Understanding Medical Surge Logistics in Emergency Situations

Medical 
Surge 
Logistics
MODULE 4  SECTION
 
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
Medical Surge
“Medical surge describes the capability to provide adequate medical
evaluation and care during events that exceed the limits of the normal
medical infrastructure of an affected community.“ (HHS, 2012).
KEY POINTS
EFFECT ON NATIONAL SECURITY
The major terrorist attacks directed against the United
States in the early 2000s (EX: September 11th and the
Anthrax Attacks) and large-scale natural disasters (EX:
Hurricane Katrina) brought national attention to the
common issues seen in hospital capacity. 
It poses an extremely complex management dilemma that
can hinder recovery efforts. 
TRIGGERING EVENTS
A Medical Surge is virtually always caused by an abnormal
event. 
Terrorist attacks, natural disasters, CBRNE outbreaks, and
infectious diseases are among the most commonly
discussed events
.
(DHHS, 2007)
MODULE 4
SOURCES
DHHS (2007). Medical surge capacity and capability: A management system for integrating medical 
and health resources during large-scale emergencies. Retrieved from
https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf
EMSA. (2021). Hospital Incident Command System. EMSA.
https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-
resources/
  
FEMA. (2018). ICS Course. FEMA. 
https://training.fema.gov/is/courseoverview.aspx?code=is-100.c
 
HHS. (2021). ICS  and Hospital ICS. 
https://www.remm.nlm.gov/ics_hics.htm
 
HHS. (2012). What is Medical Surge? 
https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedic
alsurge.aspx
 
JCAO (2006). Surge hospitals: Providing safe care in emergencies. Retrieved from 
https://www.jointcommission.org/assets/1/18/surge_hospital.pdf
 
Medical 
Surge 
Logistics
MODULE 3 SECTION
By Hannah Leonard
EDM 412 - Emergency Healthcare Logistics in Disasters 
Dr. Christopher Janik
August 15, 2021
Medical Surge Capacity
“Medical surge capacity refers to the ability to evaluate and care for a
markedly increased volume of patients... The surge requirements may
extend beyond direct patient care to include such tasks as extensive
laboratory studies or epidemiological investigations.” (HHS, 2012).
KEY POINTS
CRITICAL RESOURCES
When gauging a facility's resources there are a number of
assets that should be tracked, namely:
Medical & Pharmaceutical Equipment
Staffing
Available Beds  
  
CAPACITY MANAGEMENT 
Health Worker officials can use resources like the 
Strategic
National Stockpile
 to fulfill equipment needs during times
of duress. The Department of Defense also developed the
Modular Emergency Medical Stem (MEMS)
 to help
hospitals gauge appropriate staffing levels.
(JCAO, 2006)
Medical Surge Capability
“Medical surge capability refers to the ability to manage patients requiring
unusual or very specialized medical evaluation and care. Surge
requirements span the range of specialized medical services that are not
normally available at the location where they are needed.” (HHS, 2012).
KEY POINTS
THE QUALITIES OF MEDICAL SURGE CAPABILITY
Some of the main factors that contribute to Medical Surge
Capability are:
Responder safety
Information management
Intergovernmental Coordination
Timeliness 
MEDICAL SYSTEM RESILIENCY
This term refers to a medical facility’s ability to recover from
a compromised state of healthcare provision. 
SUFFICIENCY OF CARE
An organization also has to monitor the quality of the
medical care being provided. Sufficiency of care measures
the actual outcomes of treatment.
(DHHS, 2007; JCAO, 2006)
Medical Surge Capacity and Capability (MSCC) System
The Medical Surge Capacity and Capability system is a formalized management
strategy designed to foster a healthcare organization’s Medical Surge Capability.
It can be used by individual facilities or a network of operators. (DHHS, 2007)
KEY POINTS
INTEGRATION AND COORDINATION
One of the main goals of the MSCC System is to encourage the
facilitation of collaboration between local, State, Tribal, and
Federal medical authorities.  
THE SIX-TIER CONSTRUCT
The MSCC system organizes public health management
 
into a
tier list of responsibilities. They are as follows:
1.
Management of Individual Healthcare Assets
2.
Management of the Healthcare Coalition
3.
Jurisdiction Incident Management
4.
State Response and Coordination of Intrastate Jurisdictions
5.
 Interstate Regional Management Coordination 
6.
Federal Support to State, Tribal, and Jurisdiction  Management 
       
