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Institute for Crisis, Disaster, and Risk Management Crisis and Emergency Management Newsletter Website |
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January
2004
Volume 5
- Number 4 |
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New Plans for the Medical and
Public Health Community
Response System
By Ross Gartley
The bombing of the Alfred P. Murrah Federal building in 1995 coupled with the attacks of September 11th and the anthrax dissemination events in Florida, New York and the National Capital Region call attention to the fact that the continental United States of America faces a true threat of intentional mass casualty incidents caused by acts of terrorism. A mass casualty incident is an event in which the existing organizational and medical resources, or the management systems, are severely challenges or become insufficient in light of the event to adequately meet the medical needs of the affected population (Barbera, Macintyre 2002). Although initiatives to improve the capacity of the medical and public health communities to responds to mass casualty incidents namely through programs such as the Metropolitan Medical Response System have been undertaken by the Federal Government, the facts remains that the disjointed and ineffective mass casualty response evident during the TOPOFF 2001 exercises and the National Capital Region anthrax incident reflect a lack of a coordinated systems approach to the management of the Medical and Public Health community’s response (Barbera, Macintyre 2002).
The Metropolitan Medical Response System
(MMRS) The MMRS program provides funding and
guidance for a systems-based approach to WMD incident mass casualty
preparedness. The goal of the program is to enhance local first
responders, medical, public health and emergency planning to increase
capabilities to manage the incident until federal resources arrive.
Only those jurisdictions which have completed the development of the
baseline program through a targeted, need based sustainment activity. The MMRS program is located in the Emergency
Preparedness and Response Directorate of Preparedness Division in the
Department of Homeland Security Examination of the medical and pubic health community’s response to mass casualty events reveals a wide range of deficiencies such as a lack of standardized operational definitions of mass casualty care and inadequate descriptions of system requirements for comprehensive mass casualty care. Future exacerbating the situation is the sheer scope of the standardization effort. A response to a mass casualty incident involves numerous public and private entities, including healthcare facilities, public health departments, emergency medical services, medical laboratories and individual healthcare practitioners. These entities all have distinct organizational structures, agendas and core missions that markedly differ from one another (Barbera, Macintyre 2002). 2.0
Proposed Goals and Objectives In an effort to address these deficiencies, Joseph Barbera M.D. and Anthony Macintyre M.D. developed the Medical and Health Incident Management (MaHIM) system. This all hazards system aims to reduce future morbidity and mortality in mass casualty incidents and other emergencies through “a functional model system that promotes optimal medical management and response operations by delineating organizational responsibilities, interorganizational relationships and critical coordination process” (Barbera, Macintyre 2002). The MaHIM system model is based on preexisting medical, public health and emergency management science and practices and includes general concepts from the ICS (Barbera, Macintyre 2002). It has also been designed to meet or exceed the requirements of the MMRS contracts. The three primary medical objectives to achieve this goal are:
3.0
Development of Functional Model The MaHIM system is based upon three core principles: 3.1 Medical and Health Management MaHIM provides a single, comprehensive system for management of medical and health assets in emergencies and disasters. Because of the inherent nature of the medical and health organizations, organization of these entities occurs through “management” and not “control” (Barbera, Macintryre 2002). The specific usage of the term “management: reflects the realities that medical and health assets are generally autonomous entities and not connected through a defined “command” structure, whereas those organizations that use the ICS operate under a command structure. The management framework must be based upon “authority generated by responsibility, and/or a willingness to participate, rather tan by only statutory or regulatory power” (Barbera, Macintyre 2002). Management methodology is developed in MaHIM, incorporating concepts such as the planning process. This process incorporates a planning cycle (Appendix I) which allows for a transition to “proactive management as an incident evolves instead of remaining in a purely reactive management posture” (Barbera, Macintyre 2002). 3.2 Information
Management Recognizing the conditions that shape the value of health and medical data and information generated during an incident response, MaHIM provides an information architecture subsystem that describe the “procedures to capture, analyze, and appropriately disseminate essential information throughout the response system” (Barbera, Macintyre 2002). As with all responding entities, the dissemination of timely and accurate information presents one of the greatest challenges to consequence management and it is the goal of this subsystem to ameliorate the process. 3.3 Functional Description of Medical Response MaHIM provides a description of the principle functions that may be required in the medical and health community’s response to a mass casualty event and organizes them into a structured framework that maximizes the effectiveness of community resources (Barbera, Macintyre 2002). By “clearly defining the purpose of each function and by grouping the previously disconnected activities within those functions, processes and relationships, a more powerful and effective medical and health consequence management capability will emerge” (Barbera, Macintyre 2002). 4.0
Systems Description MaHIM system is structured according to the architecture of successful incident management. There three principle parts of the system are divided into the Medical and Health Management Functional Area, the Medical and Health Operations Area and the Medical and Health Support Functions Area.
