Vermont Healthcare Emergency Preparedness Coalition (VHEPC): Emergency Preparedness and Medical Surge Toolkit

What Happened

When the Vermont Healthcare Emergency Preparedness Coalition (VHEPC) had its first briefing on March 4, 2020, the coalition was reevaluating its position. VHEPC is a multi-disciplinary partnership that collaborates with its members, stakeholders, and surrounding communities to improve and expand emergency preparedness, response, and recovery capabilities in Vermont. All Clear Emergency Management Group was contracted by the Vermont Department of Health to manage the healthcare coalition and was in the process of reestablishing its membership. At that time, no one knew how important emergency preparedness would soon become.

According to Lauren Smith, VHEPC Interim Readiness and Response Coordinator, the coalition was looking for ways it could be valuable and support both its core and non-core members in areas such as emergency response or medical surge capacity. Core members of the coalition include hospital, public health and emergency medical services (EMS), and emergency management professionals, but Smith pointed out that there is a large group of non-core members that fall outside those groups. She explained that the coalition historically served as a convener and communicator, bringing people together for shared learning, training, preparedness exercises, and tools.

During the COVID-19 public health emergency (PHE), the coalition was tasked by the Vermont Department of Health to serve as a convener and bring hospitals together up to three times a week, to assess their status with COVID-19, and to determine needs and resources. In addition to finding out what the coalition could do to help their members, they also assessed what the hospitals needed from state, regional, or federal perspectives to function effectively.

Smith emphasized that in the beginning their calls were about hospital needs, but as time went on there was a shift in focus to sharing perspectives from many different providers: for example, EMS providers and healthcare professionals working in long-term care and home health settings on issues related to COVID-19 and providing care during a global pandemic.

Smith described the position VHEPC was operating from when they were subsequently asked to move into a data collection role for a small, rural state:

“From working across the country with different coalitions, Vermont operated in an incredibly unique capacity and leveraged existing partnerships to support each other when typical avenues had been exhausted. Another observation was it never felt like there was any type of competition among the healthcare providers in the state. It was very much one team, one fight, and the greater good was at the forefront of all decision-making.”

The data collected by the coalition was reported up through the state and aided leaders at the highest levels of public health in their decision-making and forecasting throughout the pandemic. Initially, all data were pulled manually, but then the coalition was able to work with a state data team to automate reports. And further collaboration with Vermont Health Information Exchange, reduced some of the reporting burden on hospitals.

As the new funding cycle began in 2021 and into 2022, the coalition began brainstorming supplemental projects to address the gaps identified during the pandemic. VHEPC and All Clear Emergency Management Group leveraged COVID-19 supplemental funding to address the identified gaps in Vermont. VHEPC started working on specific COVID-19 projects related to health equity, barriers for patients transitioning to the community in a post-acute setting, health communication, and information dissemination.

Success Factors

Collaboration

One of the success factors Smith pointed to was the collaborative and hopeful spirit throughout the state of Vermont: “One thing that I thought helped the relief in Vermont was walking away from meetings I always felt encouraged and like there was an understanding this is hard for everyone, but we were working together, and the coalition really tried to be a part of that by bringing together and assisting with sharing information.”

Another success factor in their pandemic efforts was VHEPC's involvement, according to Smith. Unlike a lot of other states, VHEPC was involved in the pandemic response from the very beginning and not when hospitals started experiencing a critical surge in cases.

Dr. David Nelson, a pediatric emergency physician from the University of Vermont Medical Center (UVM) and a VHEPC Clinical Advisor, shared his thoughts on the strengths of a coalition like VHEPC in a small rural state: “If you've been involved with the healthcare systems, many times within a state there's people doing parallel things and not everybody knows exactly what everyone's doing… In a smaller state it's a little bit easier, I think, for us to pull everyone in and let everyone else know what's going on.”

As one of the Clinical Advisors, Nelson's vision is for other projects at UVM, such as the Advancing Unified Guidance for Medical Emergencies with Network Telehealth for the Emergency Departments and Emergency Medical Services of Greater Vermont (AUGMENT Tele-ED/EMS) project might find a dissemination channel in VHEPC and use coalition resources to bring emergency preparedness solutions to the whole state.

Medical Surge Toolkit Development and Success

Another supplemental project that had a large impact on Vermont's COVID-19 response efforts centered around the development and dissemination of medical surge best practices. These best practices were identified from around the country. The need for medical surge information and best practices was evident at the start of the COVID-19 pandemic. Smith explained:

“As we saw across the country the healthcare systems were being stretched in ways that were unimaginable. People could not have forecasted how a pandemic would overwhelm the health system, let alone an individual long-term care facility or home health. I think in the past, a lot of thought has been put towards hospitals, so now we were looking at what medical surge looked like across the healthcare spectrum and what were the best practices. How can people prepare real time, in the midst of an emergency, so they can actually address it if next week we have another additional surge?”

A final product of the project was a medical surge best practices toolkit developed by VHEPC for the state of Vermont. The toolkit focused on hospitals and, noted by Smith, included different resources and appendices to address medical surge needs across the healthcare spectrum as well as information to help other community providers understand how they could support hospitals experiencing capacity pressure. The toolkit is available to all healthcare providers in Vermont and has been shared on webinars.

According to Smith, the toolkit addresses the four ‘S's’ in medical surge — space, staff, stuff, and systems. She commented that, in the past, medical surge planning has been a daunting task and could feel overwhelming. According to Smith, “The biggest win for this medical surge best practices toolkit was to break it down into manageable, practical implementation steps; the toolkit walks through what is included within the primary planning area and then goes into detail on planning items an organization should consider, along with an accompanying worksheet and webinar.” According to Smith, breaking down the processes makes the steps more manageable. Some examples of helpful prompts from the toolkit regarding space include questions like:

• Have you thought about how you would leverage space differently if you have to increase to a 20%, 50%, or 110% surge?
• Where are all the spaces that you could potentially use?

Smith shared how best practices are included throughout the toolkit though callout boxes to highlight items to consider and pitfalls to avoid. One best practice use case featured in the toolkit was from a hospital in Colorado that projected space utilization in a surge by going through the hospital's physical spaces to identify all of their closets and every other space option in their facility to figure out how they could surge to different levels.

Smith said VHEPC took “those lessons learned from the hospital in Colorado and put those considerations into this toolkit — these are things that actually work, these are practical and implementable, based on the size of the hospital.”

Barrier

Health Communication

One of the projects that the coalition worked on looked at identifying barriers related to health communication during the pandemic. Through this work, they determined that an ongoing challenge was the ability to ensure that the right messages were delivered to the correct stakeholders. Many of the coalition's supplemental projects were geared toward addressing this challenge.

Lesson Learned

Preparing for the Future

As a next step, VHEPC is working on applying all of its lessons learned to other potential healthcare emergencies such as cyberattacks, workforce shortages, and even rare potential events like radiation contamination and exposure.

Smith explained, “It is the intention of the VHEPC to have an all-hazards approach. So, while we have been hyper-focused on COVID-19, we have a unique platform to be able to bring people back to think about all of these other hazards that have been identified over the years that need attention.”

Person(s) Interviewed

Lauren Smith, Interim Readiness and Response Coordinator
Vermont Healthcare Emergency Preparedness Coalition (VHEPC)

Dr. David Nelson, Pediatric Emergency Physician and VHEPC Clinical Advisor
University of Vermont Medical Center