Considerations for the Use of Temporary Care Locations for Managing Seasonal Patient Surge
ASPR NHPP and ASPR TRACIE have received many questions regarding managing seasonal patient surge at health care facilities and 1135 waivers. ASPR TRACIE worked with the Centers for Medicare & Medicaid Services to provide the information included in HPP’s message about 1135 waivers and temporary surge sites. Additionally, ASPR TRACIE, along with multiple subject matter experts, developed Considerations for the Use of Temporary Care Locations for Managing Seasonal Patient Surge — Working Draft
, which describes the major issues health care facility emergency planners must consider when determining patient surge management solutions for longer-duration events, such as weeks to months of managing seasonal illness surge.
Health Care Coalition Flu Coordination Resources
This year's influenza season is stressing many health care systems. In many regions, surge capacity plans, expanded triage and other methods are being used to cope with demand. Health care coalitions
play a critical role when patient care demand exceeds available resources. These situations are more difficult because there is not a specific 'incident,' and they occur over many months, but the coordination role that HCCs play can be critical to diffusing impact. This role includes sharing available information and resources. In many cases, demand can be mitigated through strategies such as risk communication and changes in patient destination or distribution, as well as health care system and hospital-based surge strategies, potentially including expanded use of telemedicine and telephone triage. Although this is not a pandemic, with this season’s patient volumes comparable to 2009 H1N1, HCCs may find it helpful to refer to the recently released pandemic planning document for HCCs
for additional planning and response strategies. Seasonal influenza is not usually considered as a 'disaster,' but it can have pervasive and sustained impacts on local medical care that fit perfectly with the role of the HCC to assure that the resources of coalition members are coordinated to deliver the best care possible to our communities.
1135 Waivers for Influenza Surge
A follow up clarification from ASPR was provided on Feb. 9, 2018, related to 1135 waivers for influenza surge:
Many facilities are experiencing significant patient surge due to seasonal illness. There currently are no federal-level declarations of emergency from either the President or the Secretary of Health and Human Services; therefore, waivers to section 1135 of the Social Security Act are not possible at this time. The Centers for Medicare & Medicaid Services has considerable information from similar past events on ways to increase inpatient and outpatient capacity without the need for 1135 waivers. Inpatient surge activities include early discharge planning, opening already certified beds or units, and the use of remote locations. Outpatient surge activities include the use of tents or mobile facilities located on/within the hospitals’ campus as a temporary means of allowing for the management of outpatient surge. These facilities must meet all the Conditions of Participation for CMS AND must comply with all state and county licensure and life safety code requirements. This information is described in detail in the fact sheet, “Hospital Alternative Care Sites during H1N1 Public Health Emergency
,” starting on page seven of 14 for inpatient surge and page nine of 14 for outpatient surge actions permissible without waivers. As always, when using surge strategies, notify your State licensing agency and CMS Regional Offices.
MHA Influenza Resources
Additional Influenza Resources
For more information:
Please note that information on Zika is constantly evolving; therefore, if you are a clinician treating a patient, please check the Centers for Disease Control and Prevention Zika site for the most current information and clinical guidance.
Zika Virus Disease: What Medical Practitioners Need to Know
George Turabelidze, M.D., Ph.D, with the
Missouri Department of Health and Senior Services, and Charlie Hunt with the Kansas
Department of Health and Environment, provide a presentation with up-to-date
information on epidemiology, clinical presentation and diagnostic approach to
Zika, with special emphasis on management of pregnant women and
infants infected with Zika and prevention of sexual transmission.
CDC Updates Zika Considerations for Health Care Settings
The Centers for Disease Control and Prevention has released a key considerations document for health care facilities, including hospitals and health systems, as they prepare to receive patients potentially infected with Zika. The document outlines nine steps health care facilities should take, including knowing the clinical manifestations of the virus, how to assess pregnant women and advise against sexual transmission during pregnancy, and reporting and use of standard precautions. The document also notes steps that health care settings can take to educate patients and their families about the disease, transmission and steps to avoid infection.
