Disaster Alternate Care Facilities: Selection and Operation

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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

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
ACF Planned?	.	.	.	.	.	.	.	.	.	Yes
ACF Actual?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	.
ACF Location?	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	.
ACF Dates?	Sept 1, 2005—Sept 15, 2005	August 31-September 20, 2005	Sept 1- 16, 2006	Immediate post-Katrina	.	Sept. 2—Oct. 14, 2005	September 2005	August 05	September/ October 2005	.
Number of ACF patients?	>4500	Over 27,000 shelter evacuees with over 10,000 patients seen in clinic and over 13,000 immunizations given	> 10,000	> 6000 / 800 beds	> 20,000	7500	200	700	340	.
Number of ACF staff?	There were several sources of staff—for practical purposes I will only represent the outlay that [we] provided	unknown	7 common staff/1,000 workers	several hundred	400 pt 4-2 rest of the number 50	60-100 at any one time	100	Volunteers—several hundred Medical staff, in total given ~300 (some were transiently involved)	plus or minus 200	.
Structure of Opportunity ACF?	Yes	Yes	Yes	Yes	Yes	.	Yes	Yes	Yes	Yes
Structure of Opportunity Detail	[Clinic housed in convention center structure]	Convention center structure used for operations	Convention center, parking garage level	Gymnasium	.	.	Closed VA hospital	Former [redacted] box store	College gymnasium.	.
Portable ACF?	.	.	.	.	.	.	.	.	.	Yes
Mobile ACF?	.	.	.	.	.	Yes	.	.	.	.
Inpatient Augmentation: Adult?	.	Yes	.	.	.	.	Yes	Yes	Yes	Yes
Inpatient Augmentation: Pediatric?	.	Yes	.	.	.	.	Yes	Yes	.	Yes
Inpatient Augmentation: Special Populations?	.	Yes	.	.	.	.	Yes	.	.	.
Inpatient Augmentation: Special Populations: Detail	.	.	.	.	.	.	Special needs population that required routine medical support. The acuity was similar to a nursing home.	.	COPD, asthma, diabetes	.
Inpatient Augmentation: Special Medical Needs?	.	.	.	.	.	.	.	.	.	.
Inpatient Augmentation: Special Medical Needs: Detail	.	.	.	Reserved nursing home—did not receive/treat evacuated in-patients.	.	.	.	.	COPD, asthma, diabetes	.
Inpatient Replacement: Adult?	.	.	.	Yes	Yes	Yes	.	.	.	Yes
Inpatient Replacement: Pediatric?	.	.	.	Yes	Yes	Yes	.	.	.	Yes
Inpatient Replacement: Special Populations?	.	.	.	.	Yes	Yes	.	.	.	Yes
Inpatient Replacement: Special Populations: Detail	.	.	.	.	VA pt., nursing home pt, ICU patients	Chronic disease—patients without meds or care for 1 week post-storm	.	.	.	If an incident such as pan flu or a hurricane strike necessitates it we would utilize an ACF for possible temporary replacement.
Inpatient Replacement: Special Medical Needs?	.	.	.	Yes	Yes	.	.	.	.	.
Inpatient Replacement: Special Medical Needs: Detail	.	.	.	Hemodialysis, rescued nursing home pts, amputees	Ventilator pt	.	.	.	.	.
Ambulatory Augmentation: Adult?	.	Yes	Yes	Yes	.	.	Yes	.	.	Yes
Ambulatory Augmentation: Pediatric?	Yes—([Location] sent its Emergency Center (EC) for all practical purposes—it was an effort to prevent [Location] from exceeding its surge capacity)	Yes	Yes	Yes	.	.	Yes	.	.	Yes
Ambulatory Augmentation: Public Health?	.	Yes	Yes	Yes	.	.	.	.	.	Yes
Ambulatory Replacement: Adult?	.	.	.	Yes	Yes	Yes	Yes	.	.	Yes
Ambulatory Replacement: Pediatric?	.	.	.	Very minimal	Yes	Yes	Yes	.	.	Yes
Ambulatory Replacement: Special Populations?	.	.	.	.	Yes	Yes	.	.	.	.
