The Need to Incorporate Post-Acute Care Entities Into the National Disaster Medical System

The National Disaster Medical System (NDMS) is critical to healthcare preparedness and response in the United States but currently has limited capacity for handling large-scale mass-casualty surge events. Crises, such as the COVID-19 pandemic, have shown how quickly the US healthcare system can become overwhelmed, necessitating novel solutions for handling a large-scale influx of patients. This paper proposes the inclusion of post-acute care (PAC) entities, which provide long-term care rehabilitation and short-stay subacute rehabilitation support rather than acute or critical care, into the NDMS as one solution to increase its capacity during mass-casualty surges. By reviewing the unique capabilities and functions of PAC entities and considering evidence of their role in national emergencies, this paper demonstrates that PAC entities are well positioned to support the wider healthcare system in managing a mass influx of patients. We base this assertion on 4 points: (1) the support role PAC entities traditionally play for over-capacity hospitals by providing extra space for stabilized patients, (2) PAC entities' capacity to adapt their functions beyond PAC to support overall community response, (3) recent federal emergency preparedness requirement changes that increase PAC entities' disaster response capabilities, and (4) interim outcomes of NDMS efforts toward NDMS inclusion of PAC entities. We conclude by outlining challenges to integrate PAC entities into the NDMS and highlighting ongoing work by the congressionally directed NDMS Pilot Program, which is designed to increase capacity across the system. However, challenges such as limited staffed bed capacity at PAC entities, reduced availability of emergency medical service ambulances, and ongoing staffing shortages will need to be addressed.