Outpatient care settings  - including federally qualified health centers (FQHCs), rural health clinics (RHCs), urgent care centers, home health and hospice agencies, and primary care provider practices - have a wide range of capabilities that could be used to save lives in an emergency, but are they integrated into our nation’s emergency healthcare response system? How can healthcare coalitions better engage outpatient healthcare providers to enhance disaster response?

These are just some of the questions the experts from ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE) asked as they worked to better understand medical surge preparedness in outpatient settings. Their findings have important implications for healthcare system preparedness and healthcare coalitions.

Starting in 2017, ASPR TRACIE began working with experts from health clinics, urgent care centers, home health and hospice agencies, and primary care associations to learn more about their perceived roles in their healthcare coalitions. ASPR TRACIE experts found that, regardless of the healthcare setting, most participants knew they had a role to play in community emergency preparedness and response efforts; they managed many important assets, and many of them have tested their disaster response protocols, although gaps remain due in part to lack of resources. In many cases, the key to better integration of these outpatient providers into the nation’s healthcare system is to ask them to participate.

Outpatient Settings Have Critical Capabilities

Outpatient care settings have critical assets they can use to bolster community preparedness and resilience; treat lower acuity injuries and illnesses to keep patients out of or help decompress hospital emergency departments during surge responses; and provide follow-up care and monitoring during the disaster recovery phase.

Many representatives thought their settings could perform very important functions during disaster response by providing services in some of the following ten essential areas:

1. treatment for low-acuity patients
2. patient triage
3. patient risk communication
4. expertise in treating vulnerable populations
5. temporary treatment site or safe haven
6. behavioral health support
7. responder health support
8. public health surveillance
9. patient monitoring
10. support for vaccination or mass dispensing efforts

Limitations in Capacity, Unclear Role in Response

Although outpatient care settings have many resources that could be used to save lives in an emergency, ASPR TRACIE found that wide variation exists in the capacity and resources of each healthcare setting; and their potential role in responding to a medical surge incident has not been clearly defined in most communities.

Most outpatient care providers have tested their disaster response protocols and procedures, and many have started implementing business continuity strategies to enable sustained care of existing patients and potential care of new patients whose traditional care settings may have been disrupted by an emergency. However, experts from all outpatient healthcare settings indicated that a lack of time and resources to participate in training was a major barrier to better preparedness.

Engaging Outpatient Care Providers in Healthcare Coalitions

Among those less engaged in emergency management activities, the greatest motivator to participation is being asked. In some cases, “being asked” equates to patients seeking care during a disaster. Other times, participation is a result of a request from a Healthcare Coalition (HCC), a healthcare system partner, or a local, state, or federal public health or emergency management agency.

Engaging outpatient care providers before a disaster strikes can help ensure that you are working together to save lives when disaster strikes. ASPR TRACIE identified seven actions to improve the readiness of these healthcare settings for emergencies and disasters:

• Better define the role of each setting in overall community emergency management efforts.
• Increase engagement of each setting with HCCs and other community partners.
• Provide training, technical assistance, and other resources to support emergency management knowledge and activities.
• Promote opportunities for knowledge exchange and learning, particularly highlighting the lessons learned by those who have responded to real-life emergencies.
• Encourage the use of hazard vulnerability analyses to establish emergency response expectations based on capabilities and community threats.
• Promote continuity of operations planning to aid in resilience efforts.
• Support FQHCs, RHCs, home health, and hospice settings in implementing regulatory requirements, including the Centers for Medicare and Medicaid Services Emergency Preparedness Final Rule.

To learn more about the capabilities of outpatient healthcare providers and ways that you can engage them and become ready to work together to enhance medical surge capacity when disaster strikes, check out ASPR TRACIE’s Engaging Healthcare System Partners in Medical Surge resource page.