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Disaster Alternate Care Facility Selection Tool

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Appendix D: Alternate Care Facility Questionnaire—Summary of Results (continued)

Notes: Remarks in brackets [example] have been edited by the reviewing investigator to preserve confidentiality. No other changes have been made to survey data. The use of a period (.) in any field indicates no data was received from the survey respondent for that item.

Survey Question/Topic Site 1 Site 1' Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9
Info Issue Detail This response was under [name] so all PI management had to come through them - they had a very organized and orchestrated effort but other than [respondent identifying information redacted] was not privy to the process. Provision of credible, timely, and accurate information for such a large-scale response was challenging. Difficult to control media and VIP access to ACF causing issues regarding privacy. The information we received was erroneous - constantly The news media was all over the place Multiple news agencies conducting stories/interviews. We had our own PIO which facilitated this. . Volunteers were carelessly photographing patients. We stopped this. . Since in almost every major incident there are public information issues we anticipate there will be when an ACF is open and operational.
Dispatch? [Site] did this - basically the EMS provider who normally provided EMS services for the [convention center] continued to provide transport on the complex proper, with the help of dozens of agencies nationwide. Local 911 services remained under the control of the [city] EMS EMS resources were coordinated through the regional medical operations center. We had 2 EMS strategies: (1) 24/7 ALS ground ambulance for emergency transports (2) 24/7 BLS/ALS ground ambulance for routine/ scheduled transports Local EMS reps were at the ACF We didn't that was a huge issue EMS did not stand up and take a role. This is a huge issue I think. AMR was the local provider. We became part of their receiving facility network. They provided communications to us. N/A . Local EMS was coordinated through the incident command Through the Incident Commander and appropriate ESFs at the EOC.
Behavior Rules? Yes Yes No No No Yes Yes Yes Yes No
Behavior Rule Detail you'll have to ask [name] this question Curfew at 11pm, no weapons allowed, lights were dimmed at night, no loud music, wrist-band identification for shelter evacuees . It really wasn't an issue. we had National Guard and campus police nightly . 8:00 PM community curfew. No alcohol sold. . No weapons. Lights out. 1) No weapons 2) lights out at 22:00 3) No alcohol 4) No drugs - except for home meds. All medicines dispensed by onsite nurses & pharm. These will be developed with enhancement of the CONOPS for ACFs.
Other Command Issues? Yes I believe that true IC has to come from local municipalities but medical command of a specific clinic should come from the resource supplying the service. Most importantly the resource must be knowledgeable experienced, and capable of handling the response—the response should NEVER be recreated by another resource that has no knowledge or experience in the response [redacted] Command & control was key with necessity to consider extending NIMS/ICS to anticipated partners; credentialing of medical personnel; restricting access to shelters and ACF for appropriate persons. 1) Command staff were not relieved of their daily job function to perform oversight/command functions. These docs worked virtually 24-7 for the entire duration including working their scheduled ED shifts. 2) Use of ICS structure for running the ACF was a significant help in organizing the medical response Seems the biggest question is who "owns" it - who is responsible in the end - is it the ranking physician or local health or State health depts? There needs to be not only a command structure but also a continued hierarchy above - this is so questions can be answered and decisions made to help facilitate. Ex: ops need guidance or they will [indecipherable] too much and be overwhelmed. [redacted] Should be a physician (IC) - not hospital administrator. The structure was similar to the management structure @ VA hospital Need adaptability. Need "connectors" who can marshal resources and/or know where to seek them. Suspend rules and take risks. Never say no to a disaster related need if no one else can address that need. Ensure before the shelter is established that there is a clear organizational structure & that this information is available to the evacuees & local community. All command staff should wear ID clothing to identify them. There will have to be accords reached between the command of the ACF and the medical operations decision making portion of the ACF.
Security Personnel? . Yes Yes Yes - eventually Yes Yes Yes Yes Yes Yes
Armed Security? . Yes No Yes Yes Yes Yes Yes Yes Yes
Violence Issues? . No No No No No No No No Do not anticipate any but that is why armed security from law enforcement is part of the plan.
