Biomedical Engineering Reference
In-Depth Information
example, the U.S. Department of Health & Human
Services afforded liability protection to health care
workers who volunteered to treat hurricane victims.
The Emergency Medical Treatment and Active
Labor Act (EMTALA), which states that emer-
gency rooms must diagnose, treat, and stabilize
a patient before being able to transfer him or
her, was also waived because, during an emer-
gency, transfer may be the most expedient action.
By prearranged cooperative agreement, particular
medical centers in a community may be desig-
nated to accept certain types of patients, such as
burn or trauma victims. Therefore, if a burn victim
arrived at a surge facility during an emergency,
the patient would immediately be transferred to the
preselected hospital.
A number of recent laws and agreements have
made it easier for medical personnel from other
regions to provide health care assistance to affected
areas. The need to make the best possible use
of volunteer health workers in an emergency led
to the development of the Emergency System for
Advance Registration of Health Professions Volun-
teers (ESARHPV) [4]. This act, still in its devel-
opmental stages, will enable each state and U.S.
territory to set up a standardized, volunteer regis-
tration system for medical workers. Each state's
system is designed to contain up-to-date information
about avolunteer's identity, licensing, credentialing,
accreditation, and privileging in hospitals or other
medical organizations. Such a system will allow
each state to rapidly identify professional health
care volunteers duringmass casualty events andwill
enable states to share these preregistered and already
credentialed health care workers nationwide.
The Emergency Management Assistance
Compact (EMAC), enacted by Congress in 1996,
also facilitates mutual aid between 49 U.S. states,
the District of Columbia, Puerto Rico, and the
Virgin Islands in times of crisis. EMAC, which
is administered by the National Emergency
Management Association, is not an agency of the
federal government, but is instead an agreement
among the states to provide aid across state lines
when any type of disaster occurs. The governor
of the affected state must first declare a state of
emergency, and then the state can request
assistance it needs. This appeal then activates
the response from other EMAC-member states,
putting the EMAC system of coordination and
deployment in motion. EMAC garnered national
attention in 2004 when four major hurricanes hit
the U.S. in a six-week period, triggering what was
then the largest use to date of state-to-state mutual
aid in U.S. history.
Under the compact, licensed physicians or other
health care workers who travel to any of the
EMAC member states or territories (once the
conditions for providing assistance have been met)
will have their credentials honored across states
lines. EMAC provisions addressing liability and
workers compensation issues for these personnel
alleviate the financial and legal burdens of the
responding states.
EMAC enabled a massive deployment of
medical personnel and resources in response to
Hurricanes Katrina and Rita. More than 31,000
workers, including medical personnel, search and
rescue staff, law enforcement officers, waste
management experts, and fire fighters were
dispatched from dozens of states to Louisiana and
Mississippi.
Reimbursement is another issue that the federal
government would need to examine so that certain
provisions of reimbursement for Medicare and
Medicaid might be relieved in a disaster situation.
Some of these federal requirements involve certi-
fying the quality of the facility, the privileging
of its staff, and the upkeep of medical records
to secure reimbursement from the federal govern-
ment. Many of these requirements would have to
be set aside so that the health care system does
not end up with two disasters—one caused by the
event itself, and the other caused by the loss of
revenue to the health care organizations involved
in providing care.
Ensuring that long-term surge hospitals
offer safe care
All surge facilities must ensure that the care they
provide is safe. In addition, certain quality assur-
ance processes must be followed in surge hospitals
so that, for example, patients are identified and
the
