Indicators for strategy 1200
Debris is flying. The tornado seems to be a perfect indicator providing discrete information that is certain, and can be easily acted on to trigger emergency medical services EMS and health care organization disaster plan activation.
This may be true in a small community. In a large community, additional information is required before making this decision. How big was the tornado? Where did the tornado touch down?
Did it primarily affect an industrial park on a Saturday, or a school on a weekday? The storm system that generated the massive tornado that struck Joplin, Missouri, ju make money online which appropriately and immediately triggered contingency and crisis responses in the community also spawned a tornado that struck a neighborhood in Minneapolis, Minnesota.
No EMS agencies or hospitals activated their disaster plans as news footage from the scene and early EMS reports indicated mostly minor injuries, all within the scope of conventional operations.
This is why the agency and stakeholder discussions of indicators and triggers outlined in this paper are critical to help understand how indicators can be used to support operational decision making, and when triggers can be automatically activated scriptedversus those that may require expert analysis prior to a decision non-scripted. This chapter examines important concepts and considerations related to indicators and triggers. The material in this chapter will help provide background to the toolkit discussions.
The chapter begins by providing definitions and examples of indicators and triggers. Next, the indicators for strategy 1200 discusses how to develop useful and appropriate indicators and triggers. Following this, the chapter presents some limitations and issues related to indicators. Finally, the chapter discusses systems-level considerations and provides several examples of existing data systems.
Indicators and triggers guide transitions along the continuum of care, from conventional to contingency to crisis and in the return to conventional. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery.
Box provides definitions; the concepts behind the definitions are discussed in greater detail below. BOX Definitions. Indicator: A measurement, event, or other data that is a predictor of change in demand for health care service delivery or availability of resources.
Indicator information may be available in many forms. Sample indicators and associated triggers and tactics are listed in Table More detailed descriptions are available in the discipline-specific discussion toolkits Chapters When specific indicators cross a threshold that is recognized by the community to require action, indicators for strategy 1200 represents a trigger point, with actions determined by community plans.
These include plans for activation of a general disaster plan, which often occurs at the threshold between conventional and contingency care, and activation of crisis standards of care CSC plans, which would occur indicators for strategy 1200 the threshold between contingency and crisis care. Sample Indicators, Triggers, and Tactics by Discipline. Rather than creating a laundry list of possible indicators and triggers, it may be helpful to consider four steps: 1 identify key response strategies and actions, 2 identify and examine potential indicators, 3 determine trigger points, and 4 determine tactics.
The amount of information available in health care today is enormous and expanding.
- Indicators and Triggers - Crisis Standards of Care - NCBI Bookshelf
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It is attractive to look at many metrics and consider their use as indicators. The accompanying toolkits provide discipline-specific tables and materials to discuss potential indicators and triggers that guide CSC implementation.
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This section presents key concepts that will help inform the development of these discipline- agency- and organization-specific indicators and triggers. Rather than creating a laundry list of possible indicators and triggers, it may be helpful to consider the following four steps.
These indicators will become the barometer of status and trends of environmental quality and ultimately become the tool to evaluate success of our programs.
These steps should be considered at the threshold from conventional to contingency care, from contingency to crisis care, and in the return to conventional care. They should also be considered for both slow-onset and no-notice incidents.
Subsequent discussion below expands on these steps. Identify key response strategies and actions that the facility or agency would use to respond to an incident. Examples include disaster declaration, establishment of an emergency operations center [EOC] and multiagency coordination, establishment of alternate care sites, and surge capacity expansion.
Identify and examine potential indicators that inform the decision to initiate these actions. Indicators may be comprised of a wide range of data sources, including, for example, bed availability, a call, or witnessing a tornado. Determine trigger points for taking these actions.
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Scripted triggers may be derived from certain indicators. If scripted triggers are indicators for strategy 1200 because the indicators require additional assessment and analysis, it will be important to determine the process for arriving at non-scripted triggers i. Determine tactics that could be implemented at these trigger points. Scripted triggers may appropriately lead to scripted tactics and a rapid, predefined response. Predicting every disaster scenario and related key response strategies, actions, and tactics is impossible, but following these steps can help focus on key sources of information that act as indicators, and determine whether or not the information supports decisions taken to implement trigger specific tactics.
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- Full Text Introduction In a recent study, Bohmer 1 identified 4 habits that distinguish the most successful health care organizations and obtain the best outcomes.
These four steps form the basis of the approach taken in this report and will be expanded on in the toolkit with information and examples for each major component of the emergency response system. Identify Key Response Strategies and Actions Key point: In planning, organizations and other entities should first determine the response strategies and actions that will be taken in response to an incident.
