If resource sharing is an objective of the Coalition, issues should be identified and addressed during the development of any mutual aid or cooperative assistance instrument. Documenting the types of resources that may be shared and the process and expectations of the sharing arrangement enhances the potential for response success.
7.3.1 Personnel
The resource category that may require the most attention in written mutual aid and cooperative assistance instruments is the sharing of personnel. A range of healthcare professionals could be shared between Coalition members during emergency response. In addition to the usual attention to healthcare providers, important assistance may be obtained through the sharing of security officers, facility engineers, mid-level managers, and others. The following issues should be addressed:
Credentialing, Licensure, and Privileges
The differences between credentialing, privileging, and badging were explained in Section 6.2.1. Healthcare organizations typically use a credentialing and privileging process on a day-to-day basis before allowing healthcare providers to practice in the organization. During normal operations, the verification of credentials is designated “primary source verification,” since it involves contacting each credential granting organization directly and verifying credentials submitted by the applicant. This process is time and labor intensive, and for these reasons it is prohibitive for granting emergency privileges during the response to an emergency. The following alternative processes may be incorporated into the Coalition’s mutual aid documents:
- Procedures may be established to expedite the credentialing and privileging process for donated personnel. These processes rely on “secondary source verification” in which the work performed by another accredited healthcare organization is temporarily used as adequate verification for granting privileges. Thus, verification that an individual is credentialed and privileged at a similar accredited healthcare organization within the Coalition may suffice for granting emergency privileges. The Joint Commission has addressed this issue in its standards and requires primary verification of licensure within 72 hours of granting emergency privileges.[5]
- Primary source verification of basic healthcare credentials may be accomplished pre-incident for people who enroll in volunteer registration programs (e.g., Medical Reserve Corps, State ESARVHP programs). However, the receiving organization must still grant emergency privileges to donated personnel. A method must be established to verify the credentials before clinical privileges are granted. For example, the organization donating personnel may verify that they are currently employed with full clinical privileges and without pending investigation or sanctions.
Liability Coverage
Mutual aid instruments should stipulate how tort liability coverage will be maintained for healthcare providers that are shared between Coalition organizations. As this can be a complex issue, the emergency managers for Coalition members should seek advice from their legal counsel when writing these instruments.
One potential method to address tort liability coverage is to extend liability coverage from the assisting organization to its personnel who are working at the supported organization. This may be accomplished by including mutual aid services within the organization’s scope of practice for that category of healthcare providers. The mutual aid instrument may stipulate that the costs of addressing legal issues under this liability coverage will be borne by the requesting organization for actions incurred during the emergency.
Other methods for addressing liability issues may be through State legislation. It is recommended that Coalitions consult their legal advisors when examining this area.
Worker’s Compensation
Worker’s compensation should also be addressed in the Healthcare Coalition’s written agreements. Similar to tort liability, this may involve extending coverage from the donating organization, but with reimbursement of costs if an adverse event occurs (e.g., medical bills, lost wages). Relevant insurance carriers who provide this coverage should be involved when examining solutions for a specific Coalition. It may become important to detail the safety practices that should be employed with personnel donated for emergency tasking (maximum shift length, safety supervision, etc.) when establishing this section of the written mutual aid agreement.
Supervision of Deployed Personnel
The Healthcare Coalition should consider the supervision of deployed personnel when developing the terms of mutual aid. Some issues that may be addressed include the following:
- Establishing the location where deployed personnel should initially report to in a supported institution
- Mandating briefing procedures to provide orientation and tasking for deployed personnel
- Badging procedures for deployed personnel
- Assigning a supervisor for donated personnel and establishing reporting requirements so the supported organization maintains control through its incident management processes
- Out-briefing donated personnel, which may include addressing any medical issues related to disease exposure or work-related injury
- Performance evaluations provided by an immediate supervisor.
Pre-Deployment Preparation
It may be useful for the Healthcare Coalition mutual aid instrument to stipulate a minimum level of preparedness for personnel who may be deployed, including training and pre-deployment briefing requirements. The following information should be provided to deploying personnel:
- Known details about the incident
- Expected roles for deployed personnel (e.g., specific assignment if known, the supervised nature of the assignment, the reporting requirements)
- Safety issues specific to the incident and a review of general safety measures
- Review of some of the protections afforded (e.g., tort liability and worker’s compensation coverage)
- Review of deployment checklists that may be developed to address items that personnel should have when deploying (bottled water, several changes of universal precautions equipment, other PPE, change of clothes, personal medications and toiletries, etc.).
7.3.2 Equipment/Supplies
When developing mutual aid instruments, the following categories of items should be considered:
- Pharmaceuticals
- Sterile supplies
- Blood products (many regions already have established agreements through the American Red Cross)
- Critical care equipment (e.g., ventilators, suction)
- Decontamination equipment and supplies (e.g., Personal Protective Equipment and other supplies)
- Equipment for evacuation (e.g., stretchers, chairs)
- Infrastructure equipment (e.g., generators, water purification equipment)
- Others (e.g., potable water stores, linen supplies).
An important resource distinction is differentiating between durable and non-durable supplies. The mutual aid instrument should address whether non-durable supplies (e.g., pharmaceuticals, sterile supplies) will be returned to the donating organization if unused and what storage conditions are necessary for the supplies to remain suitable for return. For durable items, the mutual aid instrument should specify any rehabilitation requirements or reimbursement to the donor organization for rehabilitation and the time frame for when durable items are to be returned after use.
7.3.3 Facilities
“Facilities” for healthcare mutual aid usually refers to staffed beds available for accepting patient transfers. The Healthcare Coalition’s mutual aid instrument should address the “typing” of staffed beds so Coalition members use consistent terminology when tracking the availability of beds. The Agency for Healthcare Research and Quality (AHRQ) has developed standardized hospital bed definitions.[6] It is important to ensure consistency with national standards.
In rare situations, the management of an entire facility or a portion of a facility might be turned over to another organization. For example, an outpatient care center could be used by another healthcare organization to screen patients who have been potentially exposed to an infectious agent. The Healthcare Coalition may want to address the following issues in its mutual aid instrument:
- How the facility could be used?
- What support from the facility’s owners will be required?
- How costs will be reimbursed?
- How rehabilitation of the facility will occur?
- The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Human Resources HR 1.25 and HR 4.35, July 2006.
- AHRQ Releases Standardized Hospital Bed Definitions to Aid Katrina Responders. September 2005. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/research/havbed/definitions.htm.
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