Disaster Alternate Care Facilities: Selection and Operation

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Disaster Alternate Care Facility Selection Tool

Public Health Emergency Preparedness

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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
Visitor Limit?	[name] Question - in the [clinic] we did not limit	No	Not applicable	No - family were also evacuees, though they were provided different space	Unknown	No	No	No	No	Yes
Auxiliary Care?	.	N/A	Not applicable	Yes	Yes	Yes	Yes	Yes	Yes	No
Outside Integration?	[name] question	Yes	Yes—[State] State guard (medical branch) provided security and lab technicians and logistical support	Yes	We were a DMAT but other ACS did use DMATS	No	No	Yes	Yes—[State] medical rangers	Yes
Integration Lessons?	.	Yes	Yes	Yes	N/A	.	.	Yes	Yes	.
Integration Detail	.	Federal response agencies worked best when they integrated into the already set-up local incident command structure.	Assisted us in understanding their capabilities	We split up teams/ integrated shifts with folks from all groups which resulted in a wonderful collaborative consciousness. Included student leaders as well.	.	N/A	.	Be flexible. Learn. Respect, adapt	Need strong incident command to manage multiple levels of outside input.	.
Pets Allowed?	[name] question	No - pets were housed outside the facility in a separate shelter	No	No - but there was a place on campus for them	Yes	Yes - limited	Yes	No	No	No
Facility Issues?	Yes—[name] question	Yes	No	Yes	Yes	No	Yes	Yes	No	.
Issue Detail	lack of ample plumbing	Environmental issues related to exhaust fumes, noise, etc. due to vehicular traffic and leaving vehicles on.	.	Gymnasiums are large and noisy - it really never was quiet. Other treatment areas as well were loud & light.	Lighting (not NO but other shelters) and noise control - also bathroom access	Cell communications at first. Then satellite delivered with phones.	Drinking water, meds preparation, lack of phones	No toilets, inadequate electrical support, no air condition	(Used a gymnasium - required reassurance to college administrators that we would not damage floors)	.
Any Other Issues?	See attached file. [redacted]	.	.	.	There needs to be a troubleshooting expert group who can be called to come in and help with problems esp. when the operations people become overwhelmed and unable to make good decisions	.	The nearby VA support was a major reason for our success.	.	Bed triage & labeling helpful. Use dieticians/ licensed diabetic educators to arrange diabetic management teams. Needlesticks are hazardous.	.
Self-Presenting?	Yes - But [name] tried to prevent this	No	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
Ambulance Route?	Directly to ACF	N/A	Hospital first	Hospital first - not possible in this circumstance, though EMS did manage to take true criticals to hospitals	Directly to ACF	Directly to ACF	.	Depends on patient acuity	Hospital first	Directly to ACF
Mental Health?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Futility of Care?	[name] question	.	No	No	Yes	No	.	No	No	.
Futility of Care Details	.	Do not understand question.	Not applicable to our operation since we performed no in-patient or ICU care	It didn't come up	0 guidelines it had to do with logistics and transportation and staffing	.	.	.	.	.
Pediatrics Care: ED Nurses?	Yes	.	.	Yes	Yes	Yes	.	.	Yes	.
Pediatrics Care: ED Docs?	Yes	.	Yes	Yes	Yes	Yes	.	.	Yes	Yes
Pediatrics Care: Family Docs?	Yes	.	.	Yes	Yes	.	.	.	Yes	.
Pediatrics Care: Pediatrics ED Docs?	Yes	.	.	Yes	Yes	Yes - limited	.	.	.	.
Pediatrics Care: Pediatrics Midlevel?	Yes	.	.	Yes	Yes	.	Yes	.	.	.
Pediatrics Care: Pediatrics Nurses?	Yes	.	Yes	Yes	Yes	.	.	Yes	.	.
Pediatrics Care: Pediatricians?	Yes	Yes	Yes	Yes	Yes	.	Yes	Yes	Yes	.
Pediatrics Care: Other?	Yes	Yes - handled by another agency so cannot speak fully to this question	.	.	Yes	.	.	.	.	.
Pediatrics Care Other Detail	Answer pertains to the [clinic] only - almost every combination	Via coordination with community (private) provider for pediatrics services.	.	.	Paramedics	.	.	.	.	.
Immunizations?	Yes	Yes	Yes	Yes - but only for fire service and law enforcement coming from various parts of the country on the way to [location]	Yes - tetanus	Yes	Yes	Yes	Yes - tetanus	No
Infectious Disease Surveillance?	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No
Infectious Disease Surveillance Detail	Both the [name] public health and [name] provided this surveillance - in fact [name] was the first to identify and DNA type the organism responsible for the GE outbreak	Cot-to-cot surveys in shelter areas by Epidemiology Task Force was conducted nightly to assess for symptoms that may correlate with certain disease patterns.	County public health epidemiologist reviewed cases	Monitored trends	Walk rounds. & informal look arounds. Other facilities I know had a stronger PH component.	[State] Public Health rotated teams that interacted with [State] Epidemiology.	.	.	Minimal disease surveillance - diarrhea, respiratory tract infections were monitored	.
