Utah stakeholders forge healthcare coalition to strengthen surge capacity

In Brief

To build infrastructure and capacity for healthcare surge in Utah, a state with large frontier areas, Bear River Health Department collaborated with hospitals and other stakeholders to build the Northern Utah Healthcare Coalition. The effort has facilitated relationships, planning, training, communication, and ways to share resources before a disaster occurs.


States with large rural or frontier areas and low population density face unique challenges when preparing for a large-scale disaster. Regional access to emergency healthcare and hospital surge are two issues of particular concern to geographically isolated areas.

Local health departments in Utah play a significant role in carrying out Emergency Support Function 8 (ESF-8), the FEMA National Response Framework function responsible for public health and medical services. Across Utah's 7 health regions, local agencies work with healthcare systems and hospitals to build a support structure for emergency response.

Specific issues
  • Communication gaps. Because ESF-8 planning must occur between regions and types of healthcare and public health entities, no common language or structure exists for assuring that all agencies are receiving or communicating the same information. These inconsistencies represent a particularly significant barrier during a surge event when patient or equipment levels must be communicated rapidly for needs to be addressed.
  • Geographic challenges. Building regional healthcare collaborations is made more difficult in Utah's frontier areas where distances between sites mean longer travel time.
  • Jurisdictional responsibilities. Because local agencies in Utah bear much responsibility for implementing ESF-8 activities, they must coordinate with regional HHS ESF-8 workgroups, while not overstepping their roles.
The practice

The Bear River Health Department (BRHD) coordinated the formation of the Northern Utah Healthcare Coalition (NUHC), a multi-disciplinary group whose goal is to address healthcare surge issues during a disaster via coordinated communication and resource sharing.

The goal of the NUHC is not to act as a response unit in the event of an emergency; rather, members form a cohesive group dedicated to preparing for a surge event by building relationships between many different types of healthcare entities, providing training and education opportunities, crafting regional response plans, and building mechanisms for sharing equipment and resources.


Current members include 8 hospitals; 3 local health departments; 6 county emergency managers; 6 county Emergency Medical Services representatives; representatives from long-term care agencies, primary care clinics, the Northwest Band of Shoshonee; and ad hoc members representing emergency dispatch, home health, hospice, behavioral health, the department of transportation, highway patrol, and city emergency management.

An executive committee comprises representatives from 5 hospitals, 1 health officer, 1 clinic representative, 1 emergency medical services staff person, and 1 county emergency manager.

Essential members change depending on annual preparedness priorities and focus. During 2012, the coalition's focus was on developing Memoranda of Understanding between hospitals and skilled nursing facilities. Thus, essential members included emergency medical services, emergency management agencies, behavioral health services, specialty and support services (ie, dialysis, pharmacy, and home health), and tribal health.

It is a coalition requirement that all hospitals in Utah are included as members, and hospitals retain a voting majority at quarterly coalition meetings. The BRHD regional medical surge director convenes meetings, facilitates discussions around surge issues, acts to build consensus, and otherwise is responsible for all coalition communications.

Surge planning

The NUHC conducted numerous activities related to surge planning, including communications issues between healthcare entities, including:

  • Creating an all-hazards medical surge plan, which puts control for coordination in the hands of the county Emergency Operations Center. The National Incident Management System-compliant plan is 8 pages long, yet contains more than 100 pages of appendices and tools, which are updated quarterly.
  • Developing a shared hazards assessment for counties and hospitals to use as they complete their hazard vulnerability analyses
  • Participating in communications exercises focusing on use of satellite phones and 800 MHz, HAM, and commercial radio
  • Establishing plans to share medical assets within regions. For instance, the NUHC developed a protocol that allows any member to borrow water purifiers when needed.
What made this practice possible?
  • Relationships between members. Because the NUHC relies on cooperation between agencies, many of whom have individual agendas and priorities, strong working relationships and respect for differing or competing viewpoints are key to the coalition's success.
  • Significant engagement efforts. BRHD contributed an enormous amount of effort to maintain active participation from every hospital and county emergency manager, along with other healthcare representatives.
  • Communications protocol. The NUHC worked with Utah Department of Health and the Utah Communication Agency Networks to provide all hospitals with 3 800 MHz radios and develop a standard protocol for their use across agencies.
  • Equipment purchases. Using Hospital Preparedness Program funds, each hospital was provided with $5,000 to spend on water purifiers, filling stations, and generators for purifiers.
  • Exercises. In September 2011, the NUHC tested its regional medical surge plan via a tabletop exercise and conducted a follow-up drill during the Utah Shake-Out, a statewide earthquake response exercise. In 2012, the coalition tested its 800 MHz and satellite phone communications protocols with all 8 member hospitals.

The strategic plan for 2012-2013 addresses Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) alignment with respect to the Presidential Preparedness Directive 8 capabilities.

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