Value, 2009

California Department of Public Health

June 2009

The California Department of Public Health used AHRQ's public health emergency preparedness resources—including the Emergency Preparedness Resource Inventory and Project Xtreme—to encourage and inform State-led initiatives to develop guidelines and standards in times of mass medical emergencies.

A multidisciplinary workgroup led by the California Department of Public Health's Emergency Preparedness Office developed Standards and Guidelines for Healthcare Surge during Emergencies for various stakeholders involved in surge capacity management. These stakeholders include hospitals, alternate care sites, and payers. The materials included a volume on "Foundational Knowledge" to provide background and objectives for the workgroup's efforts, as well as to highlight gaps in knowledge and research. The work group is developing additional volumes for clinics, long-term care facilities, and licensed health care providers.

Betsey Lyman, Deputy Director of the California Department of Public Health's Emergency Preparedness Office, led the project, stating, "We mined the AHRQ Web site for emergency preparedness resources. At the time we started our project, the AHRQ products were all we had. We have used them, quoted them, and constantly review the newest materials AHRQ makes available. Our products have been made available to a number of other states, which have found the AHRQ materials equally useful and informative."

Howard Backer, MD, MPH, Chief of the Immunization Branch and currently serving as Associate Secretary for Emergency Preparedness at the California Health and Human Services Agency, describes the impact of AHRQ's emergency preparedness research. "The AHRQ materials were fully groundbreaking, as very few people were researching or writing on this issue at that time. The AHRQ guides emphasized and defined the importance of surge capacity and allocation of scarce resources. With that support, we are creating standards and guidelines for use on the State level during disasters with demands that stress or overwhelm the health care system. The [AHRQ] volumes serve as a starting point for our work and efforts to create an integrative approach to health and medical emergency preparedness and health care surge capacity."

California's 2006-07 State Budget Act allocated $214 million to build the State's surge capacity, including the purchase of 3.7 million courses of antiviral medications, 2,400 ventilators, 50 million respirators, three 200-bed mobile field hospitals, and supplies and equipment for 21,000 alternate-care-site beds. In addition, $5 million was committed for the development of standards and guidelines for health care delivery during surge events.

Backer says, "Implicit in delivering health care in times of mass casualties is the concept of allocating scarce resources, which emphasizes doing the most good for the greatest number of people to save the most lives—a very foreign concept to health care providers and patients in the United States. However, in an emergency, we must study a new paradigm of health care delivery if supplies—from antibiotics to ventilators to critical care beds—are limited. AHRQ's reports underscored the necessity of planning for these scenarios."

California's Department of Public Health surge capacity manuals and guides can be found on California's Emergency Preparedness Web site at: http://bepreparedcalifornia.ca.gov/EPO/CDPHPrograms/PublicHealthPrograms/EmergencyPreparednessOffice/EPOProgramsServices/Surge. Included on the Web site's "Resources and Links" page is a link to AHRQ's Public Health Emergency Preparedness Web site: http://www.ahrq.gov/prep/.

Impact Case Study Identifier: CP3 09-07
AHRQ Product(s): Emergency Preparedness Resource Inventory, Project Xtreme
Topic(s): Emergency Preparedness
Scope: California

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