http://www.gwu.edu/~icdrm/download/MaHIM_V2_final_report_sec%202.pdf 4.1 Medical
and Health Management Function This function of the MaHIM system is responsible for the entire incident response and addresses all strategic incident issues. It is responsible for setting the overall goals and objectives for the incident response and defines the major incident management parameters. The management function is best described as ““management by objectives”, with the incident-specific objectives and priorities developed during the planning cycle” (Barbera, Macintyre 2002). The Medical and Health Management Function’s responsibilities include:
4.2 Medical
and Health Operations Function This function of the MaHIM system is responsible for overseeing and coordinating all activities that are directly responsible for accomplishing the strategic goals and objectives established by Management. The Medical and Health Operations Function establishes the methods necessary to achieve Management’s objective. Components of the Medical and Health Operations Function include:
4.3 Medical
and Health Support Functional Areas These functions assist the Management and Operations Areas in accomplishing their goals and objectives. This support functions provides logistical support, planning and information support and administrative/ finance support. 5.0
Conclusion Although the impetus for the development of the MaHIM System was the need to address serious deficiencies in the Medical and Public Health community’s response to mass casualty incidents, it is important to note that the MaHIM System has practical applications to the management of everyday medical and public health problems as well. This is extremely important as it promotes not only familiarity with the system, but also cost effectiveness. The cost-effective nature of the MaHIM System is of paramount importance due to the fact that a response system must always be ready, enduring and sustainable which requires significant human and capital investment by the various responding entities in preparation measures as the need for adequate preparation is a precursor to any successful response.
Appendix I
: The Planning Cylce
http://www.gwu.edu/~icdrm/download/MaHIM_V2_final_report_sec%202.pdf The planning cycle defines processes for establishing objectives and strategy based upon the medical characteristics of an incident; addressing current needs and projecting future requirements; and providing management guidance across the system (Barbera, Macintyre 2003)
Appendix
II: Acronyms ICS: Incident
Command System MaHIM: Medical and Health Incident Management System MMRS: Metropolitan Medical Response System WMD: Weapons of Mass Destruction Sources Barbera J.A., Macintyre A.G. Medical and Health Incident Management (MaHIM) System: A Comprehensive Functional System Description for Mass Casualty Medical and Health Incident Management. Institute for Crisis, Disaster and Risk Management, The George Washington University. Washington, D.C. October 2002 Barbera J.A., Macintyre A.G., DeAtley C.A. Ambulances to Nowhere: America’s Critical Shortfall in Medical Preparedness for Catastrophic Terrorism. Belfer Center for Science and International Affairs Discussion Paper 2001-15, executive Session on Domestic Preparedness Discussion Paper ESDP-2001-07, John F. Kennedy School of Government, Harvard University, October 2001 The Metropolitan Medical Response System, Department of Homeland Security: Emergency Preparedness and Response Directorate Preparedness Division http://www.mmrs.hhs.gov |
