STATE OF MICHIGAN
GRETCHEN WHITMER
GOVERNOR

DEPARTMENT OF HEALTH AND HUMAN SERVICES
LANSING

Date:

March 25, 2020

To:

Michigan Hospitals

From:

Joneigh Khaldun, MD, MPH, FACEP
Chief Medical Executive and Chief Deputy for Health
Michigan Department of Health and Human Services

RE:

Participation as COVID-19 Relief Hospitals

ROBERT GORDON
DIRECTOR

The COVID-19 public health emergency has placed unprecedented demands on our
healthcare system, particularly in Southeast Michigan. Record numbers of critically ill
patients are being treated in these hospitals. Despite efforts at maximal surge, these
hospitals continue to experience demands for care that far exceed the institutions’
capacities and capabilities. Hospitals are approaching the need to implement crisis
standards of care. If immediate action is not taken by our statewide healthcare system,
needless loss of life is anticipated.
The State of Michigan has crafted a two-prong strategy to respond to the needs of
severely impacted hospitals. This strategy includes transferring patients to Relief
Hospitals in areas currently experiencing relatively minimal COVID-19 activity and the
use of alternate care sites (e.g., dormitories, former hospitals, etc.). While the use of
alternate care sites will likely be needed, these take time to establish and are unlikely to
be able to offer the level of critical care and ventilator management needed. The Relief
Hospital arm of our strategy relies on Michigan acute care hospitals located in areas
less affected by COVID-19 to offer 10% of their conventional capacity to assist the
hospitals that are so critically impacted while still preserving 50% of (expanded
conventional) capacity to be able to respond to a local outbreak.
To meet the needs of this response, MDHHS has established the COVID-19 Statewide
Load Balancing plan. The objectives of this plan are to:
1. Assure the safe, timely transfer of patients from hospitals experiencing extreme
healthcare demands to pre-identified Relief Hospitals located in communities with
minimal COVID-19 activity using qualified EMS personnel, supported by other
healthcare personnel as needed. It is the intent that transfers should occur first
within the same region; if space is unavailable in that region, transfer to a
hospital in the next closest available region should occur.
2. When load balancing is unable to be accomplished through the identified beds
within a region, this plan will provide centralized statewide coordination of patient
re-distribution from Transferring Hospitals to Relief Hospitals working
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collaboratively with the Healthcare Coalition Regional Medical Coordination
Centers (MCC).
This plan reinforces the need for physician-to-physician communications
between Transferring and Relief Hospital prior to movement of any patient.
Assure that no patient is relocated from the Transferring Hospital without
confirmed Relief Hospital acceptance, including identification of an accepting
physician. This will be accomplished working with each hospital’s incident
command center.
Provide patient tracking throughout the entire transfer process.
EMResource will be used to monitor hospital bed capacity throughout response.
Patients who are in extremis, in need of palliative care, or are felt unlikely to
survive should not be transferred.

Each Regional MCC will serve as the link between the transferring hospital(s) and state
level support coordination units. Hospitals requesting load balancing assistance will call
their Healthcare Coaltion Regional MCC who will gather preliminary information on
patient status, including the presence of COVID-19 where applicable.
The Regional MCC will reach out to the state Interhospital Coordinating Unit which will
utilize the information in EMResource to identify bed capacity within the region or if
unavailable, in the closest region with availability. The Interhospital Coordinating Unit
can be reached at 616-356-5708 and ask for the Dispatch Supervisor.
It is important to note that if the transferring hospital has their own solution for transport,
they should proceed with patient movement. If transport assistance is needed, the EMS
Agency serving as the central coordination point for load balancing will provide support
to initiate transportation. This will be coordinated through the Interhospital Coordinating
Unit. Patient movement will be accomplished using EMS personnel with skills matched
to patient acuity.
We recognize that as this outbreak continues, it is possible that other parts of the state
outside of Southeast Michigan may experience more spread of COVID-19. MDHHS will
continue to monitor data and spread and assure that this strategy remains flexible to
respond to other geographical demands. To successfully combat COVID-19 we will
need to utilize a unified, statewide public health approach.
Thank you for your attention to this important matter.
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