1. Alternative Care Sites Stephen V. Cantrill, M.D., FACEP Associate Director Department of Emergency Medicine Denver Health Medical Center

2. Alternative Care Sites

3. Concept of an Alternative Care Site: Nontraditional location for the provision of health care Nontraditional location for the provision of health care Wide range of potential levels of care: Wide range of potential levels of care: Traditional inpatient care Traditional inpatient care Chronic care Chronic care Palliative care Palliative care Home care Home care

4. Potential Uses of an ACS: Primary triage of victims Primary triage of victims Offloaded hospital ward patients Offloaded hospital ward patients Primary victim care Primary victim care Nursing home replacement Nursing home replacement Ambulatory chronic care/shelter Ambulatory chronic care/shelter Quarantine Quarantine Palliative care Palliative care Vaccine/drug distribution center Vaccine/drug distribution center

5. Potential Alternative Care Sites Buildings of opportunity Buildings of opportunity Advantage of preexisting infrastructure support Advantage of preexisting infrastructure support Convention centers, hotels, schools, same-day surgery centers, shuttered hospitals, etc. Convention centers, hotels, schools, same-day surgery centers, shuttered hospitals, etc. Portable or temporary shelters Portable or temporary shelters Flexible but may be costly Flexible but may be costly Sites best identified in advance Sites best identified in advance

6. Factors in Selecting an ACS Basic environmental support Basic environmental support HVAC, plumbing, lighting, sanitary facilities, etc HVAC, plumbing, lighting, sanitary facilities, etc Adequate spaces Adequate spaces Patient care, family areas, pharmacy, food prep, mortuary, etc Patient care, family areas, pharmacy, food prep, mortuary, etc Ease in establishing security Ease in establishing security Access: patients/supplies/EMS Access: patients/supplies/EMS Site Selection Tool: www.ahrq.gov/downloads/pub/biotertools/alttool.xls

7. Some Issues and Decision Points “Ownership” and command and control of the site “Ownership” and command and control of the site Decision to open an alternative care site Decision to open an alternative care site Supplies/equipment/staffing Supplies/equipment/staffing Documentation of care Documentation of care Communications Communications Rules/policies for operation Rules/policies for operation Exit strategy Exit strategy Exercises Exercises

8. Katrina/Rita: ACS Issues Importance of regional planning Importance of regional planning Importance of security Importance of security Advantages of manpower proximity Advantages of manpower proximity Segregating special needs populations Segregating special needs populations Organized facility layout Organized facility layout Importance of incident command system Importance of incident command system

9. Katrina/Rita: ACS Issues The need for “House Rules” The need for “House Rules” Importance of public health issues Importance of public health issues Safe food Safe food Clean water Clean water Latrine resources Latrine resources Sanitation supplies Sanitation supplies