The CDC also has a promotional toolkit that provides content and resources that hospitals can use to develop messages which encourage pregnant women to take steps to prevent Zika infection.
CDC Awards Public Health Preparedness Grants for Zika, Other Emergencies
The Centers for Disease Control and Prevention has awarded $25 million in fiscal year 2016 funding to help public health departments in 53 states, cities and territories prepare for, and respond to, a possible Zika outbreak. Recipients were selected based in part on the estimated U.S. range of the two mosquito species that carry the virus. In addition, CDC awarded 62 departments $567.5 million in FY 2016 cooperative agreements through the Public Health Emergency Preparedness Program, which provides resources to respond to infectious disease outbreaks and other emergencies.
CDC Begins Reporting Pregnancy and Birth
Outcomes of Women Affected by Zika Virus During Pregnancy
began reporting poor outcomes of pregnancies with laboratory evidence of
possible Zika virus infection, and will report two types of outcomes:
- Live-born infants with birth defects
- Pregnancy losses with birth defects
Sheets and Posters in Different Languages
fact sheets and posters for distribution to patients are available in
languages, including Spanish, Arabic, Tagalog, Vietnamese, Mandarin, Creole
and Korean. These resources cover a variety of topics, including travel
information, insect repellent, sexual transmission and mosquito control.
COCA/CDC Men's Health Toolkit
The toolkit provides content
and resources to develop messaging that promotes Zika prevention
among men who have traveled to, or live in, areas with Zika, with priority on
those men with pregnant partners.
TRACIE just released an updated resource, Zika Virus Disease Resources at Your Fingertips.
The document provides Zika resources and an overview of public health and health care system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders and other audiences.
Clinician Outreach and Communication Activity (COCA)
Updated Interim Zika Clinical Guidance for Reproductive Age Women and Men, Sexual Transmission of Zika, and the U.S. Zika Pregnancy Registry
Presented on Tuesday, April 12, 2016
During the COCA call, clinicians learned about the following. Click here to access the recording, slides and more.
- Updated CDC interim guidance on how to care for reproductive age women and men with possible Zika exposure
- CDC interim guidance for prevention of sexual transmission of Zika
- Preventing transmission of Zika in labor and delivery settings
- Interpreting pediatric testing guidance
- U.S. Zika Pregnancy Registry
CDC Concludes Zika Causes Microcephaly and Other Brain Defects
Scientists at the Centers for Disease Control and Prevention have concluded, after careful review of existing evidence, that Zika is a cause of microcephaly and other severe fetal brain defects. In the report published in the New England Journal of Medicine, the CDC authors describe a rigorous weighing of evidence using established scientific criteria.
At this time, CDC is not changing its current guidance as a result of this finding. Pregnant women should continue to avoid travel to areas where Zika is spreading. If a pregnant woman travels to or lives in an area with Zika, she should talk with her health care provider and strictly follow steps to prevent mosquito bites and sexual transmission of the virus. The CDC encourages women and their partners in areas with Zika to engage in pregnancy planning and counseling with their health care providers so that they know the risks and the ways to mitigate them.
Clinical Consultation Service for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Infection
CDC maintains a 24/7 consultation service for health care providers caring for pregnant women with possible Zika virus infection. This consultation service is NOT for patients or the general public. To contact the service, call 770-488-7100 or email ZikaMCH@cdc.gov.
WHO Launches Zika App
The World Health Organization has released a new app, called WHO Zika App, which offers medical
reference information about the Zika virus. The app is designed
for health care workers and responders, but also is available to the general
public. For the general public, the app includes information on symptoms, diagnosis, treatment and prevention.
