here the question 

Define Triage from the healthcare facility perspective. Relate this to the concepts of Surge Capacity and Capability vs. altered standards of care?FILLER TEXT

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and here are three different answers you can read them adn paraphrase 2 pages answer thank you and remember its APA style 

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Answer 1

The overarching goal of triage is to do the most good for the greatest number of people with the given resources (Frykberg, 2005). When there is a patient surge(mass increase in patient volume) in a healthcare facility, the same concept is applied. Triage is used to determine who needs care urgently, and who can wait to receive treatment. 

During a mass casualty incident (MCI), emergency services will be dispatched to triage and care for victims. Simultaneously, a transport officer will be gathering information from local hospitals regarding how many patients they can take and what level of care they can provide. While EMS may handle triage of some patients, history has shown that the critically injured can arrive at definitive care by other means. In the Las Vegas shooting Ubers, police, and civilians all worked to ferry the injured to the local hospitals (Woods, 2018). This presents a challenge to hospital-based emergency planners because they often cannot predict exactly how many casualties are inbound. They could receive dozens of additional patients than the anticipated number coming in with EMS, who then have to be triaged by hospital staff. 

The influx of patients presents an issue to healthcare facilities, referred to as the “4 S’s” of surge capacity: staff, stuff, space, systems (Hick, Barbera, & Kelen, 2013). Any strain on one of the components of surge can lead to a lower standard of care and worse patient outcomes. To accurately determine how many patients a facility is equipped to handle, the institution must conduct surge capacity and capability assessments before an MCI occurs. Surge capacity refers to “the measure of all the organizational strengths, attributes, and resources” and is measured typically by an inventory of the four components of surge (Cittione, 2006 pg 234). Surge capability refers to the ability to achieve a desired goal and is determined by some limiting factor (Cittione, 2006 pg 234). Most facilities have been required to adopt capability-based planning approaches by HSPD-8, which ensures that institutions don’t overestimate their capability based on their capacity (Cittione, 2006 pg 234). Consider a 400-bed trauma center with adequate staffing and supplies. Although the facility has a 400-person capacity, the staff cannot handle an influx of 400 critical casualties all at once. Their capability is much lower than the capacity due to the time it would take to triage patients, the varying type & extent of injuries, and specialization of available physicians. 

Just as the body re-directs blood flow to the vital organs during shock, hospitals can adopt altered standards of care to achieve the goal of doing the most good for the greatest number of people. Traditional prehospital triage uses a color-coding system to assign levels to casualties. For the triage systems employed in the U.S., a black tag is used for patients who are not breathing and have no pulse which indicates that they are the last priority for treatment (Limmer, 2016). While ordinarily an abundance of resources would be used for resuscitation, those resources are redirected to other victims who have a higher probability of survival. The same concept is used in hospitals during surges to save as many lives as possible. A company contracted by the U.S. Department of Health and Human Services described altered standards of care as “a shift to providing care and allocating scarce equipment, supplies, and personnel in a way that saves the largest number of lives in contrast to the traditional focus on saving individuals” (Health Systems Research, 2005). In a way, this is triage in a hospital setting. By setting surge capability limits, healthcare facilities can reduce the need for this kind of triage and patients can receive better overall care by being transported to a different facility equipped to handle their injuries. 

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Ciottone, G., Anderson, p., Heide, E. A. D., Darling, R., Jacoby, I., Noji, E., Suner, S. (2006) Disaster Medicine. Philadelphia, PA, Mosby-Elsevier

Frykberg, E. R. (2005). Triage: Principles and Practice. Scandinavian Journal of Surgery, 94, 272-278. Retrieved from https://journals.sagepub.com/doi/pdf/ 10.1177/145749690509400405.