*NOTE*: The MSCC System is 
NOT 
for internal operational management.
(DHHS, 2007)
MSCC System and The Incident Command System
(ICS)
The Incident Command System is derived from the directives of the
National Incident Management System (NIMS), and covers the command,
control, and coordination efforts of disaster response. It’s frameworks can
be used to guide medical surge management . (FEMA, 2018; HHS, 2021). 
KEY POINTS
HOSPITAL INCIDENT COMMAND SYSTEM (HICS)
HICS is a “incident management system based on
principles of the ICS, which assists hospitals.. in improving
their emergency management planning, response, and
recovery capabilities for unplanned and planned events.”   
IN PRACTICE
Healthcare organizations can used the guidance of the ICS
to assign emergency program managers to their roles
.   
ICS techniques can also be used to develop 
Incident
Planning Guides 
that help hospitals deal with specific types
of medical surges. 
Threat assessments and emergency exercise can also be
based on ICS doctrine.
(EMSA, 2021)
MODULE 3
SOURCES
DHHS (2007). Medical surge capacity and capability: A management system for integrating medical 
and health resources during large-scale emergencies. Retrieved from
https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf
EMSA. (2021). Hospital Incident Command System. EMSA.
https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-
resources/
  
FEMA. (2018). ICS Course. FEMA. 
https://training.fema.gov/is/courseoverview.aspx?code=is-100.c
 
HHS. (2021). ICS  and Hospital ICS. 
https://www.remm.nlm.gov/ics_hics.htm
 
HHS. (2012). What is Medical Surge? 
https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedic
alsurge.aspx
 
JCAO (2006). Surge hospitals: Providing safe care in emergencies. Retrieved from 
https://www.jointcommission.org/assets/1/18/surge_hospital.pdf
 
PUBLIC
HEALTH
POLICY 
MODULE 2 SECTION
By Hannah Leonard
EDM 412 - Emergency Healthcare Logistics in Disasters 
Dr. Christopher Janik
July 28, 2021
EMERGENCY SUPPORT FUNCTION #8
ESF#8 refers to our Public Health and Medical Services. This function
directly correlates with federal support mechanisms and their ability to
provide both domestic and international assistance  (FEMA, 2016, p.8-1).
KEY POINTS
SCOPE
The planning and coordination needed to carry out federal
healthcare delivery relies on the concepts of ESF#8. This
includes the protection of core functional areas like patient
care and mass fatality management.    
CORE CAPABILITIES
This includes any capabilities directly related to the public
health sector such as 
Transportation, Supply Chain
Logistics, and Public Warning Systems.   
THE ROLE OF FEDERAL AGENCIES
ESF#8 states that the Department of Health and Human
Services is primarily tasked with taking action against
public health emergencies. The Department of Defense and
Department of Homeland Security also play major
supporting roles.
(FEMA, 2016)
PANDEMIC AND ALL-HAZARDS PREPAREDNESS
REAUTHORIZATION ACT
A law meant “to reauthorize certain programs under the Public Health
Service Act and the Federal Food, Drug, and Cosmetic Act with respect to
public health security and all-hazards preparedness ”, ultimately
bolstering the Department of Health and Human Services (DHHS, 2013).
KEY POINTS
RELATED LEGISLATION
This law also served as an amendment to the 
Public Health
Service Act
, by giving state governments more flexibility for
preparedness measures. The 
Project BioShield Act 
also
provided funding for these preparations.  
RELATED PROGRAMS
 Hospital Preparedness Program: 
promotes public health
readiness by funding medical supply stockpiles and other
resources for hospitals. 
Public Health Emergency Preparedness Cooperative
Agreement: 
A collective formed by SLTT leaders to fund local
public health departments.
(DHHS, 2013)
NATIONAL HEALTH SECURITY STRATEGY
“Provides a vision to strengthen our nation’s ability to prevent, detect,
assess, prepare for, mitigate, respond to, and recover from disasters... It
describes strategies to improve readiness and adapt operational
capabilities to address new and evolving threats.” (DHHS, 2021).
KEY POINTS
OBJECTIVE 1
To focus on the Whole-of-Government approach by forming
better partnerships between federal and SLTT levels of
government, in addition to international stakeholders.   
OBJECTIVE 2
To develop better defenses against 
Pandemic Infectious
Diseases
 and 
CBRN Threats
. This can be achieved by
expanding public health resource capacity. 
OBJECTIVE 3
To effectively utilize the capabilities of the Private Sector by
incentivizing stakeholders and improving medical supply
chains.
(DHHS, 2021)
NATIONAL INCIDENT MANAGEMENT SYSTEM
It is a system designed to guide all levels of government and other relevant
stakeholders during any large scale incidents by providing authorities with
shared vocabulary, systems, and processes (FEMA, 2017, p.1).
KEY POINTS
RESOURCE MANAGEMENT 
Relates to the mechanisms used to manage physical
resources, and the supply chain capabilities needed to
distribute them efficiently.    
COMMAND AND COORDINATION
Lays out an ideal framework for the organizational
structures needed to respond to disasters. Also builds upon
interactions between separate structures.    
COMMUNICATIONS AND INFORMATION MANAGEMENT
Describes the methods that incident managers can use to
guide their decision making processes and the way they
communicate gathered data.
(
FEMA, 2017
)
DOD DIRECTIVE 3025.1
This publication from the Department of Defense describes the protocols
used by military leaders when 
Defense Support Of Civil Authorities
(DSCA)
 operations are enacted (DOD, 2018).
KEY POINTS
ALL HAZARDS RESPONSE
When local capabilities prove to be insufficient, the 
Stafford
Act
 can be invoked in order to declare a state of emergency.
Military forces can then be deployed to aid in disaster relief
efforts.   
SUPPORT TO LAW ENFORCEMENT
When requested, DSCA operations can be activated to assist
local law enforcement with anything from antiterrorism
operations to border security details.  
  
