California’s Department of Public Health recently released the nation’s first comprehensive guide regarding how hospitals, other healthcare facilities, and local health departments should respond to a sudden increased demand for services following a catastrophic event.

According to the Department of Public Health, organizations can use the document, Standards and Guidelines for Healthcare Surge during Emergencies, in situations such as a natural disaster, a terrorist attack, or an influenza pandemic.

MSPs can consult the “Hospital Operational Tools Manual” section of the guide to find resources, such as:

• Credentialing log for use during disasters
• List of staff support considerations to include in disaster plans
• Sample disaster volunteer application
• Flow chart showing how volunteers should be credentialed, oriented, and deployed during a disaster

“The guidelines are not requirements,” said Betsey Lyman, deputy director of public health emergency preparedness at the state Department of Public Health. “They provide advice for healthcare providers and payers.” These new surge-capacity guidelines are meant to be used in conjunction with the state’s other disaster plans.

Some members of the healthcare community are praising California for the new plan. “I don’t know of any state that has taken it to this level of detail in outlining a surge plan for everyone who needs to respond to an emergency of this magnitude,” Jeff Levi, executive director of Trust for America’s Health, a nonprofit group, told The Sacramento Bee in a March 2 article. “It’s exactly the kind of dialogue that has to happen.”

Nevertheless, parts of the plan may be startling to healthcare workers accustomed to operating with dependable, everyday resources. Some interpretations of the plan say that it allows for non-credentialed individuals, such as former military medics and veterinarians, to provide care in certain situations. “During a catastrophic event, the standard of care will be determined by the availability of resources, and some of the requirements for credentialing and privileging may change,” Lyman says.

Bob Schroeder, CPMSM, CPCS, director of medical staff services at Anaheim (CA) Memorial Medical Center and president of the California Association Medical Staff Services, has a realistic view of the situation. “If we get down to where a veterinarian is the only practitioner we can get to assist, our problems are greater than worrying about qualifications,” he says. “Ultimately, though, as a medical service professional, it is my responsibility to ensure that my facility has its own specific guidelines in place as to what we will allow in what circumstances.”

Precredentialing California medical volunteers

Aside from the new surge capacity guidelines, California has another plan that outlines credentialing policies during disasters. California Medical Volunteers is California’s statewide version of the federal program, Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), which provides instructions for:

• Credentialing practitioners and other volunteers prior to a disaster
• Guiding healthcare organizations in checking those credentialed and non-credentialed individuals during a disaster

California Medical Volunteers is part of a national program to identify, train, and organize healthcare professionals for volunteer service before a disaster strikes and is run primarily on a state-by-state basis. However, Los Angeles County is one of a few areas in the nation that is so large it receives its own federal funding, says Chris Otto, CPMSM, CPCS, CPHQ, a senior vice president at CheckPoint Credentials Management Services in Los Angeles, and past president of the National Association Medical Staff Services (NAMSS). Los Angeles County is partnering with the statewide California Medical Volunteers program to implement a seamless registry of medical and health volunteers for California.

Some ESAR-VHP programs work with their state medical boards to credential volunteers, and other programs contact other contractors. CheckPoint works with the Los Angeles County ESAR-VHP program to credential some of the volunteer providers. Otto says that such credentialing does not include privileging, but it does include verifying information such as:

• Data from the U.S. Department of Health and Human Services Office of Inspector General
• Unrestricted current licensure
• Whether the practitioner is in good standing and whether he or she has privileges at a hospital

“One of the nice things about volunteering through ESAR-VHP, [is that] volunteers and their families are inoculated first against whatever has happened to provide extra protection for them,” says Otto. However, these volunteers will never be the first responders to the disaster. “That will always be left up to the police, the fire department, the paramedics, those that are already highly trained to respond to very dangerous settings,” she adds.

A variety of groups can launch ESAR-VHP when a disaster occurs, including a national agency like the Federal Emergency Management Agency or a state group like the Emergency Medical Services agency. “If the governor declares a disaster, then California has a law that indicates that we can use out-of-state practitioners that are licensed in other states,” says Otto.

Anaheim Memorial Medical Center has a similar policy in place, stating that if the organization’s CEO declares a localized disaster based on Hospital Emergency Incident Command System guidelines, practitioners who are not members of its organized medical staff, but meet the requirements for disaster privileges, may be granted disaster privileges by the chief of staff or CEO. ESAR-VHP will accelerate the credentialing process in these situations because the organization can make one phone call to verify that the individual has been precredentialed as a volunteer rather than conducting the credentialing process the day of the disaster.

Disaster drills and learning opportunities

It is important for organizations to conduct regular drills to test parts of their disaster plan and to regularly rotate their disaster supplies so that they don’t expire. Additionally, organizations can implement sections of their disaster plans on an as-needed basis. Doing so can help organizations spot weak points in the plan and improve them. For example:

• A slow response to an accident can lead to a modification of the emergency call list to contact medical providers
• A loss of telephone service for six hours may incite the organization to purchase walkie-talkies for employees and to identify the need for availability of analog phones in an emergency if the main phone system is digital

Otto has seen disaster plans in action. During the Northridge, CA, earthquake in 1994, Otto was the director of medical staff services and quality improvement at Cedars-Sinai Medical Center in Los Angeles. She says that when nearby St. John’s Health Center evacuated its building, its director of medical staff services put the organization’s credentialing files in her car and drove them to Cedars-Sinai and other hospitals where practitioners and their patients were transferred. Then, those hospitals did a mass on-site emergency credentialing process to privilege the transferred practitioners.

“That’s why I think ESAR-VHP is so important,” says Otto. “We don’t want to face those kinds of emergencies at the time of the event. We want [practitioners] preregistered, precredentialed, and we want them to meet the same standard of credentialing that would happen if they were at the individual hospitals within our area.”

From: Briefings on Credentialing, May 2008, Vol. 17, Issue 5
Copyright 2008 HCPro, Inc.
View the entire issue at www.online-crc.com