Hospital Transfer System?	Yes	Yes	Yes - only 2-3% of ACF patients were transferred to hospital ED's (out of >10,000 patient encounters)	Yes	Initially no! After a while yes but limited. In other ACFs I have had an ambulance on standby for transfer	Yes	Yes	Yes	Yes	Yes
Surge: Early Discharge?	Yes	.	No local hospitals used these strategies	Yes	Unknown	Yes	.	.	Yes	Yes
Surge: Hospital Transfer?	.	.	No local hospitals used these strategies	.	Unknown	Yes	.	.	Yes	Yes
Surge: ICU to Ward?	Yes	.	No local hospitals used these strategies	.	Unknown	.	.	.	.	.
Surge: Interhospital Transfer?	.	.	No local hospitals used these strategies	Yes	Unknown	.	.	.	.	Yes
Surge Criteria Detail	.	Unknown	None of these strategies were employed	We were informed by local health that beds were becoming available especially after NDMS kicked in	Unknown	Guesstimations only	.	.	If patients met minimal criteria for discharge they were discharged home or back to the shelter.	.
Special Medical Needs (SMN)?	Yes	Yes	Yes	Yes	In NO all comers	Yes	No	Yes	Yes	No
SMN: Dialysis?	Yes	.	Yes	Yes	.	.	.	Yes	.	.
SMN: Mental Health?	Yes	.	Yes	Yes	.	Yes	.	.	.	.
SMN: Ventilator?	.	.	.	.	.	.	.	.	.	.
SMN: Other?	Yes	Expanded definition for what was considered MSN population - so a diabetic without insulin for few days with need to store insulin, dispose of sharps, ADA diet, etc. became a patient with MSN.	.	.	.	Yes	.	.	Yes	.
SMN Other Detail	hemonc/ transplant/ CF/ shunts/ etc	Other such patients included those morbidly obese, mental health needs, patients on chronic dialysis, etc.	.	.	.	Chronic health prob.	.	.	COPD, diabetes patients, Alzheimer/ geriatric patients	.
Special ACF Group?	Yes	No	No	Yes	Yes	No	.	.	Yes	No
Special ACF Group Detail	Ventilator dependent	In operation such as ours, integrated services worked best esp. due to fact that patient characteristics were unknown in advance of operation initiation.	.	Infectious - it wasn't an issue for us, but if we were dealing with flu etc, should have separate ACF. Also hospice/palliative care	Chronic ventilator patients with respiratory therapists	.	.	.	Ventilator patients	.
Multiple Ventilators?	Yes	No	No	No - not without extraordinary resources - which are better left in the hospital	Yes	Yes	No	Depends on staffing and resources	No - unless the personnel (nurses/ respiratory technicians) are available.	No
Other SMN/Patient Care Issues	With Hurricane RITA which came at the heels of Katrina we had appx 30 ventilator dependent children arrive at our EC - we had to open a floor just for these patients - as a result, we are working with the [State] to create a regional location [redacted]	.	Avoid segmenting patients according to medical diagnoses	We did not have many deaths - but hospice/ palliative care patients that were evacuated did come through and sent to a different facility	Morbidly obese/mobility issues are huge problems for hygiene and skin breakdown	Dialysis was not an issue, but could have been. Also we had 8 obstetric patients that we transferred out (luckily).	.	.	.	.
Patients In ACF?	[name] question	Very limited information known.	Visual head count only	We counted every 2 hours / kept track on a grease board	Walking around	Electronic system tracking tool	paper process	Database	Daily patient census recorded on Excel program. All patients signed in & out of facility.	Patient recording and tracking.
Patient Location?	[name] question	Very limited information known.	Medical record form indicated the location within the ACF where care was rendered (adult, ped, mental lhth, dental, OB, ... etc.)	Had charge nurses & team leads at each treatment area keeping track	Walking around	Computer board	a room roster started when they admit.	Generally	XY grid coordinates for bed placement.	.
Patient Disposition?	[name] question	Discharge/ transfer information was limited except for perhaps those who were transferred via the regional medical operations center	Handwritten medical record	Local EMS & social workers took care of this	Initially too many patients to too few staff	Same computer tracking system	daily count and discharge process include informing patient administration	Database	Developed an Excel program. College students assisted.	.