OTHER RELEVANT SCENARIOS
Military forces can be deployed for many other reasons
under DSCA. This can include providing security at certain
political events, to assist the Secret Service, and event
provide support to postal services.
(DOD, 2018)
ROBERT T. STAFFORD DISASTER RELIEF AND
EMERGENCY ASSISTANCE ACT
This law designates accountable authority for most forms of federal
disaster response events. It is especially important for the operations of the
Federal Emergency Management Agency (FEMA, 2021).
KEY POINTS
DISASTER PREPAREDNESS PROGRAMS
This section of the Stafford Act lays out grant plans for State
governments and federal organizations to ensure pre-
disaster readiness. It also discusses interagency task forces
and resources the mitigation measures needed for
infrastructure damage.
DISASTER AND EMERGENCY RESPONSE PROGRAMS
Establishes guidelines for the roles of 
Federal Coordinating
Officers 
and 
Emergency  Support  Teams
. This section also
discusses reimbursement measures for government
agencies and other forms of disaster assistance,
(FEMA, 2021)
MODULE 2
SOURCES
CDC. (2021). Public Health Emergency Preparedness (PHEP) Cooperative Agreement. 
https://www.cdc.gov/cpr/readiness/phep.htm
 
DHHS. (2013). Pandemic and All-Hazards Preparedness Reauthorization Act. Retrieved from 
https://www.phe.gov/Preparedness/legal/pahpa/Pages/pahpra.aspx
 
DHHS. (2021). National Health Security Strategy. Retrieved from 
https://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx
 
DOD. (2018). DoD Directive 3025.1: Military Support to Civil Authorities (MSCA). DOD. 
https://fas.org/irp/doddir/dod/jp3_28.pdf#page=1
 
FEMA. (2016). Emergency Support Function (ESF) #8, National Response Framework. 
https://www.fema.gov/sites/default/files/2020-07/fema_ESF_8_Public-Health-Medical.pdf
 
FEMA. (2017). National incident management system. FEMA. 
https://www.fema.gov/sites/default/files/2020-07/fema_nims_doctrine-2017.pdf
 
FEMA. (2021). Stafford Act. FEMA. 
https://www.fema.gov/disaster/stafford-act
 
MAJOR PUBLIC
HEALTH ROLES
MODULE 1 SECTION
By Hannah Leonard
EDM 412 - Emergency Healthcare Logistics in Disasters 
Dr. Christopher Janik
July 28, 2021
PUBLIC HEALTH NURSE
“Public health nursing is “the practice of promoting and protecting the
health of populations using knowledge from nursing, social, and public
health sciences.” (APHN, 2014, p.5).
The Role Of Phn Throughout The Disaster Cycle
PREPAREDNESS
PHN workers are expected to perform threat assessments
prior to emergencies, while also creating develop care plans
to tackle perceived obstacles,     
RESPONSE
Triage Algorithms 
are developed from data collected by PHN
workers and similar support personnel. This helps to
support the ongoing response planning needed for the
National Incident Management System.   
   