For health care workers, it offers technical guidance, a link to WHO's
response plan, research and development updates, situation reports, and
CDC Warns Local Health Agencies To Prepare For
Federal officials have urged state and local
agencies to prepare for the potential transmission of the Zika virus in the
U.S., warning that eliminating the mosquitoes that carry it could be
challenging. It has been recommended that every state name a Zika coordinator,
review preparedness plans, build up lab testing, conduct outreach with pregnant
women, and undertake other activities. Already, 312 cases of Zika have been
reported in the U.S., the vast majority in people who were infected while in a
country where Zika is circulating. Six of the cases were due to sexual
transmission. Twenty-seven of the 312 infected were pregnant women.
- CDC Zika Video Resources
- The CDC released U.S. maps identifying the estimated range where the two Zika-associated species of mosquitoes are prevalent
- Missouri Department of Health and Senior Services health update providing guidance for counseling patients about pregnancy planning and timing after possible Zika exposure
- CDC interim guidance for health care providers caring for women of reproductive age
Based on current guidance for evaluating persons with Ebola, if an individual is found to be at risk, then the specified infection control measures must immediately be instituted, and hospital leadership, along with state and local public health officials, must immediately be notified. It is very important that these steps be consistently followed in all emergency departments. To report a suspected Ebola patient call the Department of Health and Senior Services at 573/751-6113 or 800/392-0272 (24 hours a day/seven days a week), and call your local public health agency.
Lessons Learned in Developing an Effective Regional Ebola CONOPS
ASPR TRACIE has provided a webinar on lessons learned to assist regions in the development of Ebola concept of operations. The webinar shares how two regions developed their CONOPS, as well as how lessons learned shaped planning. The webinar also provides resources that support patient transport and apply promising practices to regional CONOPS development efforts.
CDC Issues Considerations For Hospitals To Ensure Adequate PPE For Ebola Preparedness
The Centers for Disease Control and Prevention issued guidance summarizing the current domestic personal protective equipment supply status and providing recommendations to ensure an adequate estimate and supply of PPE for Ebola planning and response. These recommendations are structured in accordance with the CDC’s framework for a tiered approach, which defines the roles and expectations of front-line facilities, assessment hospitals and treatment centers.
DHSS Issues Public Health Update For Ebola Hospital Preparedness
The Missouri Department of Health & Senior Services issued a health update outlining the current process for assessing at-risk symptomatic patients for Ebola in Missouri. The update also describes the appropriate packaging of laboratory specimens and provides clarity on the use of point of care equipment for testing and management of an Ebola patient. Questions can be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at 573/751-6113 or 800/392-0272.
CDC Releases Guidance On A Tiered Approach To Care
The Centers for Disease Control and Prevention has released guidance for public health, hospitals and other emergency care settings which includes an overarching framework for a tiered response to care for Ebola patients.
Joint Statement On Ebola Preparedness
MHA has joined the Missouri Department of Health & Senior Services, Missouri Nurses Association and Missouri State Medical Association in a joint statement on Ebola preparedness in Missouri. For more information, contact Dave Dillon.
Frequently Requested Documents
- CDC released guidance for safe handling of human remains of Ebola patients in U.S. hospitals and mortuaries.
- CDC released Q&A's on the transport of pediatric patients under investigation or with confirmed Ebola.
- CDC issued a fact sheet on the CDC Ebola Response Team.
- CDC released guidance to help emergency departments evaluate and manage patients who present with symptoms that could indicate Ebola.
- CDC released an algorithm for ambulatory care for evaluation of patients with possible Ebola.
- HHS OCR released a bulletin on the HIPAA Privacy Rule. Additional guidance on HIPAA in Emergency Situations: Preparedness, Planning, and Response can be found online.
- CDC released Considerations for Discharging Persons Under Investigation for Ebola guidance. The decision to discharge a patient being evaluated as a person under investigation for Ebola, who has not had a negative RT-PCR test, should be based on clinical and laboratory criteria and the ability to monitor the PUI after discharge.
