HPP Propels the Evolution of a Tennessee Health Care Coalition

Knox County, East Tennessee

From “Me” to “We”

Over the last decade, the Knox/East TN (KET) Healthcare Coalition has evolved from its focus on individual hospital preparedness to more holistic regional preparedness. A decade ago, a subcommittee of local hospitals and emergency medical services (EMS) met to discuss preparedness and response for disasters. Today, thanks to HPP’s foresight in encouraging health care coalitions (HCC) to include a diverse set of partners, the KET Healthcare Coalition has members from numerous traditional and non-​​traditional organizations and facilities. Partners include the Regional Forensic Center, blood banks, home health, dialysis, long-term care, and more. Members gain value from the coalition through the exercises, plans, memoranda of understanding, and other collaboration efforts.

“I commend ASPR for having the foresight [to include more organizations]. We didn’t like it at first, but I see the value in it now because it brought us all collectively together to look at things differently. It affected our exercises and lessons learned because we had a different focus.”
– John Brinkley, Knox Regional Hospital Coordinator

This transition from individual to collective action was difficult, but recent challenges demonstrated the value of regularly sharing information, discussing concerns, and developing plans to address those concerns with a diverse group of stakeholders. For example, two hospitals in the region were closing, and the KET Healthcare Coalition identified concerns around bed availability and emergency medical services’ (EMS) turnaround time. The hospital administrators went to the coalition for help. Using a system already in place, the Hospital Resource Tracking System, the hospitals and coalition worked to address these new challenges by adding EMS times into the system. If an EMS unit is waiting too long, the hospital can turn to “yellow” or “red” to let EMS services know there are few beds available. There is currently 100% participation in this system, and each year 90% of hospitals report their availability of beds, services, and resources (e.g., ventilators) daily.

Coordinating for Pediatric Preparedness

Pediatric preparedness is a significant undertaking that requires a holistic approach. The KET Healthcare Coalition took a three-pronged approach, providing supplies, pediatric-focused training, and tabletop and full-scale exercises to its members and other partners throughout the state. For example, the coalition provided pediatric-specific mass casualty supplies to EMS providers across the region, and ED equipment and supplies to hospitals, as long as they attended 75% of coalition meetings and committed to maintaining supplies. 

The coalition also held pediatric simulation events using new pediatric simulators. In 2019, the KET Healthcare coalition held 26 simulation event, involving 56 scenarios over 51 hours of simulation with 147 EMS providers, 179 registered nurses, 1 physician, and 44 other staff. The pediatric simulation events focus on hands-on training, in-the-moment decisions, and real conversations. One participant said he learned more in the 2 hours they spent doing the simulation than he had in the past 10 years of training. Since the simulators are mobile, the trainers could have EMS practice in a parking lot or could bring it to a hospital in a rural area so they could practice using their own supplies and resources.

Collaboration in Real Time

The coalition-building and preparedness activities of the KET Healthcare Coalition have enabled the region to successfully respond to emergencies and disasters. In 2016, a train derailment resulted in a gas leak, but the hospital that responded did not have enough critical cyanide kits to mitigate the leak. With just one call to the coalition, all cyanide kits from the region were on their way to the hospital within four hours, and all kits throughout the state were en route within 6 hours. The hospital was also able to decontaminate all 88 individuals with the decontamination materials they bought with HPP cooperative agreement funds.

With relationships already in place, those involved in the coalition didn’t have to make introductions at the scene of the emergency. Instead, they used those crucial early moments to immediately provide reports, share real-time updates with hospitals, and determine the availability of certain hospitals to accept patients. This event demonstrated the strength of the coalition members’ relationships and the impact it has on successful communication and coordination.

 “[The coalition] is the mortar between the bricks. In any event, it holds up strong.”
–Wanda Roberts, East Tennessee Regional Hospital Coordinator