RECOVERY
Evaluations for the long term impact of disasters are
supported by PHN data. This also assists in the delivery of
rapid needs assessments.
(APHN, 2014, p.7-8)
ENVIRONMENTAL HEALTH SPECIALIST
“Environmental health professionals: Find response activities by environmental health
mission to help you fulfill your important roles in all-hazards emergency preparedness,
response, recovery, and mitigation.” (CDC, 2018). 
HOW EHS HELP TO PROTECT THE FOUR MAJOR AREAS
SAFE WATER
EHS workers can monitor a water supplies for substances like 
Legionella
bacteria
, which cause over half of all waterborne disease outbreaks. 
FOOD SAFETY
Foodborne outbreaks are prevented through proper environmental
health practices. This allows restaurants and other institutions to be
regulated by FDA standards.  
ENVIRONMENTAL HEALTH PRACTICE
By strategically placing EHS workers throughout critical areas in a
community, authorities can improve health standards overall 
VESSEL SANITATION PROGRAM
Routine sanitation inspection are performed on cruise ships and other
maritime vessels to control the potential for other disease outbreaks.
(CDC, 2018).
EPIDEMIOLOGIST
“Epidemiology assesses the short- and long-term adverse health effects of
disasters to help guide emergency response and recovery efforts and
predict consequences of future disasters.” (CDC, 2019). 
HOW EPIDEMIOLOGIC TOOLS AND RESEARCH ENSURE
DISASTER PREPAREDNESS
Epidemiologists conduct morbidity and mortality
surveillance during disasters in order to keep the public
informed on the scope of a health crisis. 
Based off of the findings of epidemiologists, community
leaders can more accurately assess and update their
public health methods. 
Several epidemiological organizations exist to ensure
communication throughout the scientific community,
such as: 
The Community Assessment for Public Health Emergency
Response (CASPER) 
The Disaster Epidemiology Community of Practice (DECoP)
The National Center for Environmental Health
(CDC, 2019)
MENTAL HEALTH PROVIDER
“Even when immediate danger has passed, the impact can still be felt...
When thinking about rebuilding their lives [many] may feel overwhelmed
and not know how to begin. Taking those first steps toward recovery can be
easier with a little support.” (American Red Cross, 2021). 
THE IMPORTANCE OF MEETING MENTAL HEALTH NEEDS
FOLLOWING A DISASTER 
An individual's ability to recover from a disaster is severely
impacted by the state of their physical, psychological, and
social characteristics: meaning that mental care can
significantly improve recovery. 
Mental health providers can assist disaster victims with a
number of stressors, to include: 
Dealing with injuries  sustained during a disaster. 
The stress caused by a lack of financial assistance needed
to rebuild. 
The stress of submitting an insurance claims. 
The trauma caused from seeing others harmed and/or
dying.
(Aitsi-Selmi, Blanchard, & Murray, 2015, p.34)
MEDICAL RESERVE CORPS
“The Medical Reserve Corps (MRC) is a national network of volunteers, organized
locally to improve the health and safety of their communities.” 
(MRC, 2021)
HOW THE MEDICAL RESERVE CORPS WORKS TO SUPPORT PUBLIC
HEALTH
TYPES OF MRC VOLUNTEERS
MRC volunteers include individuals with and without healthcare
backgrounds, They can assist in critical roles such as: 
Blood Clinic Technicians 
Medical Administrator
Public Health Nurse
ACTIVITIES SUPPORTED BY MRC VOLUNTEERS
MRC volunteers actively run critical public health resources
like:
Responder Rehabilitation
Vaccination Clinics
Veterinary Support Centers
Medical Surge Facilities
(MRC, 2021)
MODULE 1
SOURCES
Aitsi-Selmi, Blanchard, & Murray. (2015). The role of public health within the United 
Nations post-2015 Framework for Disaster Risk Reduction. International Journal of Disaster
Risk Science, 6(1) 28–37. Available at Trident Online Library. 
American Red Cross. (2021). Disaster Mental Health. American Red Cross. 
https://www.redcross.org/about-us/our-work/disaster-relief/disaster-mental-health.html
 
