HLTH 6771 Week 11 Preparedness Policy Recommendation Example

A Recommendation the County Board Could Adopt: A Regional Medical Coordination Agreement With an Owner, a Funding Route and a Test

Student Name

Walden University

HLTH 6771: Terrorism: A Systematic Approach for Emergency Preparedness

Instructor Name

Month Day, Year

A Recommendation the County Board Could Adopt: A Regional Medical Coordination Agreement With an Owner, a Funding Route and a Test

The Recommendation

The county board should adopt a regional medical coordination agreement among the county, the emergency medical services agency and the five hospitals of the regional health care coalition, establishing a medical coordination center operated by the coalition with written authority to direct the distribution of patients among hospitals during declared mass-casualty incidents. The agreement should also assign the coordination center to receive relevant threat information from the sheriff's fusion center liaison and to maintain an inventory and resupply plan for mass-casualty supplies. The recommendation addresses the gap the readiness evaluation found most consequential: functions that cross organizational lines with no owner.

Why This Recommendation

The readiness evaluation found that the county's gaps, across all five criteria, share a cause: patient distribution decisions, onward sharing of threat information and mass-casualty supplies all fall between organizations, so no single body owns them. A coordination agreement assigns those functions to one body, the coalition's coordination center, and gives it the authority it now lacks. Physicians who worked the Boston Marathon response pointed to years of joint drills as a reason patients reached the right hospitals quickly (Biddinger et al., 2013); a written agreement turns that kind of informal practice into an assigned responsibility. The recommendation also moves the county toward the medical response capability target it set in its own assessment under national guidance (Federal Emergency Management Agency, 2018).

The Owner

The county board would own the decision to adopt and would sign the agreement with every participating hospital and the ambulance agency. The regional health care coalition would own the coordination center's operation, staffing it with its existing coordinator during normal times and with trained hospital and emergency medical services staff during incidents. The county emergency management director would be accountable to the board for reporting progress. Naming owners at both levels matters: the board can commit the county, but only the coalition can operate a center hospitals will trust.

The Funding Route

Three sources would fund the agreement and center. The federal program supporting partnerships for regional hospital preparedness and surge capacity (42 U.S.C. § 247d-3b), administered through the coalition, can fund the coordination center's planning, training and equipment. The State Homeland Security Program (6 U.S.C. § 605) can fund mass-casualty supplies and exercises, since the center supports terrorism preparedness, provided the request traces to gaps in the state's and county's assessments. And the county would commit local funds for the center's share of storage and resupply, which grants often do not cover. The total first-year cost would be modest relative to the gap it closes, mainly staff time, training, a supply cache and legal review of the agreement.

How We Will Know Whether It Worked

Success would be measured in exercises, using national exercise and evaluation guidance to set objectives and track corrective actions (Federal Emergency Management Agency, 2020). Four measures are proposed: time from incident notification to the coordination center's first patient distribution decision, with a target of 20 minutes; the share of simulated patients transported to the hospital the center designates, with a target of 90%; time for a simulated threat bulletin to reach the coordination center and the health officer, with a target of one hour; and completion of corrective actions from each exercise within their due dates. The county would run a functional exercise within 12 months of adoption and a full-scale exercise within 24 months, and the emergency management director would report results to the board.

Anticipated Objections

Hospitals will not accept outside direction. Hospitals may resist ceding authority over admissions. The agreement can address this by limiting the center's authority to declared mass-casualty incidents and to a set period, by staffing the center with hospital representatives and by allowing a hospital to decline a patient only when it reports it is at capacity. The coalition lacks capacity. The coalition's coordinator is a single position; the funding route is designed to add training and incident staffing. It duplicates the emergency operations center. It does not, and the agreement should say so explicitly; the emergency operations center coordinates the overall response, while the medical coordination center makes the specific patient distribution decisions the operations center is not equipped to make.

Why an Agreement Rather Than a Plan Revision

The county could simply revise its terrorism annex to assign patient distribution to the coalition. That would be cheaper and faster, but it would repeat the problem the evaluation found: duties assigned in a plan without the authority or resources to carry them out. Hospitals are independent organizations, and a county plan cannot bind them. A signed agreement can. It also survives changes in personnel, since it commits institutions rather than individuals, and it gives the coalition standing to ask hospitals for the bed reporting and drills the center needs. The instrument matters as much as the content.

What the Recommendation Does Not Do

The recommendation does not close every gap the evaluation found. It does not fix public warning, continuity of the health department or the shortage of ambulances and trauma surgeons that limits the county to about 60% of its target. It addresses the gap that most directly affects whether seriously injured people reach the right hospital in time, and it creates an owner for two other cross-organizational functions. Other recommendations, on warning templates and continuity, should follow, but this is the one to adopt first, because it addresses the gap with the most direct effect on survival.

Requested Action

The county board is asked to direct the county attorney and the emergency management director to negotiate the regional medical coordination agreement with the coalition hospitals and the emergency medical services agency within six months, to authorize applications to the hospital preparedness program and the state homeland security program and to appropriate local funds for supply storage and resupply. Progress would be reported to the board at six, twelve and twenty-four months against the measures above.

References

Biddinger, P. D., Baggish, A., Harrington, L., d'Hemecourt, P., Hooley, J., Jones, J., Kue, R., Troyanos, C., & Dyer, K. S. (2013). Be prepared: The Boston Marathon and mass-casualty events. New England Journal of Medicine, 368(21), 1958-1960. https://doi.org/10.1056/NEJMp1305480

Federal Emergency Management Agency. (2018). Threat and hazard identification and risk assessment (THIRA) and stakeholder preparedness review (SPR) guide: Comprehensive Preparedness Guide (CPG) 201 (3rd ed.).

Federal Emergency Management Agency. (2020). Homeland Security Exercise and Evaluation Program (HSEEP).

Partnerships for State and regional hospital preparedness to improve surge capacity, 42 U.S.C. § 247d-3b (2023).

State Homeland Security Grant Program, 6 U.S.C. § 605 (2023).