Speaker:  Michael Loehr, Preparedness Director, Seattle/King County Public Health Public Health - Seattle King County (PHSKC) and regional healthcare partners have developed and tested Alternate Care Facility (ACF) capability to support medical surge needs during disasters. The ACF design is modular, scalable, and mobile ranging from a 50-bed minimal care site to three 250-bed inpatient care facilities. PHSKC coordinated with numerous healthcare, emergency management, EMS, law enforcement and facilities partners to identify appropriate roles, responsibilities and resources necessary to implement this capability. Plans have been developed addressing medical supplies management, medical and non-medical staffing, scope of care, site layout, coordination with EMS and local EOCs, communications and security. ACF modules are designed to address four levels of care, and include acute care, walk-in care, pharmacy, pediatrics, lab, palliative care, limited behavioral health services and oxygen delivery. Through this presentation, we will describe the partners involved in planning, share details regarding the modular design, types of equipment acquired, the flow of patient care, medical staffing model, and approximate costs for developing this capability

1. Partners in Preparedness Conference
A il 26 2011April 26, 2011
Alternate Care Facilities:
Developing Medical Surge CapabilityDeveloping Medical Surge Capability
in King County

2. OBJECTIVES
 Define and explain the purpose of ACFsp p p
 Describe current ACF capability in King Countyp y g y
 Identify circumstances for use – likely scenarios
 Identify challenges with developing, operating and
sustaining ACFs statewide
 Review proposed Strategies for Success

3. Where did we start?
 December 2006 Windstorm  evacuation of
several nursing home facilities
 Quick realization: a medical needs shelter cannot
be thrown together overnight!
 As a group of us started working together, we
realized how extensive a project this really is

4. ACF - Definition
N di l f ilit d i d i dNon-medical facility designed, equipped
and staffed to deliver care to patients
In King County:g y
 Designated and activated by the Local Health Officer (LHO)
 LHO receives input from Healthcare Executives
 Activated in support of local inpatient healthcare facilities
N t t f i ti h lth f ilit Not part of an existing healthcare facility

5. ACF Program Goal - KC
Develop capability to activate and operateDevelop capability to activate and operate
two 250-bed ACFs simultaneously
 Flexible locations – have several sites to choose from
 Scalable – by number of patients, level of care, supplies
and staff needed
 Mobile – encourage sharing of resources, tools and
biliticapabilities

6. Current Capability in KC

7. Circumstances for Activation
1. Loss of Local Inpatient Capacity
Hospitals or nursing homes
/
1. Loss of Local Inpatient Capacity
damaged/destroyed, and
Remaining inpatientRemaining inpatient
facilities can not absorb the
load, and,
Transporting patients out of
region is not sufficient

8. Circumstances for Activation
2 Surge in Patient Demand
 Disaster generates
2. Surge in Patient Demand
widespread illness or
injuries that exceed local
it l lsurge capacity levels
3 A bi ti f b th3. A combination of both

9. Potential Scenarios
Earthquakeq
Loss of capacity, Loss of Transport Capability, Surge in Patient Demand
Severe Weather, Structure Fire
Loss of Capacity, Loss of Supporting Infrastructure
Specific Hazards (Pandemic, Radiological Contamination, BT)
S i P ti t D d i bilit t t t t f iSurge in Patient Demand, inability to transport out of region
Providing assistance to other regions
RITN, Evacuating victims with medical needs

10. Levels of Care
Tier 2
Example: Nursing home evacuation (1 or more)
 Limited number of patients start with 50 bed Limited number of patients, start with 50 bed
module
 Basic inpatient nursing care
 No acute medical conditions

11. Levels of Care
Tier 3Tier 3
Example: Hospital Evacuation after a major EQ
 I ti t i i f t bl ti t Inpatient nursing services for stable patients
 Expanded pharmaceutical services
O h il bl 6l NP Oxygen therapy available to 6l. NP
 At least one additional care module:
di t i b l t b h i l h lthpediatric, ambulatory care, or behavioral health
 Urgent capability for inappropriate patients  treat and
f ASAP!transfer ASAP!

