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Disaster Alternate Care Facilities: Selection and Operation

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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Executive Summary

Purpose. The primary objective of this task order is to review, revise, and enhance the alternate care site selection tool that was developed under AHRQ Contract No. 290-00-0014 Task Order No. 5, titled "The Rocky Mountain Regional Model for Bioterrorist Events" (available at: http://www.ahrq.gov/research/altsites.htm). Additional objectives were to:

  • Develop a template for an operations manual for an alternate care facility (ACF); the intent is to use this template as a starting point in developing a "concept of operations" manual for a specific iteration of any ACF.
  • Develop staffing guidelines for an ACF.
  • Develop an algorithm to assist health care providers in selecting hospital inpatients who might be eligible for transfer to an ACF to augment hospital surge capacity.
  • Present lists of supplies and equipment that may serve as a starting point for equipping and supplying an ACF based on expert advice and the experiences of those who have operated ACFs.

Background. In a mass casualty event of any significant magnitude, hospitals and other traditional venues for health care will most likely be overwhelmed with patients (or rendered inoperative), making it necessary to establish ACFs: alternate locations for providing care that usually would be provided in an inpatient facility, including acute, subacute, and chronic care. The work presented here builds on previous efforts that have been refined and enhanced based on recent experience gained from dealing with significant mass casualty events.

Methods. The revision of the ACF Site Selection tool involved a multi-step effort. A thorough literature review of recent experiences with ACFs was undertaken. This knowledge was augmented through the development of an extensive questionnaire concerning the establishment and operation of ACFs during recent multi-casualty events in the United States. This questionnaire was sent to and completed by a select group of experts with significant experience in the operation or development of ACFs. An Advisory Panel of experts in the field of surge capacity and ACFs guided the activities related to this Task Order.

Results. The results of the literature review and the responses to the questionnaire were used in the development of the following, which are fully described in this report:

  • ACF selection tool.
  • ACF operations template.
  • ACF staffing recommendations.
  • Hospital patient selection tool to assist in determining those patients who may be eligible for transfer to an ACF to increase hospital surge capacity.
  • ACF equipment and supply options.

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