A shortage of healthcare workers is a constant challenge for rural areas of the United States, yet it also may hinder the level of care hospitals and clinics can provide during an emergency. While retired health professionals and other volunteers may be available to augment a healthcare system response, barriers to implementing a volunteer program often include liability concerns and hospitals' ability to meet training requirements.
During 2009-2010, Mesa County Advanced Practice Center (APC) developed a toolkit for the use of volunteers in hospitals and rural medical centers. Mesa County Health Department is located in Grand Junction, Colorado, and the county is considered a "low income health professional shortage area." It is also a fairly rural region, which transforms into a populated ski resort area with a significant influx of people during the winter. These combined factors prompted development of a plan for how the APC and local hospitals would address provision of care to unexpected numbers of people during a health emergency.
The APC worked with Family Health West Hospital in Fruita, Colorado, and numerous volunteer organizations to develop a toolkit for incorporating volunteers into a healthcare surge response. The planning process accounted for clinical volunteers who would be able to perform limited medical tasks (e.g., retired clinicians) and non-clinical volunteers, which may include roles like security guards, language interpreters, or telephone operators. The APC served as a liaison between hospitals and volunteer organizations during this process – a role that ensured that any ensuing tools or training programs would serve the needs and policies held by both sets of organizations. Hospitals and clinics worked with the APC to outline the training that would be required for emergency volunteers in their facilities. Volunteer organizations held focused discussions with hospitals and the APC to better understand the roles that volunteers would play in healthcare surge, after which they identified volunteer abilities that aligned with the emergency roles.
The online toolkit focuses on several key areas important to integrating volunteers into healthcare response. The main goals of creating and assembling the toolkit included: 1) ensuring that hospitals' Emergency Operations Plans (EOPs) are up-to-date and able to implement a volunteer program for activation in times of surge; 2) encouraging Emergency Support Function 8 (ESF8) collaboration; and 3) assuring that training and exercise programs follow Homeland Security Exercise and Evaluation Program (HSEEP) requirements.
The toolkit comprises a variety of materials that make the integration of volunteers into health systems response relatively seamless. Tools include:
- A planning guide addresses general issues, such as partnerships between hospitals and volunteer organizations, site inspections, identification of appropriate volunteers, legal and credentialing issues, and information on holding trainings and HSEEP-compliant exercises.
- Brief information describes opportunities for collaborating with ESF8 functions at the state level.
- A readiness assessment is provided for each hospital to review prior to beginning a healthcare surge volunteer program. The readiness assessment evaluates whether health facilities have an updated EOP; possess programs to integrate, train, and/or credential clinical volunteers; have the capability to conduct just-in-time training; are involved in regional emergency preparedness activities; and have an HSEEP-compliant exercise and training program.
- Tools for creating a hospital EOP are included in the event that a hospital has not taken this step. Tools include staff training and orientation lesson plans, PowerPoint slides for conducting a hospital orientation workshop, two training worksheets, and an evaluation form.
- Interactive materials are provided to train hospital staff on how to hold an HSEEP-compliant exercise, such as guides and presentations, tools for exercise documentation, a target capabilities list, and national exercise priorities and scenarios.
- Detailed resources for conducting a tabletop, functional, and full-scale exercise address the potential derailment of a train carrying a hazardous chemical substance. A variety of tools are provided for conducting preparatory work, holding the three exercises, and writing an after-action report. Materials are intended to exercise various aspects related to how volunteers will perform during healthcare surge, including communication capabilities and warning systems, epidemiological surveillance, provision of mass prophylaxis and/or mass care, management of volunteers and donations, community participation, fatality management, medical supplies management, and responder safety.
- Proposed policies and procedures are intended to describe the role of volunteers in an emergency situation and enhance any policies maintained by volunteer organizations.
- Comprehensive just-in-time training and administrative tools for volunteers are available for hospitals to use or adapt to fit their needs. Tools include a staging checklist, a placement questionnaire, and workstation training materials for various settings (e.g., the emergency department, housekeeping, radiology, etc.). Also offered are volunteer orientation handouts for numerous roles, including lab assistants, language interpreters, mental health workers, Nurse Practitioners and Physician Assistants, security guards, and others. Orientation handouts include a job action sheet, a Hospital Incident Command System (HICS) chart, and room to insert a map of the hospital or clinic.
During 2009-2010, Mesa County APC, Family Health West Hospital, and local volunteer organizations held a series of exercises that tested the regional healthcare system's ability to absorb and train volunteers. The toolkit proved to be an enormously helpful resource for providing key healthcare surge information to medical facilities with varying backgrounds in emergency preparedness, assuring that healthcare volunteers who might be needed in a surge event are aware of expectations and policies, and ensuring that hospitals possess resources to rapidly train and deploy volunteer healthcare personnel.