Appendix D: Alternate Care Facility Questionnaire—Summary of Results

Notes: Remarks in brackets [example] have been edited by the reviewing investigator to preserve confidentiality. No other changes have been made to survey data. The use of a period (.) in any field indicates no data was received from the survey respondent for that item.

Survey Question/Topic	Site 1	Site 1'	Site 2	Site 3	Site 4
ACF Planned?	.	.	.	.	.
ACF Actual?	Yes	Yes	Yes	Yes	Yes
ACF Location?	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]
ACF Dates?	Sept 1, 2005—Sept 15, 2005	August 31-September 20, 2005	Sept 1- 16, 2006	Immediate post-Katrina	.
Number of ACF patients?	>4500	Over 27,000 shelter evacuees with over 10,000 patients seen in clinic and over 13,000 immunizations given	> 10,000	> 6000 / 800 beds	> 20,000
Number of ACF staff?	There were several sources of staff—for practical purposes I will only represent the outlay that [we] provided	unknown	7 common staff/1,000 workers	several hundred	400 pt 4-2 rest of the number 50
Structure of Opportunity ACF?	Yes	Yes	Yes	Yes	Yes
Structure of Opportunity Detail	[Clinic housed in convention center structure]	Convention center structure used for operations	Convention center, parking garage level	Gymnasium	.
Portable ACF?	.	.	.	.	.
Mobile ACF?	.	.	.	.	.
Inpatient Augmentation: Adult?	.	Yes	.	.	.
Inpatient Augmentation: Pediatric?	.	Yes	.	.	.
Inpatient Augmentation: Special Populations?	.	Yes	.	.	.
Inpatient Augmentation: Special Populations: Detail	.	.	.	.	.
Inpatient Augmentation: Special Medical Needs?	.	.	.	.	.
Inpatient Augmentation: Special Medical Needs: Detail	.	.	.	Reserved nursing home—did not receive/treat evacuated in-patients.	.
Inpatient Replacement: Adult?	.	.	.	Yes	Yes
Inpatient Replacement: Pediatric?	.	.	.	Yes	Yes
Inpatient Replacement: Special Populations?	.	.	.	.	Yes
Inpatient Replacement: Special Populations: Detail	.	.	.	.	VA pt., nursing home pt, ICU patients
Inpatient Replacement: Special Medical Needs?	.	.	.	Yes	Yes
Inpatient Replacement: Special Medical Needs: Detail	.	.	.	Hemodialysis, rescued nursing home pts, amputees	Ventilator pt
Ambulatory Augmentation: Adult?	.	Yes	Yes	Yes	.
Ambulatory Augmentation: Pediatric?	Yes—([Location] sent its Emergency Center (EC) for all practical purposes—it was an effort to prevent [Location] from exceeding its surge capacity)	Yes	Yes	Yes	.
Ambulatory Augmentation: Public Health?	.	Yes	Yes	Yes	.
Ambulatory Replacement: Adult?	.	.	.	Yes	Yes
Ambulatory Replacement: Pediatric?	.	.	.	Very minimal	Yes
Ambulatory Replacement: Special Populations?	.	.	.	.	Yes
Ambulatory Replacement: Special Populations: Detail	.	.	.	.	VA, nursing home, ICU
Ambulatory Replacement: Special Medical Needs?	.	.	.	Yes	Yes
Ambulatory Replacement: Special Medical Needs: Detail	.	.	.	.	Ventilator patient
Ambulatory Replacement: Shelter Support?	.	.	.	Yes	Yes
Governance: Institutional/HC System?	Yes—With permission from [health dept] [Location] provided oversight of its staff, equipment, supplies, and pharmacy	.	.	.	.
Governance: Nonprofit/Volunteer?	.	.	.	.	.
Governance: Local?	Yes	Yes	Yes	.	.
Governance: Local: OEM?	Yes—provided the entire response including the ACF (both the [City] and [County])	Yes	Yes (provided admin support only)	.	.
