- Shuttered hospitals or closed wards;
- Facilities of opportunity, such as schools, hotels, conventions centers, and other types of buildings near a hospital that can easily be adapted during emergencies to treat unusually large numbers of patients;
- Mobile medical facilities; and
- Portable facilities.
Planning for locations is important, but it is important to remember that a surge facility is not so much a place as it is a capability. Wherever a surge facility is located, it must be equipped and staffed adequately. Beyond planning for the physical location of a surge facility, hospitals and communities must consider the other factors that will affect the ability to deliver care.
For example, will essential staff be available to treat patients? What might constitute essential staff? Surge capacity plans also must take into account the need to communicate with staff during times of crisis, transport staff, and make accommodations for staff who may be facing their own personal emergencies at home (i.e., damage to their homes or vehicles, concern for vulnerable family members, and so forth).
Creating plans to assist staff and their families during a crisis will ensure that vital members of the emergency response team are able and willing to perform their duties. The U.S. Department of Defense’s Modular Emergency Medical Stem can aid efforts to determine the number of staff necessary to effectively operate a surge facility. Other methods for securing the needed number of staff during an emergency include qualified volunteers from organizations such as the Medical Reserve Corps program, Civilian Emergency Response Teams, Disaster Medical Assistance Teams, health professional students, reserve military health providers, paramedics, and midwives. In addition, communities may consider training a pool of volunteers who could assist with surge healthcare needs by providing nonmedical support to healthcare providers.
Other critical considerations for hospitals and communities planning for surge capability include:
- Medical supplies and equipment: The Centers for Disease Control and Prevention (CDC) can provide necessary supplies through its Strategic National Stockpile program, but delivery may take days, as Hurricane Katrina demonstrated. Other potential sources of supplies, such as physician offices and medical supply houses, should be researched.
- Pharmaceuticals: Sufficient inventories to last for several days in the event of an emergency will help prevent problems, as will setting up contracts with pharmaceutical suppliers that take effect only during an emergency.
- Communication: The September 11 terrorist attacks and Hurricane Katrina demonstrated the fallibility of cellular phone and radio communications; multiple forms of communication (i.e., cellular, two-way radio, pagers, satellite, two-way phones, and so forth) are necessary to ensure that if one method fails, another is available.
- Data sharing: Hospitals must plan for how they will coordinate with local, state, and federal health agencies to conduct necessary work to care for patients.
- Sufficiency of care: During emergencies, surge facilities maybe able to treat each patient only until he or she can be transferred to an organization that provides an ideal level of care. Plans for surge capacity should take this possibility into consideration so agreements can be made in advance with other hospitals, while also ensuring that patients who need specific monitoring or ventilator assistance, for example, can be cared for until transferred.
Surge Facilities and the Joint Commission
The fact that surge facilities were forced to provide care for such an extended period of time following Hurricane Katrina has prompted the Joint Commission to consider establishing standards for this unique form of a healthcare organization. The standards might require surge facilities to comply with basic safety and quality expectations and help to ensure the public that care given at these temporary facilities is adequate. JCAHO is working on the standards with healthcare organizations that are developing plans for surge facilities so that any new requirements can be implemented quickly and with minimal cost.