APHN. (2014). The role of the public health nurse in disaster 
preparedness, response, and recovery. Association of Public Health Nurses.
https://www.naccho.org/uploads/blog/nacchopreparedness/APHN_Role-of-PHN-in-Disaster-
PRR_FINALJan14.pdf
 
CDC. (2018). Environmental health services: Emergency and terrorism preparedness for 
Environmental Health Practitioners. Retrieved from
https://www.cdc.gov/nceh/ehs/etp/default.htm
 
CDC. (2019). Disaster Epidemiology & Response. CDC. 
https://www.cdc.gov/nceh/hsb/disaster/default.htm
 
MRC. (2021). About the Medical Reserve Corps. MRC. 
https://mrc.hhs.gov/pageViewFldr/About
 
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Medical surge logistics play a critical role in providing adequate medical evaluation and care during events that overwhelm the normal medical infrastructure of a community. This capability is essential to effectively manage the complex challenges posed by terrorist attacks, natural disasters, and other abnormal events. By recognizing the triggers and effects on national security, healthcare systems can better prepare for and respond to medical surges, ensuring timely and effective care for those in need.


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  1. Medical Surge Logistics MODULE 4 SECTION

  2. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  3. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  4. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  5. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  6. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  7. Medical Surge Medical surge describes the capability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. (HHS, 2012). KEY POINTS EFFECT ON NATIONAL SECURITY The major terrorist attacks directed against the United States in the early 2000s (EX: September 11th and the Anthrax Attacks) and large-scale natural disasters (EX: Hurricane Katrina) brought national attention to the common issues seen in hospital capacity. It poses an extremely complex management dilemma that can hinder recovery efforts. TRIGGERING EVENTS A Medical Surge is virtually always caused by an abnormal event. Terrorist attacks, natural disasters, CBRNE outbreaks, and infectious diseases are among the most commonly discussed events. (DHHS, 2007)

  8. DHHS (2007). Medical surge capacity and capability: A management system for integrating medical and health resources during large-scale emergencies. Retrieved from https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf EMSA. (2021). Hospital Incident Command System. EMSA. https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system- resources/ FEMA. (2018). ICS Course. FEMA. https://training.fema.gov/is/courseoverview.aspx?code=is-100.c HHS. (2021). ICS and Hospital ICS. https://www.remm.nlm.gov/ics_hics.htm HHS. (2012). What is Medical Surge? https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedic alsurge.aspx JCAO (2006). Surge hospitals: Providing safe care in emergencies. Retrieved from MODULE 4 SOURCES https://www.jointcommission.org/assets/1/18/surge_hospital.pdf

  9. Medical Surge Logistics MODULE 3 SECTION By Hannah Leonard EDM 412 - Emergency Healthcare Logistics in Disasters Dr. Christopher Janik August 15, 2021

  10. Medical Surge Capacity Medical surge capacity refers to the ability to evaluate and care for a markedly increased volume of patients... The surge requirements may extend beyond direct patient care to include such tasks as extensive laboratory studies or epidemiological investigations. (HHS, 2012). KEY POINTS CRITICAL RESOURCES When gauging a facility's resources there are a number of assets that should be tracked, namely: Medical & Pharmaceutical Equipment Staffing Available Beds CAPACITY MANAGEMENT Health Worker officials can use resources like the Strategic National Stockpile to fulfill equipment needs during times of duress. The Department of Defense also developed the Modular Emergency Medical Stem (MEMS) to help hospitals gauge appropriate staffing levels. (JCAO, 2006)

  11. Medical Surge Capability Medical surge capability refers to the ability to manage patients requiring unusual or very specialized medical evaluation and care. Surge requirements span the range of specialized medical services that are not normally available at the location where they are needed. (HHS, 2012). KEY POINTS THE QUALITIES OF MEDICAL SURGE CAPABILITY Some of the main factors that contribute to Medical Surge Capability are: Responder safety Information management Intergovernmental Coordination Timeliness MEDICAL SYSTEM RESILIENCY This term refers to a medical facility s ability to recover from a compromised state of healthcare provision. SUFFICIENCY OF CARE An organization also has to monitor the quality of the medical care being provided. Sufficiency of care measures the actual outcomes of treatment. (DHHS, 2007; JCAO, 2006)

