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 (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
Private Partners?	[name] question - I know that CVS was consulted - and [name] was eventually tapped	Yes	Yes - partnerships developed during the event	Yes—[name] EMS/Health Dept. had MOU's with local suppliers	No - donations came in	No	Yes - Wal-Mart	Yes	Yes	Yes
Food Supply?	[name] question	Via a contract food supply service at [site].	Patients fed by shelter operations (American Red Cross); workers fed by private vendor on contract to city OEM	Initially local restaurants and then [college] food service all pitched in	We initially had nothing but then used MRE (meals ready to eat). Hard for the elderly.	Local faith-based group on-site, then FEMA logistics	Contract	Restaurants/catering services supplied food	Local restaurant provided food. Food bank. College cafeteria.	Plan involves using ESF - Mass Care resources to accomplish this.
Family Food Supply?	Yes—[name] question	Yes	No - patients and family members were fed by ARC as a result of residing in the co-located shelter	No	Yes	No	Yes	Yes	Yes	No
Separate Dining?	[name] question	Yes	Yes - dining in shelter, treatment in ACF	Yes for staff; No for patients	Yes for us; No for patients	Yes	Yes	Yes	Yes	Yes
Pediatrics Meds?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Enough Pediatrics Meds?	No	Yes	Yes	.	Whatever was donated	Yes	Yes	Yes	Yes	.
Pediatrics Meds Supplier?	Initially the [hospital] provided pharmacy services - the supplies were dramatically under stocked so [name] moved in and opened and resupplied its own pharmacy and central supply	All medications were initially filled by off-site [hospital] pharmacies and eventually transitioned (a few days into the response) to CVS Pharmacy, which provided two mobile pharmacy units at no cost.	Same as for other supplies	Local resources in [location]	.	SNS-VMI	Wal-Mart	Industry, hospital, NGO. (pharma)	Local pharmacies. Samples from doctors.	.
Other Pediatrics Supplies?	[name] question - same answer as the pharmacy question	Yes	Yes	.	Yes	Yes	.	Yes	Yes	Yes
Enough Other Pediatrics Supplies?	.	Yes - unknown but likely so	Yes	.	No	Yes	.	Yes	Yes	.
Other Pediatrics Supplier?	.	If so, via clinical providers and likely donated by them as well.	Same as for other supplies	Minimal supplies initially - after 72 hours or so received quantities from Fed.	We brought them in the Fed cache	ESF-8 (FEMA)	.	Industry, hospital, NGO. (pharma)	Local hospitals.	.
Most Important Supplies?	See attached document [article]	Medications for chronic medical conditions (such as HTN, DM, etc.) were critical as were a constant re-supply of necessary equipment to run an ACF (such as wheelchairs, lab supplies, needles, gloves, gowns, masks, etc.).	Wound care supplies, point-of-care laboratory capabilities, and free standing pharmacy which stood up within the first 3-4 days of our operation. A local pharmacy chain built, de novo, a full service operation just outside the ACF site	Point of care testing: only had 2 glucometers when we arrived, EKG & other diagnostic tools. IV fluids and starter kits. Patient gowns, sheets, blankets etc.	1. Sheets - stretchers bed pans hand sanitizer diapers (young and old) chronic antiHTN and DM meds	Chronic meds (insulin, anti-hypertensives, pain mgt.) and antibiotics	.	Cots, chronic disease meds such as insulin	1) beds & cots with special mattresses. 2) dispensary run by pharmacist - antibiotics, nebulizations. 3) nebulizers & O2 supplies. 4) glucose monitoring equipment. 5) crash carts. 6) radios for communication	.
Supplies Unavailable?	We had everything we needed once [name] took over	Eventually everything was provided for - the issue was time and determining how to get the supplies in need.	.	After 48 hours desperately needed capability for dialysis - local resources were brought in.	Oxygen was difficult	None	Difficulty time with narcotics. Lack of DEA # for the shelter.	0	None.	.
General Logistics Issues?	let the regional resource do what it does every day - don't recreate the wheel	.	We offered on-site general dentistry and refraction for eyeglasses which was a great value to our patients. Also working narcotic addicted and dialysis patients into pre-existing care patterns within the community.	Once the Federal supplies arrived a forklift was needed to move pallets, break them down, and repackage for use. A strong, young non-medical labor pool was essential.	.	We were self-supporting for 72 hours.	.	Need portable shower/toilet facilities	Identify before the disaster who will provide logistics.	.