Rather than jumping straight into enumeration of indicators and triggers, it is valuable to first identify key response strategies and actions, and then consider what indicators and triggers would be most helpful in deciding to implement these response strategies and actions. System-based triggers for coalition, region, or health care system situational awareness, information sharing, and resource management should be established, for example, when more than one coalition facility declares a disaster, when victims are taken to more than three hospitals, or when staff, space, or supply issues are anticipated.
There may be significant concordance between regions and coalitions on these triggers, though geographic differences need to be factored in. Crisis care triggers tend to be based on exhaustion of specific operational resources that requires a community, rather than an individual, view be taken in regard to resource allocation strategies. Though the threshold may be crossed at an individual facility, it is critical that a system-based response be initiated whenever this occurs in order to diffuse the resource demands and ensure that as consistent a level of care as mail token is provided.
Most of these triggers will be consistent between facilities and regions and will revolve around lack of appropriate staff, space, or specific supplies.
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A community may have many more triggers than those noted here that are incorporated in existing emergency response plans e. To avoid confusion, trigger discussions should be clarified within the specific operational context e. Different communities and facilities will clearly have different thresholds based on their resources, and thus similarity of triggers across communities and facilities cannot be assumed; during an incident it is far more helpful to inquire or share details about the specific needs of the facility rather than simply note that a trigger event has occurred e.
Contextual information is important to help frame the specific issue of concern. Identify and Examine Potential Indicators Key points: After an agency or a facility determines what actions or strategies are key to its responsibilities during an incident, it should examine and optimize indicator data sources that inform initiation of these actions. Indicator data may be categorized using two primary distinctions: predictive versus actionable and certain versus uncertain. An indicator that is actionable for one agency may be predictive for another.
Certain data require less analysis before finmax trading platform overview uncertain data require interpretation before action.
Understanding these characteristics of indicators helps inform decisions about how best to use them. Indicators and triggers can lead to decisions to implement response tactics along two primary pathways.
These two pathways are illustrated in Figure One pathway begins with an actionable indicator based on certain data, which could appropriately lead to a scripted 1 trigger and associated scripted specific, predetermined tactics.
Examples of this first pathway would be a hospital trauma team activation or a first alarm response to report of a fire in a building. A second pathway begins with a predictive indicator based on uncertain data, which would require additional analysis and assessment to reach a non-scripted trigger decision and employment of non-scripted variable tactics.
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An example of this second pathway would be the pathway leading to the declaration of an influenza pandemic. This process occurs even in the context of certain data, although the filtering requirements are far less than for uncertain data. The remainder of this section uses the figure as a basis for additional discussion of these concepts.
Relationships among indicators, triggers, and tactics. Predictive indicators can be monitored, but cannot be directly impacted through actions taken within an organization or component of the emergency option quotes system. Examples include monitoring of weather, epidemiologic data, or other such information.
Data monitoring at more than one site generally yields information that is predictive, and data monitoring in aggregate may be of use from a system coordination viewpoint e.
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- Abstract Background The number of catheter related bloodstream infections CRBSI could be reduced and the outcome improved if specific standards in the quality of care were maintained.
In contrast, actionable indicators are under the control of an agency or a facility and usually only actionable at that level; the more these data are aggregated, generally the less specific and actionable they become. Examples of these types of data are staffed hospital bed capacity, emergency department ED wait times, and other operational data that may be affected directly by actions such as increasing staffed beds or activating call-back of personnel.
For example, prolonged ED wait times at a local hospital are actionable for the hospital itself, but they are predictive for the local public health agency as the agency cannot directly influence the indicator. The data on which indicators are based may be certain requiring less analysis or uncertain requiring interpretation prior to action.
Most predictive indicators tend to be based on uncertain data, though in some cases enough indicators for strategy 1200 data are provided to make immediate decisions e.
Regional capacity approximately patients in first 60 minutes assumes longer response time for mutual aid units.
Actionable indicators usually are based on certain data. It is important to note that decision making in crises often requires acting on uncertain information.
The fact that information is uncertain means that additional assessment and analysis may be required, but this should not impede the ability to plan and act. The utility of the indicator should be considered separately from the utility of the available data; for example, while bed availability may be a useful indicator, the available indicators for strategy 1200 in a community may not be useful if they are of poor quality.
Indicator and data limitations are discussed further below. When data are required to make decisions, the following issues may help frame higher-level or interagency discussion. The discipline-specific discussions later in the report provide more specific key questions.