Health Systems Research, Inc. (2005, April). Altered Standards of Care in Mass Casualty Events (Rep. No. 05-0043). Retrieved https://archive.ahrq.gov/research/altstand/altstan…

Hick, J. L., Barbera, J. A., & Kelen, G. D. (2013, April 08). Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity | Disaster Medicine and Public Health Preparedness. Retrieved from https://bblearn.philau.edu/bbcswebdav/courses/19SP-DMM-610-999/17SP-DMM-610-999_ImportedContent_20161025013001/Hick, Barbera et al Surge capacity.pdf

Limmer, D., OKeefe, M. F., Dickinson, E. T., Grant, H. D., Murray, R. H., & Bergeron, J. D. (2016). Emergency care. Boston: Pearson.

Woods, A. (2018, September 29). ‘Is this real?’: Seven hours of chaos, bravery at Las Vegas hospital after mass shooting. Retrieved from https://www.azcentral.com/story/news/nation/2017/1…

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answer 2

A significant event is impacting the community mentally and physically, which demands immediate expansion of patient care and public health services in supporting victims. Before maximizing the capability of patient care services, triage system must be implemented to determine the classification of a patient will obtain treatment considering their condition, prognosis, and the availability of resources (Ciottone, 2016). Therefore, emergency responders must attain knowledge and coordination of surge capacity. In addition, there are three stages for maintaining surge capacity. Preparing for what comes towards the community in organizing and having an objective analysis of the disaster. Outcome-based planning describes measuring staff members, structures of hospitals, and stuff that are medical equipment, or supplies to treat patients. Another factor is strategizing a surge capacity by assuming the previous history of disasters through an ongoing event. Even though healthcare services are prepared for a mass casualty being delivered to their facility, the dynamic can change, and three models adapt to the situation: the hospital surge model, pandemic influenza estimate model, and mass evacuation transportation model. Therefore, when a disaster begins in multiple communities, it is crucial to convey surge capacity with sufficient measurements of transportation, medical staff, hospitals, and medical equipment to immediately prepare on mitigating patients away from havoc to recovery.

Understanding the importance of surge capacity helps emergency responders to prepare for a disaster strategically. Surge capacity is defined “as the maximum potential delivery of required resources, either through augmentation or modification of resource management and allocation” (Koenig & Schultz, 2010, p. 35). For instance, if a whole community has been blasted with a bomb, they will need medical assistance at a hospital facility and transportation, immediately. The hospital must have a sufficient volume of rooms, medical staff, supplies, and equipment. This is how a surge capacity is operated. 

Preparedness of pre-disaster events is required to know the “what” factor situated at mitigating victims out of danger for treatment. The National Disaster Medical System (NDMS) are health professionals that are issued to significant events, such as hurricanes or floods, on treating patients in any jurisdiction of the United States. If the federal government accepts the request of the event, there are three types of response NDMS provides: deploying a team of healthcare professionals at the location, patient transportation, and providing full care facilitated in a specialized hospital. As a result, the “what” factor assists in predicting the services that are essential for preparing a surge capacity.

When determining the necessity for surge capacity, outcome-based planning is the next step. Koenig and Shultz (2010) describe the crisis of standard of care is followed by 3 S: Staff, structure, and stuff (Koenig & Shultz, 2010). Staff is for personnel that are in the medical field or specialty service. Structure are existing facilities in treating patients whether a functional hospital, mobile medical vehicles, or other site areas. Stuff is equipment and supplies to help to treat patients, such as medicine, monitors, and intravenous fluid bags. Even though the 3 S is prominent for surge capacity, the population is vital for measuring the quality of aiding victims safely.  

Assumption of surge capacity planning comprehends previous records of disasters that anticipate measuring sufficient care. If victims are in dire need of treatment during a disaster, then options are transporting them to a hospital or field and mobile hospital. Koeng and  Schultz  (2010) found, “field and mobile hospitals are too little, too late and cost-effective because they arrive from 2 to 5 days after impact, well after the last casualties are evacuated in sudden impact disasters” (as cited in Koenig & Schultz., 2010, p. 37). As a result, decision making for emergency responders requires thorough and rapid direction to initiating care effectively. 