Other Security Issues? . Planning for more security personnel at the beginning of the event, education of security personnel for restricted access to sensitive areas, badging/ identification of ACF staff so security could easily determine who required access and who did not. The ACF was co-located within a large city shelter. The security element provided for the shelter then was easily shared between the two operations (shelter and ACF) Initially only had campus security - so male students were enlisted to "look like" security. Once National Guard arrived they set a perimeter and actually placed a temporary fence around entire area . We used our own local police - they travel with us. All on SWAT team and all sworn as US Marshals (allows jurisdiction over county lines). We anticipated the need of visible security presence and requested additional support. The enforcement staff came slowly and with much confusion. We also gave staff sensitivity training before they were deployed. Have a metal detector. Local State guard, campus police & city police very helpful. There needs to be a commitment from law enforcement to support ACF operations. Oftentimes they State that they will be too busy to assist with security issues but it will be key for them to provide resources during an ACF activation.
ACF Advance Plan? No No No No No - I had been a part of others so I had input in the beginning Yes No No Yes Yes - State guidelines have been written and work is being done to get counties to develop their own local plans for ACF operation.
ACF Site Selection? [name] question When need arose When need arose Determined in advance When need arose When need arose When need arose When need arose Determined in advance When need arose
Determined in advance
Some local sites have been identified but the plan is open for sites to also be selected as the need arises.
RMBT Tool? No No No Yes No (and I had been a part of this for a while) No No No No Yes
RMBT Tool Use? . . . No . . . . . Yes
RMBT Tool Help? Not sure No . Yes - we have utilized in our State ([name redacted]) . . May be. . . .
ACF Transport Location? [name] question Minimal at most. The ACF was purposely co-located within a shelter to bring care to the evacuees. No consideration was given to transportation or evac routes Don't know situation, it was established in [location] - one of the primary evacuation routes In the Katrina situation a good choice - many mtg I have been in do not address this Located at intersection of 2 main highways - 1 mile from local hospital (which was closed due to damage). N/A Extreme consideration. Very important Consideration was given to this aspect since it will be important to have quick ingress and egress along with traffic routes that are not bottled up.
ACF Site Selection Issues? [name] question Multiple multi-use facilities on one large property was very helpful and allowed expansion of service provision as the need dictated. . Proximity to a operating health care facility particularly if capable of running labs and other diagnostic tests 1. Easy bus routes for the elderly Did not set-up on hospital grounds. This was to allow access of building crews, logistics, etc. so facility could be rebuilt. [Location] is in rural [State], there was a lack of medical support as well as social support. What was available. Caution with gymnasiums: college is very protective of their floors & equipment. We are planning to use one of four different locations for ACFs. First would be near the scene, such as near a stadium that may have been hit to avoid having to transport large numbers of people. Second would be sites midway between the scene and hospital
Social Svc Plan? . Yes Yes - planned jointly between ACF and pub health authority . . Yes Yes No Yes .
Cleaning Plan? . . Yes - planned jointly between ACF and pub health authority . . Yes Yes No Yes Yes
Recreation Plan? . . Yes - planned by OEM due to shelter operations . . . Yes No Yes .
Warehouse Plan? . Yes Yes - planned by OEM due to shelter operations . . Yes Yes No Yes Yes
Purchasing Plan? . Yes Yes - planned by OEM due to shelter operations . . Yes Yes No Yes Yes
Other Service Plan? . . Yes - planned by ACF/pub health . . Yes . No Yes Yes
Other Service Detail [clinic] provided physicians, nurses, clerks, runners, environmental services (janitors), social workers, pharmacy, central supply, and pediatric subspecialty services . Evacuee transport to city clinics, dialysis, etc. done by ACF/pub hlth; independent pharmaceutical svc All managed by locals - we were asked for input . Clinical engineering (biomed equip) and security as mentioned. . . . Food service, Linen service
Other Service Issues? . Above services not checked in question 6 [cleaning, recreational, other] were provided but not planned for in advance - provision as the need identified. Rehabilitation workers, pharmaceutical svc for drug prescriptions, mental health svc, phone internet-deaf svcs all aided us in bringing svc to our patients . . . Pet service, schooling for children, meals Make up rules/solutions on the fly. . .
Case Mix Plan: Acute [name] question . 75 . . 20 . 50 . .
Case Mix Plan: Chronic [name] question . 25 . . 40 . 50 . .