- CDC released released updated guidance for the monitoring of individuals who have potentially been exposed to Ebola and for evaluating their intended travel, including the application of movement restrictions when indicated.
- CDC released a fact sheet summarizing the Ebola monitoring guidance.
- CDC released the Epidemiologic Risk Factors to Consider when Evaluating a Person for Exposure to Ebola Virus document.
- CDC's case definition for Ebola. An algorithm is available to aid in the identification and isolation of patients who could have Ebola.
- CDC released a fact sheet on airborne versus droplet spread. An infographic was released by the Centers for Disease Control and Prevention outlining the difference between airborne and droplet transmission of viruses and how it relates to Ebola.
- Updated Guidance For EMS And 911 PSAPs
- Revised PPE guidance. A fact sheet was issued concurrently.
- Checklist for patients being evaluated for Ebola.
- Ebola algorithm for the evaluation of a returned traveler: http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf
Frequently Asked Questions
MHA has compiled a list of frequently asked questions regarding Ebola. This document will be updated frequently.
Educational Materials for Donning and Doffing of Personal Protective Equipment
The Centers for Disease Control and Prevention has released informational videos
that demonstrate the procedures described in CDC guidance
for donning and doffing personal protective equipment for all health care providers. While PPE may vary by facility according to what is available, it is important that all health care providers be trained on how to use the equipment. These informational materials are intended to promote patient safety and increase the safety of the health care provider. The University of Nebraska Medical Center's biocontainment unit has developed handouts, videos and other materials
for donning and doffing education and training. More information will be provided as it becomes available.
More recently, The University of Nebraska Medical Center in Omaha and its primary clinical partner, Nebraska Medicine, are launching two free online Ebola education courses. The courses, “The Nebraska Ebola Method for Clinicians” and “The Nebraska Ebola Method for General Public,” provide instruction and information through videos and printable documents. The course for clinicians will provide videos, media and guidelines as used in Nebraska to care for Ebola patients. Click here to access the courses.
DuPont released a technical bulletin that provides general guidance for the use of protective apparel for Ebola response.
Videos On Proper Use Of PPE
The Centers for Disease Control and Prevention and Medscape have produced a 13-minute video overview of new guidelines on the types of personal protective equipment to be used, and processes for putting on and removing PPE. The North Carolina Division of Public Health and their state partners also have released a video demonstrating donning and doffing of PPE in hospital isolation units.
Previously Recorded National Calls on Ebola Preparedness
Date: Oct. 23, 2014
Host: U.S. Department of Health & Human Services
Title: Ebola Preparedness for Healthcare Coalitions
Audio: Click here
Date: Oct. 22, 2014
Host: The Office of the Assistant Secretary for Preparedness and Response and the Centers for Disease Control and Prevention
Title: Ebola Preparedness for Emergency Medical Services
Audio: Click here
Date: Oct. 21, 2014
Host: Association for Professionals in Infection Control and Epidemiology
Title: Updated Ebola Infection Prevention and Control Guidance
Audio: Click here
Date: Oct. 20, 2014
Host: U.S. Department of Health & Human Services
Title: Preparing Your Healthcare System for Ebola
Audio: Auto replay
Date: Oct. 20, 2014
Host: Center for Disease Control and Prevention, Clinician Outreach and Communication Activity
Title: Approaches to Clinical Management for Patients with Ebola Treated in U.S. Hospitals
Audio: Auto replay
Date: Oct. 16, 2014
Title: Preparing America’s Nurses to Safely Care for a Patient with Ebola
Audio: Auto replay
Date: Oct. 14, 2014
Host: CDC COCA
Title: Preparing for Ebola: What U.S. Hospitals Can Learn From Emory Healthcare and Nebraska Medical Center
Audio: Auto replay
Date: Oct. 14, 2014
Host: National Healthcare Coalition Resource Center
Title: The Role of Coalitions in Ebola Preparedness and Response
Audio: Auto replay or access playback by phone at 888/899-7904 and enter code 143791287#