Set Provider Shifts?		.	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Shift Type	8 hour 12 hour 24 hour	.	8 hour 12 hour 4 hour	12 hour	12 hour	12 hour	12 hour	Other	8 hour	12 hour
Shift Type Detail	This is for the [Clinic] only - housed within the much larger [name] response ACF residing in the [site] - [name] will have to answer the questions from their perspective	.	All scheduling based upon volunteer availability	.	Eventually we had shifts	.	.	As available	As per availability of community resources	.
Different Day/Night Staffing?	Yes	.	Yes	It varied by number of volunteers	No	Yes	Yes	Yes	Yes	.
Docs on Shift?	Varied from day one to day 14—[identifying details redacted: summary: 4 trained medical directors, 4 scheduled specialist physicians], lots of extra volunteers	.	16 am/4 pm	Varied - generally 25/more in the beginning but specialists who really were not comfortable with general medicine.	Unable to answer	4-5	4	4	2-3	Use military recommended guidelines.
Midlevel on Shift?	Not sure - were not scheduled but many came	.	None	20	Unable to answer	1-2	5	3	2-3	.
Nurses on Shift?	Same as docs above	.	20 am/6 pm	50+	Unable to answer	8-10	20	10	20-30	.
EMT on Shift?	[name] did not supply any EMTs	.	8 am/6 pm	50+	Unable to answer.	8-10	.	1-2	10	.
Pharmacy on Shift?	One around the clock (12 hour shifts)	.	2 am/1 pm	6+ (all from USHPS)	2-3	2-3	2	1-2	1-2	.
Additional Staffing Detail	.	.	.	.	Initially we had ~ 90 people 2/3 direct patient care so they had MD/nurse/ML/EMT; 1/3 transport & holding (3 nurses 1 MD >700 pt) and 20 people offloading helicopters. Eventually increased the number of MDs/nurses (mostly) and EMT when support arrived	.	.	.	.	.
Clerks/Admins?	Yes	.	Yes - medical records, mental health	Yes	Yes	Yes	No	Yes	Yes	Yes
Clerk/Admin Detail	One around the clock (8hour shifts)	.	5 am/1 pm - much admin work done by medical command staff due to limited admin support	Well over 50, they were college students & staff	Each team has 1-2 admin folks plus there is support from NDMS	1-2	.	~6	[name] State guard medical rangers 20.	.
Outside Providers?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Outside Provider Issues?	Most pediatricians came from [name] or its referral source ([identifying detail redacted])- so they were credentialed through our hospital - did have some issues at time with [name] IC - most were resolved without incident	Communication was continual issue so daily briefings/ updates were important.	No	Very few problems - there was so much to do no time for turn battles. We always held change of shift reports within nursing - including numbers of pts., etc.	Each team has its own. In another situation we had Marines, VA nurses & public health - they stayed together but were under a command system and understood that	None	Initially with staff from DHS. Minimal command control issue	No	No - the shelter manager & health authority kept command over the shelter.	.
Licensing Issues?	Yes	.	No - credentialling consisted of a visual check of providers professional ID badge to verify identity and job function (RN, MD, EMT, etc)	USPHS managed these issues	Yes - for narcotic refills	Yes	Yes	No	No	.
Interpreter Services?	Yes	.	Yes	No	No	No	No	No	No	Yes
How Interpreted?	Trained interpreters Bilingual/ multilingual care providers Family members Other	.	Bilingual/ multilingual care providers Family members Other	.	.	.	.	.	.	.
Interpreter Detail	.	.	Deaf video phone system	.	.	.	.	.	If we did, we would use volunteers.	.
Volunteer Types?	Medical Non-medical	Medical Non-medical	Medical Non-medical	Medical Non-medical	Non-medical	None	Non-medical	Medical Non-medical	Medical Non-medical	Medical Non-medical
Volunteer Coordinator?	Yes—[name] used its own coordinator but [name] had its own also	Yes	Yes	Yes - college professors from campus	Not initially	No	No	Yes	Yes	Yes
Volunteer Lessons?	They were essential	.	Pre-plan their job function (role), teach them the role, and always direct oversight of their activities	We would've failed without them. Convene a meeting, explain the prioritized issues/problems & let volunteers choose what they can help with.	They need to be given tasks as well as coordinated as a group - in [location] we had yellow shirts and if I remember correctly orange shirt folks - all faith based.	N/A	good support.	They are invaluable. Running an ACF requires acquisition of supplies, communications, plant management, security, etc. Non-medical people may be expert in those fields	Their availability is haphazard.	.