Ambulatory Replacement: Special Populations: Detail	.	.	.	.	VA, nursing home, ICU	Chronic disease—patients without meds or care for 1 week post-storm	.	.	.	.
Ambulatory Replacement: Special Medical Needs?	.	.	.	Yes	Yes	.	.	.	.	.
Ambulatory Replacement: Special Medical Needs: Detail	.	.	.	.	Ventilator patient	.	.	.	.	.
Ambulatory Replacement: Shelter Support?	.	.	.	Yes	Yes	Yes	Yes	.	Yes	.
Governance: Institutional/HC System?	Yes—With permission from [health dept] [Location] provided oversight of its staff, equipment, supplies, and pharmacy	.	.	.	.	Yes	.	.	.	Yes
Governance: Nonprofit/Volunteer?	.	.	.	.	.	.	.	.	.	.
Governance: Local?	Yes	Yes	Yes	.	.	.	.	.	Yes	Yes
Governance: Local: OEM?	Yes—provided the entire response including the ACF (both the [City] and [County])	Yes	Yes (provided admin support only)	.	.	.	.	.	.	Yes
Governance: Local: Public Health?	Yes—County Health Dept was large part of the governance of the [site] and therefore they were incident command for the [clinic]	Yes—[County] Public Health & Environmental Services	Yes (medical oversight)	.	.	.	.	.	Yes	Yes
Governance: Local: Other?	.	Yes—[hospital district]	Yes (County hospital system; [system name])	.	.	.	.	.	.	Shared responsibility between the hospitals, Emergency Management and Public Health with the use of State Medical Response Teams (similar to Federal DMAT) serving in a command role.
Governance: State?	.	Yes	.	Yes	.	.	.	Yes	.	Yes
Governance: Federal?	.	Yes	.	.	Yes	.	.	.	.	.
Governance: Federal: DHHS?	.	.	.	.	.	.	.	.	.	.
Governance: Federal: PHS?	.	.	.	.	.	.	Yes	.	.	.
Governance: Federal: NDMS?	.	Yes	.	.	Yes	.	.	.	.	.
Governance: Federal: DoD?	.	.	.	.	.	.	.	.	.	.
Governance: Federal: Other?	.	.	.	.	.	.	Yes—and VA staff managed & support.	.	.	.
ICS?	Yes	Yes	Yes	No—One already existed	Yes	Yes	No	Yes	Yes	Yes
ICS Model	[name redacted] did not set up an IC—[name redacted] did have their IC at the [site] and it was based on HICS	NIMS	Generic ICS	.	No—standard ICS for a DMAT	HICS & NIMS	.	Not a formal one. [respondent identifying information redacted] Responsibility was divided with a "deputy" in charge of nursing, medicine, facility setup/management	NEMS	NIMS
IAP?	Don't know—we were not involved at that level of IC	Yes	No—medical operation provided intel and data to local emergency management agency.	No—not formally	No	Yes	No	Do not know what this is but if it involved a form, no.	Yes	Yes
IAP Frequency	.	Daily	.	.	.	.	.	.	.	Daily
IAP Frequency—Other	.	.	.	Not formally though a per 12 hours shift plan was produced, as well as daily OPS briefings	.	.	.	.	.	If needed one would be established for each 12 hour operational period (12 hours).
IAP Type	.	Previously prepared form	.	.	.	Previously prepared form	.	.	A form we created	Previously prepared form
Command Problems	Yes	Yes	No	Yes	Yes	Yes	Yes	No	No	No
Command Problem Detail	We were not invited to play initially—we just showed up—initially we were not noticed because of the chaos of the moment—the [name redacted] version of the medical director showed up on night one and began to move pedi pts through the system—[name] noticed us and felt like we knew what we were doing and gave us more space—we filled that...—when things calmed down [name] began to see us as a rogue clinic and made it clear that we had to operate within their IC rules [redacted]	Local government command & control integrating with private partners (e.g. NGO's, CBO's, private partners, etc.)	.	Internal issues of authority and command. Did not impact us as responders from other State but caused issues between local, county, and State players	Above the commanders that came with the teams there was no one above there to give direction.	1st time tested; learning curve	No problem internal to the shelter—confusing command structure outside of the shelter	.	.	.
