Surge Facilities
Recent experiences have shown that community-wide emergency management plans should include preparations to establish temporary healthcare facilities when a major disaster—or series of disasters as occurred in New Orleans—creates a surge of patients or cripples hospitals and forces patients and staff to evacuate. When an emergency occurs, the demands placed on a hospital escalate beyond the normal level of services required. Surge facilities provide care when permanent facilities exhaust their capacity or cannot operate because of damage or other conditions. Surge facilities also act as a buffer for lower acuity patients to protect the scarce resources of the operating hospital.
Some surges are such that a hospital can meet community needs within its own walls. For example, a hospital may be able to handle a commuter train accident that brings 30 injured patients through its doors. But, in many instances, economic factors operating over the past decade mean that hospitals are already operating at capacity and have little room for surge. Remember that “room” for surge is not just the number of beds, but the number of beds that can be adequately staffed and supplied. Where would patients already in an at-capacity organization go if a significant number of new patients—whether 30, 300, or 3,000—need treatment?
This scenario occurred during the aftermath of Hurricane Katrina when the Louisiana Department of Health and Hospitals (DHH) determined that it needed to establish an acute care surge facility at the Louisiana State University Pete Maravich Assembly Center in Baton Rouge because existing hospitals in the area would be inundated with patients.1
This recent example of coordination shows the imperative for hospitals and health officials to plan with community organizations to increase surge capacity at temporary locations. Off-site locations, which may be at facilities as diverse as civic centers, schools, or even veterinary hospitals, must be part of community-wide emergency management plans.
While there is general consensus about this idea and the need for a community-wide response plan to emergencies, a recent JCAHO examination of the issue reveals that there is no single model available today for surge facilities, but what is developing is a series of guidelines based on experience.2 Communities should study available examples of organizations that have faced with surge situations and then create contingency plans after assessing potential community needs and available resources.
While it is important for a hospital to take the initiative to consider surge capacity planning, no single hospital can by itself be expected to be able to address a large-scale emergency that sends large numbers of patients in search of healthcare. Securing temporary facilities, adequate staff, and critical supplies, equipment, and pharmaceuticals takes the concerted efforts of healthcare organizations, communities, and government agencies.
Hospitals must work with organizations such as hospital districts, state and county departments of health, the National Guard, various agencies charged with homeland security, medical schools, and so forth to plan for and operationalize surge capacity.
For example, the Commonwealth of Massachusetts maintains a statewide system to allocate surge capacity by identifying empty beds and distributing patients among existing hospitals.3 The very declaration of an emergency should automatically trigger government intervention necessary for surge capacity on the local, state, or federal level, as appropriate.
Components of Surge Facilities
Communities and healthcare planners preparing responses to a crisis must be innovative when considering how to accommodate a surge of patients. Surge facilities commonly fall into one of the following basic categories: