COVID-19 Escalation Management and Response Plans
COVID-19 Escalation Management Plans describe the actions taken by the State’s major hospitals and related facilities in response to COVID-19. There are three regional Escalation Management Plans - North, North West and South.
The aims of these plans are to:
- document the regions’ command, control and coordination arrangements for COVID-19
- outline the actions that the regions will undertake to prevent disease transmission between staff, patients and visitors
- clarify the roles and responsibilities across the regions and partners for the response to and recovery from a COVID-19 pandemic
- assist all sites and campuses of the regions to manage COVID-19 effectively, including management of outbreaks, and
- outline surge capacity and response of the THS in the event of an escalation.
Roles and responsibilities
Each THS region has a Regional Health Emergency Management Team (RHEMT) in place, led by a Regional Health Commander (RHC). The RHEMT supports progression of the actions outlined in their regional Plan, identifies risks, develops mitigation strategies and escalates as appropriate.
The RHC is a member of the Tasmanian Health Service Emergency Operations Centre (THS EOC), led by the THS EOC Commander. The THS EOC is responsible for the coordination and management of Tasmanian Health Service COVID-19 response operations and consequence management consistent with the Escalation Plans.
There are four escalation levels within the plans:
- Level 1: is the Preparation Phase, which involves maintaining business continuity whilst plans are made for the region to prepare for an escalation to Level 2. The THS has been at Level 1 for most of the pandemic.
- Level 2: is the Response Activation Phase, involving an operationalisation of some plans and actions in preparation for an escalation to Level 3.
- Level 3: is the Response Phase, involving activation of strategies and actions to respond to an increase in COVID19 presentations and inpatients that require treatment.
- Level 4: is a heightened Response Phase, where Level 3 capacity has been exceeded and a State-wide system response is necessary to manage the number of presentations or patients with COVID19.
Moving between escalation levels
Each Plan includes the trigger points and actions for escalation levels, from one through to four. These triggers are designed to allow the RHEMT and/or the THS EOC to consider the need to recommend escalation. Trigger points in isolation do not mean an automatic change in the level of response.
The triggers that drive consideration of movement between escalation levels are the number of patients admitted with COVID-19, the number of patients admitted requiring ICU-level care, the level of community transmission, and the level of service delivery compromise due to impact on staffing levels.
For movement between escalation levels one, two and three, on the recommendation of the relevant RHEMT, the THS EOC Commander approves the change escalation level and informs the Emergency Coordination Centre and State Health Commander. For escalation to or from level four, the THS EOC Commander endorses the change to escalation, informs the Emergency Coordination Centre of the recommendation to escalate, and formally writes to the State Health Commander for approval for the change in escalation level.
Key Features at each escalation level
Level 1 (Business as Usual Phase)
- At this level, there is endemic transmission in the Tasmanian community with no new variants.
- Staffing levels are managed flexibly under existing THS patient flow escalation protocols.
- Contact and emergency contact details are updated.
- There is appropriate and consistent signage at entrances, reception and waiting areas is arranged.
- Hand hygiene stations are in place at all entrances and reception areas, and visitor screening and restrictions are maintained at hospital entry points including rural facilities.
- All staff and visitors undertake the Health Screening Questionnaire which assesses and manages the risk posed by staff members, patients, and visitors to health services facilities.
- Visitor policy is in place which guides rules of entry. Restrictions for visitors include mask wearing and limited visiting hours.
- Baseline PPE for staff to include use of a surgical mask by all persons working in all clinical areas, or as otherwise directed by Public Health.
- Staff will take responsibility for monitoring their own health status and not come to work if experiencing any respiratory symptoms or feeling unwell.
- Prepare for an imminent Level 2 response.
Level 2 (Activation Phase).
- At this level, there is endemic transmission in the Tasmanian Community with an emerging variant of concern.
- Staffing levels are managed with only minimal service delivery impact.
- There is operationalisation of some plans and actions in preparation for an escalation to Level 3.
- Additional visitor restrictions are in place. Exemptions will be considered for exceptional circumstances, including end of life care, birthing or other situations.
- Baseline PPE for staff - approved P2 (N95) mask and protective eyewear by all persons working in all clinical areas, including acute, subacute, outpatient and community settings.
- EDs are reconfigured and ED receiving processes changed (including use of Extended Triage Areas) to risk assess and stream patients who are, or are suspected to be, COVID positive. ED entry restricted to essential staff only.
- Cleaning of frequent touch point areas is increased.
- All meetings and gatherings to comply with physical distancing requirements.
- Vulnerable staff to be allocated alternative duties or implement working from home arrangements.
- Staff testing in line with Public Health directions.
- Prepare for anticipated/imminent Level 3 response.
Level 3 (Response Phase)
- At this level, a community outbreak is evident in one or more regions with an emerging variant of concern.
- This level involves activation of strategies and actions to response to an increase in COVID-19 presentations and inpatients that require treatment and/or increased numbers of furloughed staff.
- Visitors and non-essential staff are excluded from clinical areas of hospitals.
- All non-essential outpatient services and visiting health services are suspended.
- All staff to have completed PPE training and competency assessment and maintain training and assessment documentation for auditing purposes.
- Appropriately prepared clinical staff to be relocated as required to COVID wards/beds including ICU and ED.
- Staff testing in line with Public Health directions.
- Prepare for anticipated/imminent Level 4 response.
Level 4 (Heightened Response Phase and facility at capacity)
- Level 4 response will be activated when level 3 response capacity is exceeded and a State-wide system response is necessary to manage the impact of COIVD-19 on the State's health system.
- Facility is closed to all visitors.
- The general public and clients are notified of cessation of any services.
- Consider cancellation of leave.
- COVID-19 surveillance testing will be introduced for staff caring for COVID positive patients in line with Public Health directions.
- Decanting of patients to private health facilities and district hospitals as appropriate.
- Response for Level 4 beyond this point is managed by a State-wide response, with the surge capacity of all hospitals utilised to meet to meet both COVID and non-COVID patient demand.