Implementing surge capacity can continuously change, which emergency responders should recognize the capabilities of adapting to the significant event. There is consideration that includes vast majorities of countries to have the prime concern of their population on formulating effective medical care in responding to an emergency (Koenig & Schultz, 2010). This proposed three models to assist their demands: The hospital surge model, Pandemic influenza estimate model, mass evacuation transportation model.    

The hospital surge model gauges the number of resources capable of operating a mass casualty inside the hospital. Whether the causes are chemical, biological, radiological, or nuclear, the hospital has a planned template surge prepared. The North Dakota Department of Health (2015), explains their plan with a checklist from bed capacity, resources of functional staff and equipment, categorizing patients in specific rooms, to additional care facilities if needed (North Dakota Department of Health, 2015). Providing a hospital surge model is vital to a hospital’s resources for emergency operations.    

The hospital administrator and health officials use the pandemic influenza estimate model called “FluSurge.” This accommodates each hospital’s resources of information to transfer patients their treatment in a safe facility. The model details the numbers providing medical care and deaths through the influenza pandemic that pinpoints an efficient hospital for patients to be delivered for treatment (Koenig & Schultz, 2010).  Furthermore, FluSurge has been beneficial for treating patients in a precise location for pandemic influenza.    

Mass evacuation transportation model describes the process of notifying staff members and patients of an incoming disaster and helping them evacuate and transfer to a secured area before the catastrophe strikes. In a global setting, the model has different variations to assess an evacuation. The Pan-America Health Organization, between the United Nations and the European Committee, they created the Global Disaster Alert and Coordination System, where the device uses several features, such as media monitoring, map catalogs, and a Virtual On-Site Operations Coordination Center (Keonig & Schultz, 2010). The focus on terrorist or disaster events can help the world notify in advance to evacuate safely.    

Ciottone, G. R. (2016). Ciottone’s Disaster Medicine (2nd Ed.). Philadelphia, PA: Elsevier

Koenig, K. L. & Schultz, C. H. (2010). Disaster Medicine: Comprehensive Principles and Practices. Cambridge University Press

North Dakota Department of Health: Redacted Response Plan  (2015). Retrieved from: https://www.health.nd.gov/epr/readacted-response-p…

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answer 3

“Triage is the utilitarian sorting of patients into categories of priority to allocate limited resources rationally” (Ciottone, 2016). Triage sorts patients into categories to determine who can benefit the most from the limited resources and it determines the order in which patients receive treatment (Ciottone, 2016). From a healthcare facility’s perspective, this categorizes patients into those that need to receive care immediately and those that can wait to receive treatment. When a disaster event occurs, or a situation that causes a surge of patients, healthcare facilities would opt to discharge or transfer non-critical patients to create more bed space for the surge incoming patients that have been categorized to need immediate care.

Surge capacity and capability is a facility’s ability to handle and care for a sudden, unexpected increase of patients that exceeds the typical capacity of the facility (Hick, Barbera, & Kelen, 2009; Ciottone, 2016). Surge capability is the facility’s ability to “optimize patient outcomes for the greatest number of people” (Ciottone, 2016). The measure of a facility’s surge capacity is more than just the amount of available beds. Surge capacity is a measure of resources available for the facility to achieve its goal (Ciottone, 2016). It is the measure of the facility’s ability to triage patients and treat them (Ciottone, 2016; Hick et al., 2009).FILLER TEXT

Ciottone, G. R., Biddinger, P. D., Darling, R. G., Fares, S., Keim, M. E., Molloy, M. S., . . . Suner, S. (2015). Ciottone’s disaster medicine Elsevier.

Hick, J. L., Barbera, J. A., & Kelen, G. D. (2013, April 08). Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity. Disaster Medicine and Public Health Preparedness. Retrieved from https://bblearn.philau.edu/bbcswebdav/courses/19SP…