Case Mix Plan: Pediatric Approx 30 . 20 . . 5 . 20 . .
Case Mix Plan: Adult [name] question . 80 . . 80+ . 80 . .
Case Mix Plan: Nonspecific [name] question Unknown as had no information on types of medical needs of population to be sheltered from [location] . Entire population Yes . . . Yes Yes
Case Mix Received: Acute [name] question . 10 30 5 10 . 0 20 .
Case Mix Received: Chronic [name] question . 90 40 95 60 30 100 80 .
Case Mix Received: Pediatric [name] question . 10 10 10 10 . 5 25 .
Case Mix Received: Adult [name] question . 90 20 90 90 . 95 75 .
Case Mix Received: Nonspecific [name] question Data unavailable at this time. . . Rough estimates . . . . Yes
Case Mix Plan Changed? [name] question . Yes Yes N/A No Yes . Yes .
Case Mix Plan Change Detail [name] question N/A Significant emphasis more along the lies of chronic care issues. If medical infrastructure is destroyed, chronic care becomes acute care fairly quickly . . . I am not involved with ACF planning Recognized that cute care should be handled at regional hospitals. .
Pediatric Care Plan? Provided these services but was not invited to help with the planning - we are invited to participate in the planning for future disasters; [name] question but I will tell you that yes they thought about kids but did not consult [name] for help—they provided 2 beds to the response both of which had adults in them when we arrived Not specified differently than other types of patients No Yes Yes Yes No Yes Yes Yes
Pediatric Care Location? Yes—[name redacted]—initially there was 2 beds, both with adults in them. After the arrival of [name] docs—they took over 4 chairs then within 6-8 hours [name] medical command on site agreed that more was needed and provide a much larger space. [redacted] Yes Yes Yes No Yes No Yes Yes Yes
Pediatric Care Plan: ED Nurse? [name] question . . Yes . . Yes . Yes .
Pediatric Care Plan: ED Doc? [name] question . . Yes . Yes Yes . Yes Yes
Pediatric Care Plan: Midlevel? [name] question . . Yes . . . . Yes .
Pediatric Care Plan: Ped ED Doc? [name] question . Yes - pediatric physician Yes . . Yes Yes . .
Pediatric Care Plan: Ped Nurse? [name] question . Yes Yes . . . Yes . .
Pediatric Care Plan: Other? [name] question . Yes Yes Yes . . . Yes .
Pediatric Care Plan: Other Detail [name] question Via coordination with community (private) provider for pediatrics services. Please note, pediatrics was considered in general as an important area to be addressed but no in-advance specific plans were in place. ACF medical command staff, EM physicians, EMS fellows Pediatricians Feds plan and on the fly . . . Family medicine residents from [location]. PharmD residents. .
Pediatric Care Consult: Care Center? [name] question - but basically NO . Yes . . . . No . .
Pediatric Care Consult: Peds Dept? [name] question - but basically NO . No . . . . No Yes .
Pediatric Care Consult: Other? [name] question - but basically NO . Yes . . . . No Yes .
Pediatric Care Consult: Other Detail . Yes, as above in question 3. county public health dept . . None . . Family medicine doctors. .
Equip Provider? [name] question Under [name] Medical Branch Operations, with ACF primarily equipped by [hospital]. Majority from the six [garbled] hospitals in town, some from private vendor and/or clinicians Was standing when we arrived. [College] provided much - SNS eventually arrived We brought it - Feds. DMAT Self Public health service and VA Donation from hospitals and a purchased "kit" Health department. State regional ACF caches.
Resupply Provider? [name] question As above - with additional supplies by private donors, community agencies/ groups, and volunteers. Majority from the six hospitals in town, some from private vendor and/or clinicians, plus county health dept. Locals, State of [State] & State of [State], FEMA, HHS Feds & national stockpile ESF-8 (FEMA) and donations VA N/A Health department. Local direct medical equipment. Additional State resources as well as community and possibly Federal resources.
Federal Cache? [name] question No No Yes Yes Yes Yes No No Yes
Cache Detail . . . Don't know specifics SNS ESF-8 (FEMA) as above. We were the first to deploy the SNS-VMI!!! . . . Plan to make use of NDMS resources and Federal Medical Stations as well as Strategic National Stockpile resources.


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