Vermont Healthcare Emergency Preparedness Coalition (VHEPC): Emergency Preparedness and Medical Surge Toolkit
When the Vermont Healthcare Emergency Preparedness Coalition
(VHEPC) had its first briefing on March 4, 2020, the coalition was reevaluating its position. VHEPC is a
multi-disciplinary partnership that collaborates with its members, stakeholders, and surrounding communities
to improve and expand emergency preparedness, response, and recovery capabilities in Vermont. All Clear
Emergency Management Group was contracted by the Vermont Department of Health to manage the healthcare
coalition and was in the process of reestablishing its membership. At that time, no one knew how important
emergency preparedness would soon become.
According to Lauren Smith, VHEPC Interim Readiness and Response Coordinator, the coalition was looking for
ways it could be valuable and support both its core and non-core members in areas such as emergency response
or medical surge capacity. Core members of the coalition include hospital, public health and emergency
medical services (EMS), and emergency management professionals, but Smith pointed out that there is a large
group of non-core members that fall outside those groups. She explained that the coalition historically
served as a convener and communicator, bringing people together for shared learning, training, preparedness
exercises, and tools.
During the COVID-19 public health emergency (PHE), the coalition was tasked by the Vermont Department of
Health to serve as a convener and bring hospitals together up to three times a week, to assess their status
with COVID-19, and to determine needs and resources. In addition to finding out what the coalition could do
to help their members, they also assessed what the hospitals needed from state, regional, or federal
perspectives to function effectively.
Smith emphasized that in the beginning their calls were about hospital needs, but as time went on there was
shift in focus to sharing perspectives from many different providers: for example, EMS providers and
healthcare professionals working in long-term care and home health settings on issues related to COVID-19
and providing care during a global pandemic.
Smith described the position VHEPC was operating from when they were subsequently asked to move into a data
collection role for a small, rural state:
“From working across the country with different coalitions, Vermont operated in an incredibly unique
capacity and leveraged existing partnerships to support each other when typical avenues had been exhausted.
Another observation was it never felt like there was any type of competition among the healthcare providers
in the state. It was very much one team, one fight, and the greater good was at the forefront of all
The data collected by the coalition was reported up through the state and aided leaders at the highest
levels of public health in their decision-making and forecasting throughout the pandemic. Initially, all
data were pulled manually, but then the coalition was able to work with a state data team to automate
reports. And further collaboration with Vermont Health Information Exchange, reduced some of the reporting
burden on hospitals.
As the new funding cycle began in 2021 and into 2022, the coalition began brainstorming supplemental
to address the gaps identified during the pandemic. VHEPC and All Clear Emergency Management Group leveraged
COVID-19 supplemental funding to address the identified gaps in Vermont. VHEPC started working on specific
COVID-19 projects related to health equity, barriers for patients transitioning to the community in a
post-acute setting, health communication, and information dissemination.
One of the success factors Smith pointed to was the collaborative and hopeful spirit throughout the state of
Vermont: “One thing that I thought helped the relief in Vermont was walking away from meetings I
always felt encouraged and like there was an understanding this is hard for everyone, but we were working
together, and the coalition really tried to be a part of that by bringing together and assisting with
Another success factor in their pandemic efforts was VHEPC's involvement, according to Smith. Unlike a
lot of other states, VHEPC was involved in the pandemic response from the very beginning and not when
hospitals started experiencing a critical surge in cases.
Dr. David Nelson, a pediatric emergency physician from the University of Vermont Medical Center (UVM) and a
VHEPC Clinical Advisor, shared his thoughts on the strengths of a coalition like VHEPC in a small rural
state: “If you've been involved with the healthcare systems, many times within a state there's people
doing parallel things and not everybody knows exactly what everyone's doing… In a smaller state it's
a little bit easier, I think, for us to pull everyone in and let everyone else know what's going on.”
Another supplemental project that had a large impact on Vermont's COVID-19 response efforts centered
around the development and dissemination of medical surge best practices. These best practices were
identified from around the country. The need for medical surge information and best practices was evident at
the start of the COVID-19 pandemic. Smith explained:
“As we saw across the country the healthcare systems were being stretched in ways that were
unimaginable. People could not have forecasted how a pandemic would overwhelm the health system, let alone
an individual long-term care facility or home health. I think in the past, a lot of thought has been put
towards hospitals, so now we were looking at what medical surge looked like across the healthcare spectrum
and what were the best practices. How can people prepare real time, in the midst of an emergency, so they
can actually address it if next week we have another additional surge?”
A final product of the project was a medical surge best practices toolkit developed by VHEPC for the state
Vermont. The toolkit focused on hospitals and, noted by Smith, included different resources and appendices
to address medical surge needs across the healthcare spectrum as well as information to help other community
providers understand how they could support hospitals experiencing capacity pressure. The toolkit is
available to all healthcare providers in Vermont and has been shared on webinars.
According to Smith, the toolkit addresses the four ‘S's’ in medical surge — space, staff,
stuff, and systems. She commented that, in the past, medical surge planning has been a daunting task and
could feel overwhelming. According to Smith, “The biggest win for this medical surge best practices
toolkit was to break it down into manageable, practical implementation steps; the toolkit walks through what
is included within the primary planning area and then goes into detail on planning items an organization
should consider, along with an accompanying worksheet and webinar.” According to Smith, breaking down
the processes makes the steps more manageable. Some examples of helpful prompts from the toolkit regarding
space include questions like:
Have you thought about how you would leverage space differently if you have to increase to a 20%, 50%,
or 110% surge?
Where are all the spaces that you could potentially use?
Smith shared how best practices are included throughout the toolkit though callout boxes to highlight items
to consider and pitfalls to avoid. One best practice use case featured in the toolkit was from a hospital in
Colorado that projected space utilization in a surge by going through the hospital's physical spaces
to identify all of their closets and every other space option in their facility to figure out how they could
surge to different levels.
Smith said VHEPC took “those lessons learned from the hospital in Colorado and put those
considerations into this toolkit — these are things that actually work, these are practical and
implementable, based on the size of the hospital.”
One of the projects that the coalition worked on looked at identifying barriers related to health
communication during the pandemic. Through this work, they determined that an ongoing challenge was the
ability to ensure that the right messages were delivered to the correct stakeholders. Many of the
supplemental projects were geared toward addressing this challenge.
Preparing for the Future
As a next step, VHEPC is working on applying all of its lessons learned to other potential healthcare
emergencies such as cyberattacks, workforce shortages, and even rare potential events like radiation
contamination and exposure.
Smith explained, “It is the intention of the VHEPC to have an all-hazards approach. So, while we have
been hyper-focused on COVID-19, we have a unique platform to be able to bring people back to think about all
of these other hazards that have been identified over the years that need attention.”