Wisconsin Department of Health Services - Healthcare Emergency Preparedness Tiers Overview

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The Wisconsin Department of Health Services outlines a tiered response plan for healthcare emergency preparedness, involving various levels of coordination and resource management. The plan spans from local healthcare organizations to federal support, emphasizing communication, situational awareness, and coordination among healthcare coalitions. Each tier has specific responsibilities and criteria for activation to efficiently manage medical resources during emergencies.


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  1. Wisconsin Department of Health Services Healthcare Scenarios within the Tiered Response Plan Wisconsin Healthcare Coalitions Health Emergency Preparedness 1

  2. Wisconsin Department of Health Services Presenters Brian Kaczmarski, Training and Exercise Coordinator Office of Preparedness and Emergency Health Care Wisconsin Healthcare Coalitions Health Emergency Preparedness 2

  3. Wisconsin Department of Health Services Outline Review of Tiers Similarities to the Incident Command System Scenarios Review Next Steps Wisconsin Healthcare Coalitions Health Emergency Preparedness 3

  4. Wisconsin Department of Health Services Review of the 6 Tiers 1. Local health care organization 2. Area coordination 3. Regional coordination 4. Inter-jurisdictional (amongst the 7) and State 5. Interstate (FEMA Region 5) 6. Federal Support Wisconsin Healthcare Coalitions Health Emergency Preparedness 4

  5. Wisconsin Department of Health Services Tier 1 Local healthcare organization (HCO) Incident Command EOC Hospital Liaison Medical triage and management will continue at the HCO Until event over or until can no longer handle If overwhelmed, activate Tier 2 Wisconsin Healthcare Coalitions Health Emergency Preparedness 5

  6. Wisconsin Department of Health Services Tier 2 Area Medical Coordination Center Must notify all involved (those in Tier 1) that Tier 2 is activated Assuming lead of medical coordination ONLY (ESF 8) Job coordinate medical resources from all area coalition partners. Maintain situational awareness WI-TRAC, WISCOM and traditional modalities Manage until overwhelmed Consider the need for Tier 3 activation Wisconsin Healthcare Coalitions Health Emergency Preparedness 6

  7. Wisconsin Department of Health Services Tier 3 - Regional Medical Coordination Center (RMCC) Assume medical coordination lead from AMCC. Communicate transfer. Is AMCC still communicating situational awareness or will it go to RMCC? Communicate with EOCs that are activated Encourage activation for those that are not Job coordinate medical resources from all region coalition partners. Maintain situational awareness WI-TRAC, WISCOM and traditional modalities Manage until overwhelmed. Consider the need for Tier 4 activation Wisconsin Healthcare Coalitions Health Emergency Preparedness 7

  8. Wisconsin Department of Health Services Clarification between Tier 2 and Tier 3 Both coordinate info and patient movement Different scales Both are pre-determined centers Multiple AMCCs within a region ONE RMCC within a region Wisconsin Healthcare Coalitions Health Emergency Preparedness 8

  9. Wisconsin Department of Health Services Tier 4 - State and Intra-regional response Do neighboring regions need to get involved? Does state need to coordinate? WI-DHS and likely Wisconsin State Emergency Operations Center (SEOC) would be activated. Declarations likely to occur here Is state able to provide and coordinate adequate response? Consider need for Tier 5 activation. Wisconsin Healthcare Coalitions Health Emergency Preparedness 9

  10. Wisconsin Department of Health Services Tier 5- Interstate Regional Management Coordination Emergency Management Assistance Compact (EMAC) FEMA Region 5 , FEMA, US-DHS may be needed for coordination Can Region 5 manage the resources needed and delivery of medical assets to support the response? Consider Tier 6 activation Wisconsin Healthcare Coalitions Health Emergency Preparedness 10

  11. Wisconsin Department of Health Services Tier 6 - Federal Support to Response Impacted governor(s) request federal support Federal assets coordinated under ESF 8 (Nat l Response Framework) U.S. Department of Health and Human Services Secretary s Operation Center activated to coordinate Wisconsin Healthcare Coalitions Health Emergency Preparedness 11

  12. Wisconsin Department of Health Services Similar to ICS? Yes! ICS/NIMS is a foundational element of the tiers Traditional Emergency Management response Local Regional State Federal Follows the National Response Framework Wisconsin Healthcare Coalitions Health Emergency Preparedness 12

  13. Wisconsin Department of Health Services Why add this now? Traditional emergency management response Local EOC Regional EOC State EOC Tiered Response Plan Focuses ONLY on ESF 8 type resources - established in 2004 (recognized best practice) Traditional response still needed, still continues Wisconsin Healthcare Coalitions Health Emergency Preparedness 13

  14. Wisconsin Department of Health Services The Vision Rapid activation and coordinated approach to managing patients from large-scale or unusual incidents Increased collaboration between health care , emergency response, and public service sectors Increased Communication Interoperability between all participants in the greater Health Care Coalition Seamless integration with the national/federal system so that our state will be able to provide the best medicine in the worst of times! Wisconsin Healthcare Coalitions Health Emergency Preparedness 14

  15. Wisconsin Department of Health Services Scenarios Let s look at a few scenarios: Collapse of the grandstands at the county fair Outbreak of highly contagious disease at the local school Chemical tanker spill in a high-traffic area Wisconsin Healthcare Coalitions Health Emergency Preparedness 15

  16. Wisconsin Department of Health Services Grandstand Collapse Summary: 55 green 27 yellow 19 red Can your HCO handle this? Can your AMCC handle this? What tier would you anticipate needing? What medical coordination needs would you anticipate? Wisconsin Healthcare Coalitions Health Emergency Preparedness 16

  17. Wisconsin Department of Health Services School Outbreak Summary: Highly contagious outbreak Rapid spread Several hundred exposures Multiple jurisdictions involved Significant spike in ED visits Can one local HCO handle this? Area? What types of coordination needs might you have? Wisconsin Healthcare Coalitions Health Emergency Preparedness 17

  18. Wisconsin Department of Health Services Tanker Spill in High Traffic Area Summary: Anhydrous Ammonia spill in a high traffic area. Large volume of individuals exposed. Environmental issues. Exposure issues; health issues, decon issues Rapid surge to local, area, regional hospital 25 people splashed with the chemical 75+ overcome by fumes/plume Accident causes MCI 8 green 5 yellow 6 red Wisconsin Healthcare Coalitions Health Emergency Preparedness 18

  19. Wisconsin Department of Health Services The Bottom Line Ability to respond to large-scale disasters that overwhelm and exhaust our health systems and resources Save lives get the right patient to the right place at the right time and improve patient outcomes in disasters and significant emergency events At the regional level, coordinate public health and medical response to disasters and large scale events Wisconsin Healthcare Coalitions Health Emergency Preparedness 19

  20. Wisconsin Department of Health Services Next Steps Learn more about the Tiered Response Plan http://www.phe.gov/preparedness/planning/mscc/hand book/documents/mscc080626.pdf Educate your staff and local partners Be involved in your regions healthcare coalition development Wisconsin Healthcare Coalitions Health Emergency Preparedness 20

  21. Wisconsin Department of Health Services Questions? DHSHCC@wisconsin.gov Wisconsin Healthcare Coalitions Health Emergency Preparedness 21

  22. Wisconsin Department of Health Services Resources Portions of this presentation adapted from; Introduction to Disaster Coordination Response Tiers webcast recorded by Dr. Liu and Dr. Clark. Link to webcast: http://dhsmedia.wi.gov/main/Play/368747a8e01e49568ac9d 175c15d68501d Wisconsin Healthcare Coalitions Health Emergency Preparedness 22

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