  12. Medical Surge Capacity and Capability (MSCC) System The Medical Surge Capacity and Capability system is a formalized management strategy designed to foster a healthcare organization s Medical Surge Capability. It can be used by individual facilities or a network of operators. (DHHS, 2007) KEY POINTS INTEGRATION AND COORDINATION One of the main goals of the MSCC System is to encourage the facilitation of collaboration between local, State, Tribal, and Federal medical authorities. THE SIX-TIER CONSTRUCT The MSCC system organizes public health management into a tier list of responsibilities. They are as follows: 1. 2. 3. 4. 5. 6. Management of Individual Healthcare Assets Management of the Healthcare Coalition Jurisdiction Incident Management State Response and Coordination of Intrastate Jurisdictions Interstate Regional Management Coordination Federal Support to State, Tribal, and Jurisdiction Management *NOTE*: The MSCC System is NOT for internal operational management. (DHHS, 2007)

  13. MSCC System and The Incident Command System (ICS) The Incident Command System is derived from the directives of the National Incident Management System (NIMS), and covers the command, control, and coordination efforts of disaster response. It s frameworks can be used to guide medical surge management . (FEMA, 2018; HHS, 2021). KEY POINTS HOSPITAL INCIDENT COMMAND SYSTEM (HICS) HICS is a incident management system based on principles of the ICS, which assists hospitals.. in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. IN PRACTICE Healthcare organizations can used the guidance of the ICS to assign emergency program managers to their roles. ICS techniques can also be used to develop Incident Planning Guides that help hospitals deal with specific types of medical surges. Threat assessments and emergency exercise can also be based on ICS doctrine. (EMSA, 2021)

  14. DHHS (2007). Medical surge capacity and capability: A management system for integrating medical and health resources during large-scale emergencies. Retrieved from https://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf EMSA. (2021). Hospital Incident Command System. EMSA. https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system- resources/ FEMA. (2018). ICS Course. FEMA. https://training.fema.gov/is/courseoverview.aspx?code=is-100.c HHS. (2021). ICS and Hospital ICS. https://www.remm.nlm.gov/ics_hics.htm HHS. (2012). What is Medical Surge? https://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedic alsurge.aspx JCAO (2006). Surge hospitals: Providing safe care in emergencies. Retrieved from MODULE 3 SOURCES https://www.jointcommission.org/assets/1/18/surge_hospital.pdf

  15. PUBLIC HEALTH POLICY MODULE 2 SECTION By Hannah Leonard EDM 412 - Emergency Healthcare Logistics in Disasters Dr. Christopher Janik July 28, 2021

  16. EMERGENCY SUPPORT FUNCTION #8 ESF#8 refers to our Public Health and Medical Services. This function directly correlates with federal support mechanisms and their ability to provide both domestic and international assistance (FEMA, 2016, p.8-1). KEY POINTS SCOPE The planning and coordination needed to carry out federal healthcare delivery relies on the concepts of ESF#8. This includes the protection of core functional areas like patient care and mass fatality management. CORE CAPABILITIES This includes any capabilities directly related to the public health sector such as Transportation, Supply Chain Logistics, and Public Warning Systems. THE ROLE OF FEDERAL AGENCIES ESF#8 states that the Department of Health and Human Services is primarily tasked with taking action against public health emergencies. The Department of Defense and Department of Homeland Security also play major supporting roles. (FEMA, 2016)

  17. PANDEMIC AND ALL-HAZARDS PREPAREDNESS REAUTHORIZATION ACT A law meant to reauthorize certain programs under the Public Health Service Act and the Federal Food, Drug, and Cosmetic Act with respect to public health security and all-hazards preparedness , ultimately bolstering the Department of Health and Human Services (DHHS, 2013). KEY POINTS RELATED LEGISLATION This law also served as an amendment to the Public Health Service Act, by giving state governments more flexibility for preparedness measures. The Project BioShield Act also provided funding for these preparations. RELATED PROGRAMS Hospital Preparedness Program: promotes public health readiness by funding medical supply stockpiles and other resources for hospitals. Public Health Emergency Preparedness Cooperative Agreement: A collective formed by SLTT leaders to fund local public health departments. (DHHS, 2013)

  18. NATIONAL HEALTH SECURITY STRATEGY Provides a vision to strengthen our nation s ability to prevent, detect, assess, prepare for, mitigate, respond to, and recover from disasters... It describes strategies to improve readiness and adapt operational capabilities to address new and evolving threats. (DHHS, 2021). KEY POINTS OBJECTIVE 1 To focus on the Whole-of-Government approach by forming better partnerships between federal and SLTT levels of government, in addition to international stakeholders. OBJECTIVE 2 To develop better defenses against Pandemic Infectious Diseases and CBRN Threats. This can be achieved by expanding public health resource capacity. OBJECTIVE 3 To effectively utilize the capabilities of the Private Sector by incentivizing stakeholders and improving medical supply chains. (DHHS, 2021)

