Emergency Preparedness: State Efforts to Plan for Medical Surge Could Benefit from Shared Guidance for Allocating Scarce Medical Resources Page: 4 of 20
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including beds, workforce, equipment, and supplies; (2) identifying and
operating alternate care sites5 when hospital capacity is overwhelmed;
(3) registering and credentialing volunteer medical professionals; and
(4) planning for appropriate altered standards of cares in order to save the
most lives in a mass casualty event.
Federal and state entities both play roles in preparing for emergency
preparedness. The Department of Homeland Security (DHS) has the
overall federal responsibility under the Homeland Security Act of 2002 for
managing national emergency preparedness.7 In December 2006, the
Congress passed the Pandemic and All-Hazards Preparedness Act
(PAHPA). PAHPA designated the Secretary of Health and Human Services
as the lead official for all federal public health and medical responses to
public health emergencies, including medical surge.8 Under the federal
plan for responding to emergencies,9 states have responsibility for
producing emergency preparedness plans in coordination with regional
and local entities, and both DHS and the Department of Health and Human
Services (HHS) are responsible for supporting their efforts. In addition,
the Department of Defense (DOD) and the Department of Veterans Affairs
(VA) are expected to assist state and local entities in emergencies. A DOD
directive authorizes local military hospitals to coordinate with state and
local entities to plan for emergency preparedness, and DOD hospitals are
authorized to accept civilian patients in a mass casualty event.1 VA
policies and procedures allow VA hospitals to participate in state and local
5Alternate care sites deliver medical care outside of hospital settings for patients who
would normally be treated as inpatients.
sThe term "altered standards" generally means a shift to providing care and allocating
scarce equipment, supplies, and personnel in a way that saves the largest number of lives,
in contrast to the traditional focus of treating the sickest or most injured patients first. For
example, it could mean applying principles of field triage to determine who gets what kind
of care, changing infection control standards to permit group isolation rather than single-
person isolation units, changing who provides various kinds of care, or changing privacy
and confidentiality protections temporarily.
7See Pub. L. No. 107-296, 116 Stat. 2135 (2002).
sPub. L. No. 109-417, 101, 120 Stat. 2831, 2832 (2006) (codified at 42 U.S.C. 300hh).
9The National Response Framework details the missions, policies, structures, and
responsibilities of federal agencies for coordinating resource and programmatic support to
states, tribes, and other federal agencies.
'oDOD Directive 3025.1, Military Support to Civil Authorities 22.214.171.124 and 4.5.1 (Jan. 15,
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United States. Government Accountability Office. Emergency Preparedness: State Efforts to Plan for Medical Surge Could Benefit from Shared Guidance for Allocating Scarce Medical Resources, text, January 25, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc290623/m1/4/: accessed April 22, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.