National Hospital Preparedness Program:Priorities, Progress & Future Direction

Gregg Pane, MD, MPA, FACEP

Director

National Healthcare Preparedness ProgramsHHS/ASPR

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Mission Statement:

“To ready hospitals and supporting health care systems,

in collaboration with other partners,

to deliver coordinated and effective care,

to victims of terrorism and other public health emergencies “

Hospital Preparedness Program (HPP)

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Pandemic and All Hazards Preparedness Act (PAHPA)

Signed into law December 2006

Establishes the ASPR– Leadership– Personnel– Countermeasures– Coordination– Logistics

HRSA program ASPR

Title III: All Hazards Medical Surge Capacity– Transfers NDMS from DHS to HHS– Section 302: Enhancing Medical Surge Capacity– Section 305: Partnerships for State and Regional Hospital Preparedness to Improve

Surge Capacity

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FY02-FY08 HPP Funding History

Fiscal Year (FY)Cooperative Agreements

(millions)

Healthcare Facility Partnerships

(millions)

FY 2002 $125 n/a

FY 2003 $498 n/a

FY 2004 $498 n/a

FY 2005 $471 n/a

FY 2006 $460 n/a

FY 2007 $415Facilities $18

E-care $25

FY 2008 $398 n/a

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Tiers of Response

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FY08 HPP Funding Opportunity ($398M)

$398M in Cooperative Agreement Funds Released August 2008

Overarching Requirements:

– National Incident Management System (NIMS)

– Education and Preparedness Training

– Exercises, Evaluation and Corrective Actions

– Needs of At-Risk Populations

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FY08 HPP Funding Opportunity

Required Activities (Level One sub-capabilities)– Interoperable Communications Systems– ESAR VHP– Tracking of Bed Availability (HAvBED)– Fatality Management– Medical Evacuation / Shelter-in-Place– Partnership/Coalition Development

Once all the above are met in full States may propose a host of other activities:– PPE, Decon, Pharm Caches– ACS and Mobile Medical Assets– CIP– MRC

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FY08 HPP Funding Opportunity

Significantly increased accountability in 2008 that will affect funding in 2009:

– Meeting mid year and end-of-year targets for performance measures– Pan Flu plan submission and successful “grade” on medical surge

and fatality management sections– Not exceeding established maximum carry-over limits– Maintenance of Effort for State funding

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Performance Measures

State/Territory can report available beds for at least 75% of participating hospitals per HAvBED definitions

S/T can query ESAR-VHP system during drill/exercise/event and generate list of potential VHP, by discipline and credential level, within 2 hours of request

S/T can compile initial list of VHP within 12 hours, and report verified list of available VHP with 24 hours of a request

S/T conducts statewide and regional exercises that incorporate NIMS concepts and principles, and include hospitals

Proportion of hospitals that can report beds by HAvBED within 60 minutes Hospitals demonstrate redundant communications capability; and two-way

capability with local Operations Command or coalition partners Hospitals have written plans for mass fatalities and medical evacuation Incorporate NIMS concepts/principles; identify training needs and verify courses

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Charting Progress: A Comparative Look at Hospital Preparedness FY02 to FY06

Preparedness Element 2002 2006

Federal GuidanceLimited infrastructure for integrated and

coordinated hospital preparedness activities among US hospitals

87% (5,067) of all US hospitals participate in HPP

Surge Bed Capacity No known surge bed capacity among US hospitals

Participating hospitals report the ability to surge over 200,000 beds above the current

daily bed staffed bed capacity within a 24-hour period.

DecontaminationTwo-thirds (66%) of hospitals report the

ability to handle less than nine patients an hour through a 5-minute decontamination

shower per 100 staffed beds

Over 400,000 persons could be decontaminated nationwide over a 3-hour

period.

Personnel TrainingSeven out of ten hospitals trained their

staff to diagnose biological-agent-related illnesses, with unknown extensiveness of

the training

629,083 healthcare personnel nationwide were trained in competency-based programs in fiscal

year 2006

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Charting Progress: A Comparative Look at Hospital Preparedness FY02 to FY06

Preparedness Element 2002 2006

Personal Protective Equipment

Half of all hospitals reported having three or fewer PPE suits

Nearly 80% (3995) of hospitals report having appropriate PPE for staff and volunteers

Isolation CapacityHalf of all hospitals reported having fewer

than four isolation beds per 100 staffed beds

Over 79% of US hospitals (4,655) report the capacity to maintain at least one suspected infectious disease case in negative pressure

isolation

Drills and ExercisesAbout half of all hospitals had

participated in drills or tabletop exercises focused on a biological attack during the

past two years

9751 drills, 2914 tabletop exercises, and 4120 functional exercises completed. Nearly 80% of hospitals prepared After Action Reports within

60 days of the drill or exercise

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Future Directions

Shared focus on required program performance metrics

Proactive approach to problem-solving; achieving goals

Broad, pre-decisional input on policy, guidance, measures

Adoption and spread of exemplary practices

Focus on health system preparedness and coordination

Medical surge and health system resiliency

Lessons and accomplishments from actual events

Longer planning cycle