1. Alternate Care Facility Planning Strategy Northern Virginia Emergency Response System Dan Hanfling, MD Director, Emergency Management and Disaster Medicine Inova Health System Richmond, VA December 2008

3. Distinctions Between Alternate Care Facilities Stood Up in Response to a Widespread Outbreak of Disease and in Response to an Acute Event Drivers Widespread Outbreak of DiseaseAcute Event Reason for Standing Up Facility Overflow Patients Admitted From Hospital Event Related Casualties Expected Ramp Up TimeDays to WeeksHours Expected DurationWeeksDays Expected Inpatient Availability Outside RegionLimitedSignificant Bulk of Staffing MRC or Community Health Care ProvidersHospital Employees Availability of Community Health Care ProvidersReducedAvailable Principal County PartnerHealth DepartmentEMS Probability of Communicable Disease Outbreak (Infection Control Need)HighLow Probability of Terrorist Related Incident (Security Need)LowModerate From the files of Dr. David Goodfriend, Loudoun County Health Dept.

4. Planning Process Initial Steps Develop subcommittee under auspices of the MMRS (NVERS) Steering Committee Co-Chair, Northern VA Hospital Alliance Co-Chair, Loudoun County Health Director –NVHA Planner Health Departments No VA EMS Council Emergency Management Legal/Regulatory Northern VA Medical Society

5. Planning Process Establish Basic Assumptions The most appropriate location for the delivery of acute medical care is in the hospital. A primary role will be to accept patients within the established scope of care so as to free up beds in the hospital for more critical patients. There will be a shortage of necessary health and medical resources and as a result standards of care will be altered across the health care spectrum.

6. Surge Capacity Planning ‘Conventional’ Surge Capacity ‘Conventional’ Standard of Care ‘Contingency’ Surge Capacity ‘Contingency’ Standard of Care ‘Crisis’ Surge Capacity ‘Crisis’ Standard of Care

7. Creating a Systems Approach Proposed Taxonomy ACF – Triage (Community Based) Telephone Triage Integration of Outpatient Resources ACF -T ACF – Healthcare (ACF-HC) ACF-Isolation (ACF-Iso) ACF-Palliative Care (ACF-PC)

8. Alternate Care Facility Planning Process ‘Standard of Care’ Protocol development Operational Matrix for Decision Making Critical Care Crisis Capacity/Trauma (C4T) NVERS Inova MAC NVHA

9. Planning Process Next Steps Local versus Regional ACF-T, ACF-HC Emergency Management vetting process Scope of Services Site selection/’Stuff’ procurement Staffing plan models (contractual?) Fiduciary/Regulatory/Legal requirements Test/Drill/Exercise

10. Dan Hanfling, MD Inova Health System dan.hanfling@inova.com 703-776-3002