Governance: Local: Public Health?	Yes—County Health Dept was large part of the governance of the [site] and therefore they were incident command for the [clinic]	Yes—[County] Public Health & Environmental Services	Yes (medical oversight)	.	.
Governance: Local: Other?	.	Yes—[hospital district]	Yes (County hospital system; [system name])	.	.
Governance: State?	.	Yes	.	Yes	.
Governance: Federal?	.	Yes	.	.	Yes
Governance: Federal: DHHS?	.	.	.	.	.
Governance: Federal: PHS?	.	.	.	.	.
Governance: Federal: NDMS?	.	Yes	.	.	Yes
Governance: Federal: DoD?	.	.	.	.	.
Governance: Federal: Other?	.	.	.	.	.
ICS?	Yes	Yes	Yes	No—One already existed	Yes
ICS Model	[name redacted] did not set up an IC—[name redacted] did have their IC at the [site] and it was based on HICS	NIMS	Generic ICS	.	No—standard ICS for a DMAT
IAP?	Don't know—we were not involved at that level of IC	Yes	No—medical operation provided intel and data to local emergency management agency.	No—not formally	No
IAP Frequency	.	Daily	.	.	.
IAP Frequency—Other	.	.	.	Not formally though a per 12 hours shift plan was produced, as well as daily OPS briefings	.
IAP Type	.	Previously prepared form	.	.	.
Command Problems	Yes	Yes	No	Yes	Yes
Command Problem Detail	We were not invited to play initially—we just showed up—initially we were not noticed because of the chaos of the moment—the [name redacted] version of the medical director showed up on night one and began to move pedi pts through the system—[name] noticed us and felt like we knew what we were doing and gave us more space—we filled that...—when things calmed down [name] began to see us as a rogue clinic and made it clear that we had to operate within their IC rules [redacted]	Local government command & control integrating with private partners (e.g. NGO's, CBO's, private partners, etc.)	.	Internal issues of authority and command. Did not impact us as responders from other State but caused issues between local, county, and State players	Above the commanders that came with the teams there was no one above there to give direction.
Transfer of Command	Verbal report Other	Verbal report Written report	Verbal report	Verbal report	Verbal report
Transfer of Command Detail	[Clinic] Medical Directors came from [location] so we formally checked out. [name] IC meetings were held twice daily and our main medical director was eventually invited and made the official [name] IC medical director for the [clinic]	.	.	.	.
How Open?	Two of our faculty showed up at the request of the news media to help with the response and noticed that there were only 2 pediatricians on site—hours later we were coordinating the pediatric response	State & county elected officials made decision	Joint decision between OEM (city Office of Emergency Management), city EMS medical directors, and county public health authority.	Was already open. Local & regional health care providers had staffed it for about 48 hours prior to our arrival	Federal deployment
Who Decides?	The physician who showed up and took command of the pedi clinic contacted the admin for [location] who then agreed to full out resource support of the effort.	Governor & County Judge	Medical director of county public health dept (health authority)	Unknown	NDMS/DHS
How Close?	When it was clear that patient volume had dropped significantly, the med director from [Location] worked with [Locations] to relinquish control over the [clinic] to the [Location] and they sent a pedi medical director to take over (transitioned over one weekend).	Another impending Category 5 Hurricane was set to strike community—so shelter was closed & residents evacuated.	Declined in shelter population as evacuees were placed in more permanent housing locations	After about 8-9 days patients were no longer arriving for care—and the patients we had were able to be shipped out	NDMS/DHS—all the patients had been evacuated
Pre-Close Check?	Lack of patients	Ensuring all evacuees were relocated safely to other shelter facilities elsewhere	None	Local and regional health care facilities were decompressed enough to receive patients directly. Transfer of PMAC patients were completed	No more patients
CONOPS?	Yes—remember that we were separate for the [site redacted] plan—we used our own concept of operations—50 years in the business of taking care of [patients]	Yes	No—we made it up as we went along	Yes and no; our initial ops plan did not entail such a large number of patients with so many needs	No