  19. NATIONAL INCIDENT MANAGEMENT SYSTEM It is a system designed to guide all levels of government and other relevant stakeholders during any large scale incidents by providing authorities with shared vocabulary, systems, and processes (FEMA, 2017, p.1). KEY POINTS RESOURCE MANAGEMENT Relates to the mechanisms used to manage physical resources, and the supply chain capabilities needed to distribute them efficiently. COMMAND AND COORDINATION Lays out an ideal framework for the organizational structures needed to respond to disasters. Also builds upon interactions between separate structures. COMMUNICATIONS AND INFORMATION MANAGEMENT Describes the methods that incident managers can use to guide their decision making processes and the way they communicate gathered data. (FEMA, 2017)

  20. DOD DIRECTIVE 3025.1 This publication from the Department of Defense describes the protocols used by military leaders when Defense Support Of Civil Authorities (DSCA) operations are enacted (DOD, 2018). KEY POINTS ALL HAZARDS RESPONSE When local capabilities prove to be insufficient, the Stafford Act can be invoked in order to declare a state of emergency. Military forces can then be deployed to aid in disaster relief efforts. SUPPORT TO LAW ENFORCEMENT When requested, DSCA operations can be activated to assist local law enforcement with anything from antiterrorism operations to border security details. OTHER RELEVANT SCENARIOS Military forces can be deployed for many other reasons under DSCA. This can include providing security at certain political events, to assist the Secret Service, and event provide support to postal services. (DOD, 2018)

  21. ROBERT T. STAFFORD DISASTER RELIEF AND EMERGENCY ASSISTANCE ACT This law designates accountable authority for most forms of federal disaster response events. It is especially important for the operations of the Federal Emergency Management Agency (FEMA, 2021). KEY POINTS DISASTER PREPAREDNESS PROGRAMS This section of the Stafford Act lays out grant plans for State governments and federal organizations to ensure pre- disaster readiness. It also discusses interagency task forces and resources the mitigation measures needed for infrastructure damage. DISASTER AND EMERGENCY RESPONSE PROGRAMS Establishes guidelines for the roles of Federal Coordinating Officers and Emergency Support Teams. This section also discusses reimbursement measures for government agencies and other forms of disaster assistance, (FEMA, 2021)

  22. CDC. (2021). Public Health Emergency Preparedness (PHEP) Cooperative Agreement. https://www.cdc.gov/cpr/readiness/phep.htm DHHS. (2013). Pandemic and All-Hazards Preparedness Reauthorization Act. Retrieved from https://www.phe.gov/Preparedness/legal/pahpa/Pages/pahpra.aspx DHHS. (2021). National Health Security Strategy. Retrieved from https://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx DOD. (2018). DoD Directive 3025.1: Military Support to Civil Authorities (MSCA). DOD. https://fas.org/irp/doddir/dod/jp3_28.pdf#page=1 FEMA. (2016). Emergency Support Function (ESF) #8, National Response Framework. https://www.fema.gov/sites/default/files/2020-07/fema_ESF_8_Public-Health-Medical.pdf FEMA. (2017). National incident management system. FEMA. MODULE 2 SOURCES https://www.fema.gov/sites/default/files/2020-07/fema_nims_doctrine-2017.pdf FEMA. (2021). Stafford Act. FEMA. https://www.fema.gov/disaster/stafford-act

  23. MAJOR PUBLIC HEALTH ROLES MODULE 1 SECTION By Hannah Leonard EDM 412 - Emergency Healthcare Logistics in Disasters Dr. Christopher Janik July 28, 2021

  24. PUBLIC HEALTH NURSE Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. (APHN, 2014, p.5). The Role Of Phn Throughout The Disaster Cycle PREPAREDNESS PHN workers are expected to perform threat assessments prior to emergencies, while also creating develop care plans to tackle perceived obstacles, RESPONSE Triage Algorithms are developed from data collected by PHN workers and similar support personnel. This helps to support the ongoing response planning needed for the National Incident Management System. RECOVERY Evaluations for the long term impact of disasters are supported by PHN data. This also assists in the delivery of rapid needs assessments. (APHN, 2014, p.7-8)