Credentials Verified?	[name] used its own credentially process—[name] used its own system	.	We did not	USPHS did this	90% were all Federal	EMAC took care of that	not done, however they all came from VA with proper credentials	We did not	Local hospitals. Medical society. [name] State guard.	State is about to implement a credentialing system.
Worker ID?	Yes	.	Yes	Yes	No	Yes	No	No	Yes	Yes
Worker ID Detail	[name] used its IDs but [name] also tried numerous cards - none were successful	.	A make-shift badge maker	Actually used wrist bands the university had thousands for special events	Already had some	Yes (owned by [State] office of EMS)	US VA ID card	.	.	.
Worker ID Lessons?	Yes - early identification - prior to the response	.	Nothing different	.	.	No	Yes, a standardized system	We had 48 hours to become operational. Worker ID's was a nicety	Identify credentials of workers prior to any event.	.
Imposters?	Yes	.	No - not that we are aware of	No - but we had a person from the media impersonate a priest to get in	Not that I was aware	No	No	No	Yes	.
Out-of-State Profs?	They allowed instant licensure with sponsorship - our section at [name] provided that sponsorship	.	The State of [State] did not assist in this issue.	Don't know. But as part of a pre-existing State team sent via EMAC we came with verified credentials	Ask [name] [email] - he coordinated with the State	Again - EMAC handled everything	None, no need.	To give blanket reciprocity and malpractice coverage to MDs and RNs from other States	Volunteer nurses were screened through the [State] nursing association.	.
Pre-Event Training?	Yes	Yes	No	.	Yes	Yes	Yes	No	Yes	Yes
Pre-Event Training Detail	only a few	Mass medication dispensing (for health department staff).	.	Nothing could have prepared us and we only prepared for field response - and only for 72 hours	Drills	2 years of team training on [clinic]	Some has emergency disaster training and HICS training	.	Health department trained in disaster management. [State] State guard medical brigade trained in disaster management.	.
Other Staff Issues?	Credentialing must occur but a balance between rapid recruitment to meet rapid enormous need must be reached	.	Logistic/supply officer and medical records personnel very important. Pharmacists very important. We want to have a record of who (which providers) were present at given times. No easy way to credential, even now	Labor pool essential - college students particularly well suited. They all have IDs, can be verified by college. Professors & staff also extremely useful (counselors admin asst., etc.) A number of MDs with unique specialties found themselves out of the [redacted]	MDs are not the best people to have in charge - nurses are better at shifts - jobs - and people coordination	Emergency medicine, trauma surgery, orthopedic surgery, anesthesiology at first (2-3 weeks), then more primary care (FP, IM, Peds, etc.)	.	.	After action report - established a list of local physicians available in time of disaster. Established a medical reserve corp of volunteers. Utilize State guard.	.
ACF Admin Agency?	[name] question	No	No	Yes and no	No	No	No	No	No	.
ACF Admin Agency Detail	.	.	.	Initially locals have to get things going but as other assistance arrives a collaborative approach (like Unified Commerce) developed and was very effective	.	.	.	.	.	.
ACF Purpose?	[name] question Shelter care Medical treatment facility	Shelter care	Shelter care (ACF colocated within a shelter); Medical treatment facility (operated as a standalone facility)	Shelter care Medical treatment facility Both at first then became strictly medical	Shelter care Medical treatment facility	Medical treatment facility	Medical treatment facility	Shelter care Medical treatment facility	Shelter care	Medical treatment facility
ACF Goal?	Primary receiving facility	Primary receiving facility	Primary receiving facility	Primary receiving facility	Hospital decompression Primary receiving facility	Primary receiving facility	Primary receiving facility	Hospital decompression	Hospital decompression Primary receiving facility	Hospital decompression Primary receiving facility May serve as both
Daycare?	[name] question	Don't think we addressed via Medical Branch Operations.	No service provided. Volunteers were responsible for arranging this themselves.	N/A	N/A	N/A	N/a	N/A	Community resources. Church groups.	.
Patient Childcare?	[name] question	No	No - the shelter provided this service	Yes—[college] students	No	No - other than our staff assisting when needed	No	No	Yes	Yes
ICU Patients?	No	No	No	Yes	Yes	Yes	No	No	No	No
ICU Reasonable?	Yes—[name] question	No	No	No	Yes - with supplies skilled people and ability to place in comfort care if necessary	Yes	No	Depends	No - this would have to be a fully operational field hospital.	No
Rounds System?	.	No - of note, no inpatient care was provided at the ACF / although an observation/ isolation unit was set-up	Not applicable	Nursing did; medicine did not - formally	Yes	Yes	Yes	.	Yes	.

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