Establishing a Regional Disaster Health Response System in the U.S.

At the multi-state level, the Regional Disaster Health Response System (RDHRS) will cultivate and establish mechanisms for sharing the clinical expertise necessary to respond to low-probability, high-risk threats (e.g. chemical, biological, radiological, and nuclear threats) and provide a mechanism to coordinate patient care and movement across jurisdictional boundaries.

The U.S. Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR) aims to better identify and address gaps in coordinated patient care during disasters through the establishment and maturation of a Regional Disaster Health Response System (RDHRS).

In FY 2018, ASPR awarded two pilots under the Partnership for Disaster Health Response cooperative agreement to address health care preparedness challenges, establish best practices for improving disaster readiness across the health care delivery system, and demonstrate the potential effectiveness and viability of a RDHRS. The pilot programs receiving funding were the Nebraska Regional Disaster Health Response Ecosystem/Region 7 Partnership for Regional Health Disaster Response (NRDHRE/R7 RDHRS) and the Massachusetts/Region 1 Partnership for Regional Health Disaster Response (MA/R1 RDHRS). More information about the progress of the current RDHRS demonstration projects can be found in a Report to Congress, which was released in July 2020.

ASPR is now building on this effort by funding a demonstration site that will advance the vision for a nationwide, regional response system, and that will help identify issues, develop best practices, and demonstrate the potential effectiveness and viability of this concept.

The primary stated objectives of the RDHRS are to:

1. Improve bidirectional communication and situational awareness of the medical needs and issues of the response between healthcare organizations and local, state, regional, and federal partners

2. Leverage, build, or augment the highly specialized clinical capabilities critical to unusual hazards or catastrophic events

3. Augment the horizontal (whole of community) integration of key stakeholders that comprise healthcare coalitions with readily accessible and clinical capabilities that are largely missing from the current configuration of such coalitions.

The RDHRS structure is conceptualized as a tiered system that builds upon the existing Medical Surge Capacity and Capability (MSCC) foundation for local medical response (e.g. trauma systems and HCCs) by enhancing coordination mechanisms and incorporating discrete clinical and administrative capabilities at the state and regional levels.

The RDHRS is not intended to alter or displace current local patient referral patterns, but is instead intended to define the delivery of clinical care when the existing referral patterns and health care delivery capacity and capabilities are exceeded by catastrophic events (requiring either redistribution of patients, importation of resources, or resource utilization guidelines).

At all levels of RDHRS, activities aim to optimize clinical surge capacity, provide clinical expertise to support healthcare surge planning, and ensure that appropriate clinical expertise is involved and empowered as a partner in emergency planning and response.

At the state level, RDHRS specifically aims to establish more robust situational awareness of healthcare system capability and capacity, coordination and prioritization mechanisms for patient transfers, process and policy for resource management, and access to clinical specialists in areas such as pediatrics, trauma and burn care, and infectious disease. The maturation of these capabilities will better enable states to respond to healthcare crises within their geographic boundaries and increase their ability to support resource requests from other states.

RDHRS will also integrate with and leverage the expertise and resources of existing response systems for biologic (e.g. National Emerging Special Pathogens Training and Education Center) radiologic (e.g. Radiation Injury Treatment Network), and trauma- based (trauma systems) disasters.

The recipient will establish a statewide Partnership of health care and governmental partners relevant to the coordinated delivery of patient care in disasters. The Partnership will operationalize the capabilities necessary for effective and coordinated emergency response to identify best practices, lessons learned, and barriers to state- and regionwide implementation and coordination of the RDHRS concept; and develop readiness metrics related to the operational capabilities.

Highlighted objectives of the demonstration Partnership include:

• Identify and document regional and statewide health care resources and services that are vital to continuity of health care delivery during a disaster
• Identify basic elements to be included in a standardized training program for medical response personnel (e.g., state-sponsored medical teams), health care providers, and medical volunteers.
• Assess capability gaps in disaster ethics, triage principles, assessment and care of injuries or illness resulting from known CBRN threats, and other topics.
• Identify and document potential gaps in state and regional surge capacity planning for conventional, contingency, and crisis surge.
• Identify and document surge capacity assets in the state and region required for a clinical response to high consequence infectious disease, burn, pediatric, and mass casualty scenarios.
• Conduct a statewide needs assessment of the implementation of an alternate care system (e.g., alternate care site locations, personnel, supplies, equipment)and the means by which such systems would complement the conventional delivery of health care services (e.g., telemedicine, electronic prescribing, triage lines).
• Identify and resolve potential conflicts related to coordination of health care assets (e.g., patient movement, patient tracking, expertise and resource sharing, and policy support) across multiple coalitions.
• Document the state processes for declaration of emergencies, specific state-level waivers that may be implemented, existing liability protections for health care providers in disasters, and laws and regulations related to allocation of personnel, resources, and equipment.
• Document the state-level legalities surrounding alternate care systems (e.g., alternate care sites, crisis standards of care, quarantine and isolation).
• Develop processes and procedures to rapidly acquire and share clinical knowledge among health care providers and health care organizations during responses to a variety of emergencies (e.g., CBRN, trauma, burn, pediatrics, or highly infectious disease); this could include conference calls, newsletters, trainings, telehealth/telemedicine, and other means.
• Provide specialized surge management, expertise, education, and patient care coordination (to include EMS capabilities) during emergencies that result in a surge of (1) chemical, (2) radiation, (3) burn, (4) trauma, (5) high consequence infectious disease, and/or (6) pediatric patients.
• Implement mechanisms to use appropriately licensed health professionals from states within and outside of the HHS region during disasters (e.g., Uniform Emergency Volunteer Health Practitioners Act, central credentialing process, centralized request for hospital staff).
• Describe the process for patient tracking and transport across coalitions and/or jurisdictional boundaries and outside of regular referral patterns during a catastrophic event, including transport of high-consequence infectious patients and others who may require specialized care during evacuation and relocation.

Initial cooperative agreement grant funding for the demo Partnership will be limited to $3 million dollars for year one, with an anticipated start date of Sep 30, 2020.