  25. ENVIRONMENTAL HEALTH SPECIALIST Environmental health professionals: Find response activities by environmental health mission to help you fulfill your important roles in all-hazards emergency preparedness, response, recovery, and mitigation. (CDC, 2018). HOW EHS HELP TO PROTECT THE FOUR MAJOR AREAS SAFE WATER EHS workers can monitor a water supplies for substances like Legionella bacteria, which cause over half of all waterborne disease outbreaks. FOOD SAFETY Foodborne outbreaks are prevented through proper environmental health practices. This allows restaurants and other institutions to be regulated by FDA standards. ENVIRONMENTAL HEALTH PRACTICE By strategically placing EHS workers throughout critical areas in a community, authorities can improve health standards overall VESSEL SANITATION PROGRAM Routine sanitation inspection are performed on cruise ships and other maritime vessels to control the potential for other disease outbreaks. (CDC, 2018).

  26. EPIDEMIOLOGIST Epidemiology assesses the short- and long-term adverse health effects of disasters to help guide emergency response and recovery efforts and predict consequences of future disasters. (CDC, 2019). HOW EPIDEMIOLOGIC TOOLS AND RESEARCH ENSURE DISASTER PREPAREDNESS Epidemiologists conduct morbidity and mortality surveillance during disasters in order to keep the public informed on the scope of a health crisis. Based off of the findings of epidemiologists, community leaders can more accurately assess and update their public health methods. Several epidemiological organizations exist to ensure communication throughout the scientific community, such as: The Community Assessment for Public Health Emergency Response (CASPER) The Disaster Epidemiology Community of Practice (DECoP) The National Center for Environmental Health (CDC, 2019)

  27. MENTAL HEALTH PROVIDER Even when immediate danger has passed, the impact can still be felt... When thinking about rebuilding their lives [many] may feel overwhelmed and not know how to begin. Taking those first steps toward recovery can be easier with a little support. (American Red Cross, 2021). THE IMPORTANCE OF MEETING MENTAL HEALTH NEEDS FOLLOWING A DISASTER An individual's ability to recover from a disaster is severely impacted by the state of their physical, psychological, and social characteristics: meaning that mental care can significantly improve recovery. Mental health providers can assist disaster victims with a number of stressors, to include: Dealing with injuries sustained during a disaster. The stress caused by a lack of financial assistance needed to rebuild. The stress of submitting an insurance claims. The trauma caused from seeing others harmed and/or dying. (Aitsi-Selmi, Blanchard, & Murray, 2015, p.34)

  28. MEDICAL RESERVE CORPS The Medical Reserve Corps (MRC) is a national network of volunteers, organized locally to improve the health and safety of their communities. (MRC, 2021) HOW THE MEDICAL RESERVE CORPS WORKS TO SUPPORT PUBLIC HEALTH TYPES OF MRC VOLUNTEERS MRC volunteers include individuals with and without healthcare backgrounds, They can assist in critical roles such as: Blood Clinic Technicians Medical Administrator Public Health Nurse ACTIVITIES SUPPORTED BY MRC VOLUNTEERS MRC volunteers actively run critical public health resources like: Responder Rehabilitation Vaccination Clinics Veterinary Support Centers Medical Surge Facilities (MRC, 2021)

  29. Aitsi-Selmi, Blanchard, & Murray. (2015). The role of public health within the United Nations post-2015 Framework for Disaster Risk Reduction. International Journal of Disaster Risk Science, 6(1) 28 37. Available at Trident Online Library. American Red Cross. (2021). Disaster Mental Health. American Red Cross. https://www.redcross.org/about-us/our-work/disaster-relief/disaster-mental-health.html APHN. (2014). The role of the public health nurse in disaster preparedness, response, and recovery. Association of Public Health Nurses. https://www.naccho.org/uploads/blog/nacchopreparedness/APHN_Role-of-PHN-in-Disaster- PRR_FINALJan14.pdf CDC. (2018). Environmental health services: Emergency and terrorism preparedness for Environmental Health Practitioners. Retrieved from https://www.cdc.gov/nceh/ehs/etp/default.htm CDC. (2019). Disaster Epidemiology & Response. CDC. MODULE 1 SOURCES https://www.cdc.gov/nceh/hsb/disaster/default.htm MRC. (2021). About the Medical Reserve Corps. MRC. https://mrc.hhs.gov/pageViewFldr/About

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