Core Concept: Using Existing Infrastructure, the Provision of Large Scale Accessibility

Patient Care Augmentation Plan for Influenza Pandemic; Concept Paper

I. Core Concept: This Concept Paper provides a means for the New Jersey Department of Health and Senior Services and supporting governmental agencies, using existing infrastructure, to provide statewide accessibility to tailored medical information and select patient home medical treatment during an influenza pandemic.

Goals:

-  Reduce patient flow to acute care health facilities

-  Provide tailored medical information to state residents and visitors

-  Track epidemic

-  Augment existing influenza prophylaxis and treatment programs

-  Support state pandemic strategy to include social distancing, containment, and appropriate care

-  Address specialized medical needs of populations effected by the pandemic

Key Principles:

-  Use of existing regional Medical Coordination Centers (MCCs) as foci for regional public health operations to include phone bank operations, dispatch, medical advice, security, Medical Reserve Corps operations, anti-viral pharmaceutical operations, and EMS coordination.

-  Use of Regional Health Agency (LINCS) Health Officers as Incident Commanders for these regional centers

-  Incorporation of Local Health Departments in the regional response

-  Use of Medical Reserve Corps

-  Home visits for populations with special medical needs

-  Home Isolation/Quarantine support

-  Time expansion; slowing of influenza transmission as a means for lower patients/day

II. Concept of Operations:

A. General

1. Using existing New Jersey Medical Coordination Centers, LINCS Health Officers will direct a regional public health response during an influenza pandemic supportive of state plans and the need for augmented patient care. The goal is to control patient flow to existing health care facilities and to reduce the number of patients presenting at acute care facilities during a pandemic, to provide surge support to existing patient care operations, to provide access to care for populations with special needs, and to support the NJ pandemic response strategy that includes social distancing and other non-pharmaceutical interventions.

2. The State’s nine (9) Medical Coordination Centers will enact a Pandemic Influenza Response Plan under the direction of the NJ Department of Health and Senior Services and the local leadership of a LINCs Health Officer that: (1) accommodates the set-up and staffing of a phone center (2) staffs the MCC with Infectious Disease medical staff able to provide guidance to phone staff and medical command to field staff (3) provides data entry staff responsible for tracking calls and input of data into the State’s HIPPOCRATES and CDRS software, (4) provides dispatch capability in support of public health and medical house calls, (5) provides security staff with the authority to direct state or local law enforcement in support of the public health effort (6) provide mental health support for health staff.

3. Public Information campaigns will announce the availability of the MCC hotlines and reinforce the use, capabilities and restrictions of this effort.

4. The plan is scalable in its ability to conduct these operations at levels from statewide to local.

B. Medical Information Program

1. DHSS will direct the activation of MCCs for the purpose of staffing medical information hotlines that provide residents and visitors with information related to a pandemic.

2. DHSS will develop answering guides and protocols for phone bank staff (Operators). Under the supervision of medical staff co-located at the MCC, Operators will triage phone calls into categories of (1) Information only, (2) Medical direction required, (3) Public Health Dispatch required.

3. DHSS will acquire a statewide 800 number that through tele-routing, will direct resident’s calls to the appropriate regional MCC.

C. House Call Program

1. DHSS will direct the dispatch of health professionals to private residences and fixed facilities under circumstances that support social distancing, reduction in patient flow to acute care facilities, and populations who are either unable to reach medical care or should not be moved based on medical or physical restrictions.

2. Regional MCCs will coordinate this “House Call” program with county and local health departments through use of MCC staff.

3. Criteria for dispatch include patient need, available health staff, and security. MCC’s will coordinate centralized dispatch, with staff originating from local health services. All dispatched staff will receive the highest level of influenza counter-measures available.

4. The “House Call” program is manpower intensive and requires appropriate medical and public health staff, medical protocols that ensure appropriate and legal medical assessment and treatment, and security to guarantee the safety of the House Call responders.

5. Medical command will originate from the MCCs modeled after the EMS medical command system. MCC’s will maintain a direct line for MCC medical staff. Cell phones are the primary communication mode between response teams and MCCs.

6. State, county, and local health and medical Staff are to be drawn from state, county and local health and medical communities supported by the NJ Medical Reserve Corp. Composition of the response teams is TBD. The EMS system is not considered for this program to enable maintenance of the primary EMS mission. The limiting factor of this program is trained and willing staff.

7. The House Call program will use Dispatch/appointment software (funded by DHSS) to connecting MCC phone banks and responder base of operations.

8. This program is dependent on continued public confidence that a call to this program will result in a timely response (time from call to MCC to house call appointment, and timely arrival of health team are acceptable to public) and satisfactory medical care is provided by response teams.

9. House Call operations would be initiated at a point where the daily healthcare system required surge support lest the system begin to fail, and terminate when the number of request for house calls supercede the ability for the responders to react in a timely manner. Declaration of Public Health Emergency in accordance with then New Jersey Health Emergency Powers Act is a pre-requisite for this operation.

10. The House Call program may be augmented by an Alternate Care Site Triage program for those patients physically, and with the transportation capabilities, able to travel to a surge capacity facility.

III.  Summary

1. Recognizing a need to provide surge support to New Jersey’s health care system during an influenza pandemic, and recognizing the need to use non-traditional methods to support a health response to this large scale public health emergency, DHSS will use existing health infrastructure to provide residents and visitors a means for receiving medical advice and selective medical care during an influenza pandemic emergency.

2. This operation will control patient flow to existing health care facilities and to reduce the number of patients presenting at acute care facilities during a pandemic, to provide surge support to existing patient care operations, to provide access to care for populations with special needs, and to support the NJ pandemic response strategy.

3. The operation is highly dependent on coordination of the vertical governmental infrastructure and on staff capable and willing to conduct patient visits during an influenza pandemic.

4. Upon completion of a feasibility, acceptability and suitability study in January 2007, DHSS will pilot this program to determine full scale implementation.