For decades, the State has worked to develop a health care system that is integrated with its public health, emergency medical services, chronic care, behavioral, and specialty care systems. Since 1970, the State has had a trauma and burn care system within the hospital network as well as other specialty care centers for pediatric and high-risk neonatal patients. The State of Columbia’s medical care facilities include two Level I trauma centers – each with pediatric trauma centers, four Level II trauma centers, a tribal hospital, and a veteran’s hospital. Two hospital systems, Noble General Hospital System and Columbia Regional Health Network (CRHN), serve the more concentrated population areas in the southern part of the State. Psychiatric in-patient hospitals are located one each in Kingston, Liberty County, and in Pineville, Pine County.

The State of Columbia has 26 acute care hospitals, two in-patient psychiatric hospitals, and one clinic categorized as a hospital because of its remote location and free-standing emergency capability.

• Central City Hospital and Grand County Hospital are Level I and Pediatric Trauma Centers.
• Capital City, Metropolis General, St. Dorothy’s, and Tower Beach are Level II Trauma Centers.
• Pony Primary Care Clinic is the only Level IV Trauma Center.
• Alder Hospital and Newday Hospital are the only in-patient psychiatric hospitals; most acute medical care hospitals have at least one holding bed for psychiatric emergencies. The psychiatric hospitals are almost always at 100% occupancy so in-patient psychiatric admissions are often backed up waiting for beds to become available.

Health Clinics

• The State has a system of Community Health Centers (CHC) and federally qualified health centers (FQHC). These outpatient medical clinics serve un– and under–insured residents in their local catchment areas.
• Mental health out-patient clinics are co-located with many acute care hospitals.

Dialysis Centers

The Columbia Regional Hospital System operates regional dialysis centers that are located in Metropolis, Capital City, Big Rock (tribal), Central City, and Kingston.

Private Medical Offices and Physicians

Liberty County has more than 75 private outpatient medical practices ranging from solo practices to multi-specialty clinics with more than 25 physicians, representing a full range of primary care, specialties, and sub-specialty. Practices generally affiliate with the hospital or hospitals geographically closest to them, and many primary care providers coordinate with hospitalists for admissions. The Liberty County Medical Society has more than 450 physician members; approximately 5% of the membership is members of the Medical Reserve Corps in each of the EMS regions.

Nursing Homes

Three hundred sixty–two nursing homes are licensed in the State. Fifteen, including one operated by the Veteran’s Administration, are in Liberty County.

Hospice

Hospice facilities are located in Kingston, Harvest Junction, Fisherville, Deep River, Bayport, and Central City. Each facility has 10 beds and is staffed with 20 registered nurses and 20 ancillary staff. No surge capacity exists at any of the facilities.

Over the last decade, Columbia has developed a robust catastrophic response capability to complement the existing health care systems. All hospitals are part of the statewide emergency response plan and have key staff trained in Hospital Incident Command System (HICS) for hospitals. Annual exercises are comprehensive and multi-jurisdictional. Partnerships with emergency management and among all disciplines at multiple levels have led to an increased understanding among responders about the hospital and healthcare systems. Many hospitals have modified physical plants to support patient decontamination and isolation of infectious patients. Surge plans, continuity of operations, and emergency power support plans are in place at all hospitals as a requirement for State licensure. All hospitals in the State are required to participate in the CDHHS statewide syndrome surveillance system and the Columbia Medical Resource Tracking Tool System.

Medical Reserve Corps (MRC)

Three Medical Reserve Corps (MRC) exist in Columbia – one in each EMS region - using volunteers from the State’s licensed medical professionals. The MRCs are administered by their host local Public Health Department. The EMS Region 2 MRC is based in Central City and is administered by LCPHD. The MRC program coordinates the skills of practicing and retired physicians, nurses and other health professionals, as well as other citizens interested in health issues who volunteer to help during large-scale emergency situations. Each MRC consists of approximately 100 members who will deploy for missions such as augmenting staff at health facilities, administering immunizations, and staffing mobile disaster medical facilities and treatment points. The MRCs can be requested through the State EOC and DOH.

State Medical Assistance Team (SMAT)

As part of the medical surge plan, three State Medical Assistance Teams (SMAT) are available within the State of Columbia through the State EOC and DOH for missions such as managing the National Pharmaceutical Stockpile (NPS) reception, establishing a mass drug distribution/immunization administration site, staffing an austere field medical treatment facility (300+ patients/day with a 20–bed holding capacity) or managing the 150–bed portable hospital available through Central City Hospital. Each SMAT comprises 55 medical/healthcare practitioners (including veterinarians), law enforcement, HAZMAT, and support personnel. SMAT members are paid by their employers while training or when deployed.

Deployable Hospitals and Staffing

One deployable 150-bed hospital exists in Columbia. The set is divided into three 50-bed packages with one each positioned at Capital City Hospital, Central City Hospital, and Metropolis General Hospital; personnel at each hospital maintain the sets. The set can be deployed in increments of 50 or as the entire 150-bed resource. The deployable hospital is a CDHHS State asset that can be requested for response in the State through the State EOC and is also available to other States through the EMAC process. The hospital is staffed with teams that meet the FEMA resource typing requirements such as Ancillary Support Teams for Laboratory, Pharmacy, and Radiology services (Type 1); Emergency/Critical Care Team (Type 1); Mobile Field Medical Team (Type 1); and Specialty Services Teams (Type 1) as required. The number of and kinds of teams can be tailored to the mission.

Medical/Public Health System Assessment Team

Three Medical/Public Health System Assessment Teams (Type 1) exist in the State of Columbia – one in each EMS region. The teams provide immediate and ongoing assessment of public health and medical systems of a disaster-affected community when activated by the CDHHS. Each team is composed of a leader, an expert in public health systems, and an expert in medical systems.

State Emergency Registry of Volunteers in Columbia (SERVCO)

Like most States, Columbia, through its CDHHS, operates a registry for healthcare professionals who are willing to respond during catastrophic events. Presently, more than 12,000 physicians, nurses, therapists, physician assistants, pharmacists, and numerous other healthcare practitioners have registered through the system. See Appendix I for more information on SERVCO and the MRCs.

CDHHS Palliative Care/Hospice Team

This team provides comfort care and palliative medicine for the chronically and terminally ill in hospice, home care, and hospital settings during disasters. CDHHS maintains one Type I team for intra-state or EMAC deployment.

The Columbia State Office of Emergency Medical Services (OEMS) has developed and implemented a centralized statewide monitoring tool capable of monitoring hospital, EMS, and health center resources on a near real-time basis. The CMRTT system can be activated when a need for additional hospital beds, clinical supplies, equipment or services, or EMS capabilities at the local, regional, or statewide level is identified.

Activation of the CMRTT is initiated at the local level by request to the local EOC. The local EOC in turn activates the State request mechanism. An example of how the system works in Central City, Liberty County, is presented here: