sus was that this is a local responsibility. The asset should be sent to a centralized point and then it is up to the receiving State and local government to distribute. Local receiving authorities should decide what they want and need, where the people should go and what they should do.
Issue 3: What is the hierarchical structure for cache utilization?
This should be locally determined, but would likely mirror concepts put forward in Hospital Emergency Incident Command (HEICS).
2. Using the three different levels of supply caches, determine which cache should be deployed and the factors considered
Issue 1: Which factors should be considered in requesting a level of cache?
There are three possible levels of cache developed by the RMBT Working Group. These assets may be owned by State or private entities. The requesting State could request the asset from either type of institution depending on what they need to address their surge requirements. Factors that should be considered include: Communicable or non-communicable event, access to medical supply resources at site, variation in deployment for each of the three caches, and acuity and number of patients.
Issue 2: Who will transport the cache?
The Working Group consensus was to contract with a local trucking company that can dispatch at anytime, or the local law enforcement. Caches should be in pre-positioned locations. Vehicles that pull the cache may be multi-use for efficiency purposes and availability issues.
3. Identify the legal limitations to deploying staff and supplies across State lines and potential solutions
Issue 1: Licensing for health care providers from another State?
- Investigate and potentially utilize National Reserve Corps concept.
- Create enabling legislation re: licensing.
- Develop gubernatorial orders.
- Utilize Disaster Medical Assistance Teams (DMATs); they are federally credentialed.
Issue 2: When can the resources be deployed?
The Working Group debated whether resources should be deployed when the formal contract is signed or when the verbal agreement is made in the interest of time sensitivity. It is very likely that some resources may deploy on their own.
Issue 3. Who will be legally responsible for costs?
EMAC specifies that the recipient State will reimburse the providing entity for cost of supplies and staffing. If a private entity is providing the asset, a memorandum of understanding (MOU) should be signed during the requesting period.
4. Determine the level of staffing that will be required and how and from where they will be mobilized
Issue 1: Does the cache come with staff?
May depend upon source of cache and any agreements made in advance or at time of deployment.
Issue 2: What will staffing needs be?
This is again a function of number of patients and severity of illness.
5. Identify the additional supplies and equipment that will be needed, where it will come from and how it will be mobilized
Current caches are largely shelf-life-insensitive in terms of supplies and oriented towards basic level care in terms of equipment. Any expectations beyond that will require supplementation from additional resources (such as the Strategic National Stockpile) or entertaining concept of transporting patients to distant hospitals for ongoing care (e.g., utilizing the National Disaster Medical System).
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