Patient Tracking System?	[name] question	No	No	No—[college] students went bedside to bedside with laptops to develop database	Yes	Yes	No	No	No	Yes
Medical Records?	EMR - took 2 days to perfect but it was quite good once it overcame the sudden rush of patients - [name] question	Not handled by our agency.	Developed de-novo a paper medical record - all completed records were scanned and stored. Data entry clerk created database (name and chief complaint) which was searchable.	Initially - just one sheet of paper taped to the cot	Couldn't initially then ran out of supplies	Paper/file cabinets	Electronic VA record	Paper	(Electronic for monitoring patient status.) In clinic & shelter used a paper record. Patient chart created & attached to bed.	.
Records Ownership?	[name] question	Not handled by our agency.	County public health dept.	Records were sent with the patient when transferred and/or given to them with a discharge summary. Local EMS kept copies of discharge/transfers	Feds	[State] Public Health	VA?	State	Public health department.	Have not given thought to this issue. Good point.
Adult/Peds Together?	Families kept together Adult/peds separated	Families kept together	Adult/peds separated - moms typically took children needing care to the pediatric section	Families kept together - as much as possible	Families kept together	Families kept together	Families kept together	Families kept together	Families kept together	Families kept together
Spouses Separated?	[name] question	No	No	No	No	No	No	No	No	Yes
Families Together?	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Patient Privacy?	.	Depends on emergency scenario but in general the preference due to the high anxiety of such scenarios is to keep families together as much as possible.	.	Tough to do in a gymnasium. We used sheets & other barriers when possible. Far more important to allow access to patients as most families were also evacuees and separating families at the time would have just made things worse.	Family takes precedence over privacy in a disaster	Limited	Each family unit had private room	Did not	.	.
Active Finance Section?	Yes—[name] financed its own efforts in the hope that it would be reimbursed - I don't think it was reimbursed	Yes - handled through overall County Government, not our agency specifically.	No	No - all done by locals/I do not have the info	No	Yes	No	No	Yes	Yes
Volunteer %?	not sure	Unknown	20	.	.	.	.	25	Not sure.	.
Charitable Donation %?	not sure	Unknown	10	.	.	.	.	15	Not sure.	.
Institution/System %?	not sure	Unknown	40	.	.	.	.	10	Not sure.	.
Private Corporation %?	not sure	Unknown	10	.	.	.	.	.	Not sure.	.
Local Gov %?	not sure	Unknown	10	.	.	.	.	.	Not sure.	.
State %?	not sure	Unknown	.	.	.	.	.	25	Not sure.	.
Federal %?	not sure	Unknown	10	.	.	100	.	25	Not sure.	.
Other %?	not sure	Unknown	.	.	.	.	.	.	Not sure.	.
Other % Detail	not sure	Unknown	.	.	.	.	.	.	Not sure.	.
Federal Invoice?	Yes	Yes - County Government did.	No	.	.	Yes	.	Yes	Yes	Yes
Federal Reimbursement?	No	Yes	.	.	.	Yes	.	Yes	No - uncertain	.
Reimbursement Secrets?	yes - create an agreement before the response	.	Not applicable	.	.	None	.	No	No	.
Worker Illness/Injury?	Yes	Unable to quantify.	No - not that we were aware of	No	Yes	Yes	No	No	Yes - 1 needlestick injury	.
Workers' Comp Issues?	[name] question	N/A	No - not that we were aware of	No	Yes	Yes	No	No	No	.
Workers' Comp Detail	.	.	.	.	Their commander dealt with it through the Federal Government	Handled by parent hospital	.	.	.	.
Other Finance Issues?	Pay the resource if you want them to return	.	ACF financing will now go through the finance section of the city entity which has requested a medical support function.	.	.	.	.	Buy on credit, keep receipts, if it is reasonable, it will eventually be reimbursed	Health Department was not reimbursed at the State or local level. Most work was voluntary. [Name] State Guard was paid a daily stipend.	.
General Comments		Advanced planning and development of relationships with partners in advance is critical to the success of any large-scale operation.	See two documents [attached] describing our ACF operations	[From included cover letter] ... I am an advocate of college campuses as ACF for many reasons. This is a short list: 1. handicapped accessible; 2. large crowds can generally be accommodated; 3. there is already a security presence, and a perimeter can be	Can not be rigid - flexibility important. Red Cross volunteers. Family together. Palliative care areas. Animals need to be considered. Uniforms very helpful. Understand limitations in your mission.	.	Any plan that developed needs to be flexible. A cook book approach would not work well in a disaster situation. VA being a national system has enough resources to sustain a shelter for a "period" of time (no more than 3 months).	Have good leadership. Tap into churches for volunteers. Help others and they will accommodate/assist you.	Plan in advance of disaster. We have subsequently identified a university campus with a nursing school to be a ACF for 240 people. We have run [illegible] exercises & call down events to ensure that we can stand up the facility.	We have had to approach planning from a couple of different angles. Our most likely scenario would be a situation whereby the ACF is used for a short fused- short duration event. On the other hand, we are also approaching the issue with the thought in mind

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