Transfer of Command	Verbal report Other	Verbal report Written report	Verbal report	Verbal report	Verbal report	Verbal report	Verbal report Written report	Verbal report	Verbal report Written report	Verbal report
Transfer of Command Detail	[Clinic] Medical Directors came from [location] so we formally checked out. [name] IC meetings were held twice daily and our main medical director was eventually invited and made the official [name] IC medical director for the [clinic]	.	.	.	.	.	N/A	.	.	.
How Open?	Two of our faculty showed up at the request of the news media to help with the response and noticed that there were only 2 pediatricians on site—hours later we were coordinating the pediatric response	State & county elected officials made decision	Joint decision between OEM (city Office of Emergency Management), city EMS medical directors, and county public health authority.	Was already open. Local & regional health care providers had staffed it for about 48 hours prior to our arrival	Federal deployment	Request via EMAC	N/A	Ask to do so by the State	E.O.C. contacted the M.O.C who contacted the Public Health Department	Assessment of surge impact.
Who Decides?	The physician who showed up and took command of the pedi clinic contacted the admin for [location] who then agreed to full out resource support of the effort.	Governor & County Judge	Medical director of county public health dept (health authority)	Unknown	NDMS/DHS	State of [State Redacted]	N/A	An assistant to the Governor	Health Authority. After being asked by the fire chief.	Collective decision between the Incident Commander, the Emergency Manager, the Medical Director and the Health Department Director with hospital input.
How Close?	When it was clear that patient volume had dropped significantly, the med director from [Location] worked with [Locations] to relinquish control over the [clinic] to the [Location] and they sent a pedi medical director to take over (transitioned over one weekend).	Another impending Category 5 Hurricane was set to strike community—so shelter was closed & residents evacuated.	Declined in shelter population as evacuees were placed in more permanent housing locations	After about 8-9 days patients were no longer arriving for care—and the patients we had were able to be shipped out	NDMS/DHS—all the patients had been evacuated	Demobilization plan prepared between [State] Office of EMS & [State] Dept. of Health	N/A	The expected surge was directed elsewhere.	Once all evacuees had a safe place to be transferred to.	Collective decision between the ACF Commander, the Emergency Manager, the Medical Director, the Health Department Director and the hospitals.
Pre-Close Check?	Lack of patients	Ensuring all evacuees were relocated safely to other shelter facilities elsewhere	None	Local and regional health care facilities were decompressed enough to receive patients directly. Transfer of PMAC patients were completed	No more patients	Rebuilding and increased service delivery of the affected community hospital.	Patient load, discharge philosophy, shelter occupants desire to go home ASAP	There were no predetermined requirements	All evacuees had to have a safe home.	N/A
CONOPS?	Yes—remember that we were separate for the [site redacted] plan—we used our own concept of operations—50 years in the business of taking care of [patients]	Yes	No—we made it up as we went along	Yes and no; our initial ops plan did not entail such a large number of patients with so many needs	No	Yes	Yes	Yes—although not written	Yes	Yes
NIMS/HICS Training?	No	Yes	Yes	Yes—our own team did	Yes	No	Yes	No	Yes	Yes
Training %?	.	60	25	75	100	.	20	.	20	UND
EMTALA?	No	Unknown	No	No	No	No	No	No	No	Yes
EMTALA Detail	.	.	.	.	It was an evacuation—patients came from high centers which had nothing to us (aid station)	.	.	.	.	We anticipate there will be issues related to the use of non-hospital facilities and issues if hospitals send people to an ACF without a full assessment first.
Info Issues?	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes

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