Deborah Smith, Manager, Clinical Services, James L. Paturas, Senior Deputy Director, Anthony Tomassoni, Medical Director and Joseph Albanese, Radiation Biodosimetrist, Yale-New Haven Center for Emergency Preparedness and Disaster Response
Abstract
The objective of the work described in this article was to develop the Hospital Emergency Support Function (HESF) model, which could be used by hospitals to augment medical surge capacity based on the reallocation of internal hospital personnel, in the wake of a catastrophic natural or manmade disaster. A group of subject matter experts, including clinicians with disaster response experience, hospital emergency coordinators and business continuity planners, was assembled to conceptualise the basic framework of the HESF model. The model was validated via feedback from a panel of decision makers at Yale-New Haven Hospital and development of a consensus among the panel, using a modified Delphi method. Hospital personnel and departments were reviewed, evaluated and stratified according to their latent contributions to medical surge capacity. Those pivotal to medical surge capacity were deemed HESFs, whereas those ancillary to medical surge capacity were considered non-critical or ancillary functions. Based on this classification, personnel assigned to non-critical hospital departments were identified as potentially divertible to HESFs, i.e. available to enhance medical surge capacity during a catastrophic emergency. The activation of the HESF model provides an alternative to utilising external resources for enhancing staffing during a medical surge event. The HESF model is based on the National Response Framework Emergency Support Functions and relies solely on internal hospital personnel to augment medical surge capacity in the event of a medical and public health crisis.
Keywords
hospital emergency support functions, medical surge capacity, hospital readiness, disasters
Deborah Smith is Manager, Clinical Services for the Yale-New Haven Center for Emergency Preparedness and Disaster Response (YNHCEPDR) and has more than 30 years of nursing experience in the emergency department setting. She has board certification in emergency nursing and is an active member of the Emergency Nurses Association. She is presently lead supervisory nurse of the CT-1 Disaster Medical Assistance Team. She has responded to multiple disasters, including Hurricanes Frances, Katrina and Gustav. She is a Homeland Security Exercise and Evaluation Program trained drills and exercise evaluator and provides training for hospital incident command systems, hazardous materials operations and various disaster-related education courses for healthcare agencies. In addition, she has served as an instructor for the US Department of State, Diplomatic Security Service, Antiterrorism Assistance Program (Bahamas). Ms Smith has assumed the position of Statewide Hospital Pandemic Influenza Coordinator, which includes serving as a member of the Connecticut Department of Public Health Pandemic Influenza Support Team, the Standard of Care Workgroup and the Supportive Care Shelter Workgroup, and providing coordination and guidance for the state acute care hospitals during the recent H1N1 outbreak.
James Paturas is the Senior Deputy Director for the YNH-CEPDR. He also serves as Director of the World Health Organization/Pan-American Health Organization (WHO/PAHO) Collaborating Centre for Emergency Preparedness and Disaster Response and the Connecticut Center of Excellence for Bioterrorism Preparedness and Response for the YNH Health System. Mr Paturas serves as the Vice Chairperson of the Connecticut Department of Health Public Health Preparedness Advisory Committee. He also serves on the Certified Emergency Manager (CEM) Commission for the International Association of Emergency Managers, the Department of Homeland Security (DHS) Healthcare Sector Coordinating Council and the Health and Human Services-Assistant Secretary for Preparedness and Response Joint Advisory Working Group Executive Team for the Healthcare and Public Health Sector Critical Infrastructure Protection programme. He has served on the National Fire Protection Association (NFPA) Technical Committee on Disaster Management which developed the NFPA 1600 Standard on Disaster/Emergency Management and Business Continuity Programs 2000 Edition and the 2006 Hospital Incident Command System IV Edition Review Group sponsored by the California Emergency Medical Services Authority.
Anthony J. Tomassoni practises emergency medicine, disaster medicine and medical toxicology at the Yale School of Medicine. He is the Medical Director of the YNH-CEPDR and the PAHO/WHO Collaborating Centre for Emergency Preparedness and Response for the YNH Health System. Dr Tomassoni also holds credentials in education, biochemistry and hyperbaric medicine. During training at the University of Cincinnati, he also served as a flight physician, an EMS medical director, and on the Greater Cincinnati Red Cross Medical Assistance Team. He has served on the Federal Emergency Management Agency’s Urban Search and Rescue Massachusetts Task Force 1 since 1995, responding to the 2001 World Trade Center collapse. He has taught at the Department of Homeland Security’s Noble Training Center and for the US Department of State’s Diplomatic Security Service Antiterrorism Assistance Program. Dr Tomassoni recently served on the Centers for Disease Control and Prevention’s Chemical Emergencies Workgroup and was the team leader for one of two Yale medical teams sent to Haiti after the 2010 earthquake. He received the American College of Emergency Physicians 2010 National Faculty Teaching Award.
Joseph Albanese is a radiation biologist and currently Radiation Biodosimetrist for the YNHCEPDR and the State of Connecticut. Dr Albanese is an experienced research investigator and Assistant Clinical Professor in the Department of Therapeutic Radiology and Pharmacology at the Yale University School of Medicine. Dr Albanese received his PhD in experimental medicine from McGill University and completed a post-doctoral fellowship at Yale University, where he worked on research focused on understanding the effects of ionising radiation on intercellular communication and global gene expression. Dr Albanese’s work has appeared in peer-reviewed literature, book chapters and other publications, and he has reviewed grant proposals for the US Department of Energy and the National Institutes of Health. He is a member of the International Society for Experimental Hematology, the American Society for Cell Biology, the American Society for Hematology, the Radiation Research Society, the Radiation Health Physics Society and the American Association for Cancer Research.
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