Emergency Management Strategies for Identifying and Integrating Community Resources to Expand Medical Surge Capacity: Ro

1. Emergency Management Strategies for Identifying and Integrating Community Resources to Expand Medical Surge Capacity: Role for Health Call Centers • Gregory M Bogdan, PhD • - Research Director & Medical Toxicology Coordinator • Rocky Mountain Poison & Drug Center – Denver Health • Associate Professor, Dept. Pharmaceutical Sciences • University of Colorado Health Sciences Center

2. Challenges For Healthcare • Lack of surge capacity in healthcare systems • Information and triage needs of “worried well” and “walking wounded” • Quarantine and isolation to halt spread of disease • Mass prophylaxis or immunization of communities • Pandemic or severe seasonal influenza

3. Estimates of Influenza Impact Demands for health resources during a severe influenza outbreak may cripple healthcare systems * % US population with a clinical case of influenza

4. Challenges for Preparedness • 2004 Redefining Readiness Project* • 60% of public would not heed official instructions to get vaccinated during smallpox outbreak • 40% of public would not heed official instructions to shelter in place during a dirty bomb incident • Its not disregard for authority, but the need to obtain additional information from a trusted source that would limit public compliance with these directives Need to educate, inform and support what the public should do in an emergency *R. Lasker, Center for the Advancement of Collaborative Strategies in Health

5. Public Does Rely Upon Call Centers in Emergencies Toronto lines received >300,000 calls with daily peak of 47,567 calls (using >200 PH nurses) Hotline Contacts (% population) Certain events (bioterrorism, child-targeted, new emerging disease) will effect the amount of public concern and numbers of people having information or others needs.

6. How Can Call Centers Help? Information partners relay accurate, up-to-date, consistent messages and collect data from public Public Health/Safety agencies announce health emergency Controlled Messages Uncontrolled Messages Public will initially receive information from the mass media Poison Center Nurse Line Health Hot Line Perhaps up to 25% of the public will have questions which call centers can help with 1 2 3 Interactive Response Recordings “Tools” for Call Center Responses

7. Health Call Centers Reduce Hospital Surges Everyday • United States Poison Control Centers • Of 2.4 million contacts about potential toxic exposures each year, 1.8 million (75%) are managed outside of health care facilities • Denver Health NurseLine • Manages 40% of callers at home • Study: 70% of callers change their plans after calling (most seek lower intensity of care than originally planned: home > clinic > ED)

8. Health Emergency Line for the Public (HELP) Model • Standardized, prepared response to public health events: • Providing consistent, accurate information • Collecting and maintaining structured data to characterize events and responses (for both sentinel events and situational awareness) • Capability and capacity to adapt to other public health emergencies (using technology & tools) • Operating daily since 2003 (7a-10p) and has responded to several major health events in Colorado • Used in annual WNV & influenza responses (>80,000 calls) • Collects data used for situational awareness (influenza, dead animal, emerging disease reports) • Model of poison center/public health partnership

9. HEALTHEMERGENCYLINEFOR THEPUBLIC Hospitals & Healthcare Facilities GOAL: “Preventing” Patient Surges to Overwhelmed Healthcare Agencies Medical Evaluation & Treatment H E L P Referral of Screened Patients For Triage & Evaluation Health Information General Public Triage & Decision Support Info Request Info Delivery Disease Surveillance Quarantine & Isolation Support Health Professionals Outpatient Drug Info & Adverse Events Real-Time Reporting of Collected Epidemiologic Information Local & State Public Health Agencies GOAL: “Redirection” of Contacts from Overwhelmed Health Agencies Epidemiologic Surveillance, Investigation & Control Measures, Prophylaxis (Operational Model From an AHRQ Task Order)

10. HELP’s First Test - 2003 Jul 22: Colorado (4.4 million) confirms 1st human WNV case, HELP launched just two hours prior • HELP received 12,150 calls (Jul 22 - Oct 11) including >2,500 dead bird reports (5 information providers) • 60% of callers serviced with upfront messaging • As of Oct 30: 47 deaths and 2,543 confirmed cases [Toronto (4.6 million) SARS experience - 44 deaths and 438 SARS cases]

11. Our Experience Shows • Need for and importance of providing information and support to public (trust) • Surveillance - not the original purpose of line, became an important function (data) • Structured hotline capabilities are an important response component (capacity) • Health call centers can and do serve a vital role in response efforts (ready or not) • Need tools and guidance for large events

12. Latest AHRQ Task Order • Develop, implement and test a model to adapt community health call centers to support home management and shelter-in-place approaches in certain mass casualty or health emergency events • Determined best DHS scenarios for such strategies

13. DHS National Planning Scenarios • Strategies and tools were developed specifically for 4 of the 15 scenarios: • Biological Attack – Aerosol Anthrax • Biological Disease Outbreak – Pandemic Influenza • Biological Attack – Plague • Biological Attack – Food Contamination *Tools have wider applicability and can be modified for other scenarios *Dept of Transportation (EMS/911) and CDC exploring call centers’ roles in pandemics

14. Response Model & Tools • HELP Model (strategies & blueprint for structured call center emergency response) • Interactive Response (IR) Tools • Quarantine & Isolation Monitoring (outbound) • Zip Code Specific Messaging (inbound) • Pill Identification/Information (inbound) • FAQ Library (inbound)

15. Why Quarantine Monitoring? • Taiwan - 131,132 people in quarantine for SARS (10 to 14 days) • Quarantine included limited travel and health monitoring (primarily with in-person home visits, some phone calls) • 99% of those in quarantine did not develop SARS and only needed monitoring • Call center • Periodic checks • Referral to other sources if symptoms develop.

16. But Will It Be Acceptable in US? • Harvard School of Public Health Survey revealed that: • 76% favor quarantine of people suspected of having been exposed to a serious contagious disease • 29% no longer favor if people are arrested for refusing • 75% favor use of periodic telephone calls to monitor quarantined people (84% favor daily visits) • 43% guards, 40% e-bracelets, 31% periodic video screening • 70% prefer they or family member be quarantined at home • These factors suggest quarantine monitoring by call centers is good strategy for disease control/containment Blendon RJ et al. Attitudes Toward The Use Of Quarantine In A Public Health Emergency In Four Countries. Health Affairs 2006; 25:w15-w25.

17. Why this response capability? • Public health events will continue to occur and will require coordinated responses to protect our healthcare systems • Need structured, integrated responses that are: • Cost-effective • Efficient (use of staff and technology) • Accurate • Consistent • Adaptable • Health call centers can fill a vital role in providing information, collecting surveillance data and monitoring/supporting home care strategies

18. Summary • Health call centers already exist within communities and should be considered/integrated as part of emergency response strategies • Health Call Centers can: • Improve information support for public and providers • Assist with surge capacity • Provide surveillance signals, situational data • Realize the new Public Health environment • Increase visibility (extend response capabilities outside of Mon to Fri 8 am to 5 pm period, improve access) • Handle evolving info while maintaining control (assist with info management, improve dissemination) • Aid decision support (assist with healthcare utilization)

19. Further Information For inquiries regarding presentation: Gregory M. Bogdan, PhD Rocky Mountain Poison & Drug Center – Denver Health 777 Bannock St, Mail Code 0180 Denver CO 80204 303-739-1239 Greg.bogdan@rmpdc.org For additional info on AHRQ task orders: “Health Emergency Assistance Line and Triage Hub (HEALTH) Model” - www.ahrq.gov/research/health/ “Adapting Community Call Centers for Crisis Support: A Model for Home-Based Care and Monitoring” - www.ahrq.gov/prep/callcenters/