12. Levels of Care
Tier 4
All modules activated, all services provided

13. Staffing Model
Administrative and Logistical
Per HICS standard org chart
Medical Reserve Corps
Patient Care Providers
Medical Reserve CorpsMedical Reserve Corps
Staff from evacuating facilities
Staff from local hospitals / clinics

14. Staffing Model
I ti t N i C M d l
Day (12 hr) Evening/night
Inpatient Nursing Care Model
Day (12 hr) Evening/night
(12hr)
Inpatient RN 2 2
LPN 5 4LPN 5 4
Nursing Assistant /
Certified Nursing Assistant / Medical
Assistant
3 3
Housekeeping 1 1
Total (50 bed activation) 11 = ideal
*9* = minimum
10 = ideal
*8* = minimum

15. Equipment and Supplies
E Bed CotsE Bed Cots
CribsCribs

16. Equipment and Supplies
MedLox O2 Distribution System
National Oxygen Kit (NOK)

17. Equipment and Supplies
3 Manual ACLS Defibrillators3 Manual ACLS Defibrillators
3 AEDs3 AEDs
2 122 12--lead ECG Unitslead ECG Units
6 I6 I--Stat AnalyzersStat Analyzers
12 HemoCue WBC systems12 HemoCue WBC systems12 HemoCue WBC systems12 HemoCue WBC systems
3 Braun IV Pumps3 Braun IV Pumps
3 Ultraclave sterilizers3 Ultraclave sterilizers
Di it l XDi it l X R i tR i tDigital XDigital X--Ray equipmentRay equipment

18. Equipment and Supplies
Broselow Pediatric
SystemSystem
 2 each - Broselow Carts
 2 each - Broselow Packs
 5 each - Broselow Tapes

19. Equipment and Supplies
 Blood Pressure Units Ga e and Bandages  Blood Pressure Units
 Cervical Collars
 X ray Illuminators
 IV Supplies
 Gauze and Bandages
 Sutures
 Syringes
M  IV Supplies
 Catheters
 Otoscopes
O h h l
 Microscopes
 Sanitizers
 Ambu Bags
 Ophthalmoscopes
 Scales
 Suction Pumps, tubing and
canisters
 Backboards
 Patient Lifts
 Wheelchairs
canisters
 Stethoscopes
 And much more………
 Traction Splints
 Various Forceps
 Various Tubes

20. Readiness Contracts
M di l S li & O Medical Supplies &
Pharmaceuticals
 PSS
 Oxygen
 Airgas
 Cardinal
 McKesson  Other
 Home Depot
 Patient Feeding, Portable
Toilets & Showers, Mobile
 Home Depot
 Grainger
 Keeney’s
Laundry
 Bishop Services
 OK’S Cascade
y
 Abbey Party Rents
 Honey Bucket OK S Cascade
 Mountain Mist

21. Strategies for Success

22. Building and Sustaining Capability
 ACFs MUST be part of a
medical surge strategy
 Integration with Disaster
M di l C t l C t dMedical Control Centers and
inpatient care sector essential
 Innovative staffing plans

23. Building and Sustaining Capability
 Expertise in medical planning
and logistics required
 Storage and maintenance
l i d i tplans required - ongoing costs
 Training and exercises are
critical

24. Key Questions:
 What’s the statewide strategy for building and What s the statewide strategy for building and
maintaining this capability?
 What scenarios are we What scenarios are we
planning for?
 ACF vs transport to other areas? ACF vs. transport to other areas?
 Role of federal assets and
l id?mutual aid?
 How do we keep it affordable?

25. Comprehensive ACF Strategy
1 Establish clear understanding among healthcare1. Establish clear understanding among healthcare
and PH regarding the purpose of ACFs in WA
 Support LTC facility evacuation only? Support LTC facility evacuation only?
 Support hospital evacuations?
 Accept walk-ins (outpatient capacity)?
 Accept kids, psych?
2. Clarify roles of Disaster Medical Control Centers
and local PH in decision making, coordination
with healthcare sectorswith healthcare sectors

26. Comprehensive ACF Strategy
3 Establish statewide consistency and interoperability3. Establish statewide consistency and interoperability
of equipment and supplies
4. Develop a statewide storage plan
5. Develop statewide transportation capability to
rapidly mobilize equipment and suppliesrapidly mobilize equipment and supplies

27. Comprehensive ACF Strategy
6 A t f t t id t l id i ACF t t6. Account for statewide mutual aid in our ACF strategy,
and expand mutual aid to hospitals and LTC facilities
7. Develop statewide efficiencies for ACF training and
exercise development and implementationexercise development and implementation
8 E t bli h th h ld f ti f d l t8. Establish thresholds for requesting federal assets
(FMS, DMAT) as integral parts of ACF capability

28. Questions?
Tamlyn Thomas, RN
STAT ICU Resource Nurse
UWMC Emergency Management Coordinator
University of Washington Medical Center
Michael Loehr, MRP, CBCP
Preparedness Director
P bli H lth S ttl & Ki C tPublic Health – Seattle & King County