904-4241. E-mail: john.hick@ co.hennepin.mn.us.

For more on surge capacity, see this resource:

  • Hick JL, Hanfling D, Burstein JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004; 44:253-261.