2010 Testimony

2009 Testimony

The Hospital & Healthsystem Association of Pennsylvania (HAP) represents and advocates for the more than 252 acute and specialty care hospitals and health systems across the Commonwealth of Pennsylvania, and the patients they serve. HAP appreciates the opportunity to present testimony regarding closing the gap in medical surge capacity in Pennsylvania, the nation’s sixth most populous state.

Pennsylvania’s proximity to the nation’s capital and other metropolitan areas, such as New York City, make it a vital part of the Mid-Atlantic Region. However, these characteristics, combined with Pennsylvania’s unique geography, also make it vulnerable to natural and man-made risk, along with being susceptible to the effects of a larger regional incident.

Currently, health care systems are operating at or near capacity. Rural, suburban, and urban areas in the commonwealth each face the challenge of little flexibility for absorbing a substantial surge in demand for care. Current guidance suggests that a community, including hospitals, should be prepared to self-sustain for up to seventy-two (72) to ninety-six (96) hours before federal relief resources may arrive.

Federal money that has been allocated for medical surge has been supportive of building medical surge capacity in Pennsylvania, especially enhancing event management. Over the past several years, hospitals have purchased decontamination units and supplies; radios for communication, triage tags, and established limited stockpiles of supplies and pharmaceuticals. Overarching emergency plans have been developed and exercised. Lessons learned from exercises have provided an opportunity to improve emergency plans and staff training. Hospitals and health systems have been working on flexible strategies to accommodate internal medical surge capacity. While hospitals have thought about the flexibility to accommodate medical surge, capacity to accommodate surge must continue to be expanded and grown.

The H1N1 outbreak illustrates how hospitals found the flexibility to accommodate a medical surge. Hospitals established alternate treatment sites for influenza-like illnesses outside of the emergency department. One hospital used an adjacent building to the emergency department to direct anyone with influenza-like illness to be screened at that location before entering the emergency department. Other hospitals established trailers on hospital property to be the sole location to screen and treat influenza-like illness. Other hospitals established clinics to treat influenza-like illness in other non-patient care areas in their facility. As they worked to address increased outpatient volume because of H1N1, hospitals used supplies from their in-house stockpiles. Hospitals relied upon plans that were exercised and revised. Staff was familiar with plans that were activated due to training and exercises.

However, hospitals faced challenges during the H1N1 outbreak, including supply shortages of N95 respirators and antiviral pharmaceuticals. Some hospitals experienced double or more of normal emergency department visits due to H1N1, stretching staff and other resources as they cared for patients.

Continued federal disaster preparedness funding will help hospitals to expand medical surge in Pennsylvania. Dedicated funding for medical surge capacity planning targeted to the regional level is critical. Four key areas to focus expansion of medical surge capacity include staff, resources, facilities, and infrastructure:

Staffing

In Pennsylvania, there are multiple databases, such as SERVPA, to access additional staff in a medical surge scenario. HAP suggests it is appropriate to move forward from the databases to organizing and training individuals listed in the databases for possible medical surge scenarios.

Resources

As the H1N1 outbreak grew, hospitals used their limited stockpile of N95 respirators and antiviral pharmaceuticals. Hospitals shared the challenges and concerns about the inability to receive ordered materials due to a six- to eight-month back order. HAP suggests that public policymakers examine avenues to provide a robust supply chain of needed resources to health care facilities in the event of a peak demand that could occur in an outbreak, such as H1N1, or in a major disaster.

Facilities

Hospitals have examined ways to create surge capacity within their own facilities and campuses. Hospitals also have worked with community partners to determine where alternate care sites could be located. HAP suggests that the multi-disciplined community planning efforts for medical surge continue.

Infrastructure

When hospitals surge into non-traditional patient care spaces, such as a lobby, it is necessary to determine how to support the needs of medical care that may occur there such as oxygen, suction, and cardiac monitors. The same holds true if an alternate care site is opened in a school or library. How is medical care supported in that venue? HAP suggests that efforts should continue regarding how to support alternate care sites on hospital campuses, as well as off-campus sites such as a library or school.

HAP and its member hospitals and health systems appreciate the opportunity to submit testimony and to provide the Pennsylvania hospital and health system community’s perspective on medical surge. HAP supports continued federal funding for disaster preparedness to enable hospitals and health systems to respond to health care needs that can arise during major public health crises, natural disasters, or other disaster events.

HAP looks forward to future discussions on this important issue. If you or your staff has any questions about this issue, feel free to contact Michael Strazzella, vice president, federal relations, at mstrazzella@haponline.org or (202) 863-9287; or Kirsten Saweikis Sullivan, director, outpatient services & community health, at ksullivan@haponline.org or (717) 561-5356.

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