NIMS/HICS Training?	No	Yes	Yes	Yes—our own team did	Yes
Training %?	.	60	25	75	100
EMTALA?	No	Unknown	No	No	No
EMTALA Detail	.	.	.	.	It was an evacuation—patients came from high centers which had nothing to us (aid station)
Info Issues?	Yes	Yes	Yes	Yes	Yes
Info Issue Detail	This response was under [name] so all PI management had to come through them - they had a very organized and orchestrated effort but other than [respondent identifying information redacted] was not privy to the process.	Provision of credible, timely, and accurate information for such a large-scale response was challenging.	Difficult to control media and VIP access to ACF causing issues regarding privacy.	The information we received was erroneous - constantly	The news media was all over the place
Dispatch?	[Site] did this - basically the EMS provider who normally provided EMS services for the [convention center] continued to provide transport on the complex proper, with the help of dozens of agencies nationwide. Local 911 services remained under the control of the [city] EMS	EMS resources were coordinated through the regional medical operations center.	We had 2 EMS strategies: (1) 24/7 ALS ground ambulance for emergency transports (2) 24/7 BLS/ALS ground ambulance for routine/ scheduled transports	Local EMS reps were at the ACF	We didn't that was a huge issue EMS did not stand up and take a role. This is a huge issue I think.
Behavior Rules?	Yes	Yes	No	No	No
Behavior Rule Detail	you'll have to ask [name] this question	Curfew at 11pm, no weapons allowed, lights were dimmed at night, no loud music, wrist-band identification for shelter evacuees	.	It really wasn't an issue. we had National Guard and campus police nightly	.
Other Command Issues?	Yes I believe that true IC has to come from local municipalities but medical command of a specific clinic should come from the resource supplying the service. Most importantly the resource must be knowledgeable experienced, and capable of handling the response—the response should NEVER be recreated by another resource that has no knowledge or experience in the response [redacted]	Command & control was key with necessity to consider extending NIMS/ICS to anticipated partners; credentialing of medical personnel; restricting access to shelters and ACF for appropriate persons.	1) Command staff were not relieved of their daily job function to perform oversight/command functions. These docs worked virtually 24-7 for the entire duration including working their scheduled ED shifts. 2) Use of ICS structure for running the ACF was a significant help in organizing the medical response	Seems the biggest question is who "owns" it - who is responsible in the end - is it the ranking physician or local health or State health depts?	There needs to be not only a command structure but also a continued hierarchy above - this is so questions can be answered and decisions made to help facilitate. Ex: ops need guidance or they will [indecipherable] too much and be overwhelmed. [redacted]
Security Personnel?	.	Yes	Yes	Yes - eventually	Yes
Armed Security?	.	Yes	No	Yes	Yes
Violence Issues?	.	No	No	No	No
Other Security Issues?	.	Planning for more security personnel at the beginning of the event, education of security personnel for restricted access to sensitive areas, badging/ identification of ACF staff so security could easily determine who required access and who did not.	The ACF was co-located within a large city shelter. The security element provided for the shelter then was easily shared between the two operations (shelter and ACF)	Initially only had campus security - so male students were enlisted to "look like" security. Once National Guard arrived they set a perimeter and actually placed a temporary fence around entire area	.
ACF Advance Plan?	No	No	No	No	No - I had been a part of others so I had input in the beginning
ACF Site Selection?	[name] question	When need arose	When need arose	Determined in advance	When need arose
RMBT Tool?	No	No	No	Yes	No (and I had been a part of this for a while)
RMBT Tool Use?	.	.	.	No	.
RMBT Tool Help?	Not sure	No	.	Yes - we have utilized in our State ([name redacted])	.
ACF Transport Location?	[name] question	Minimal at most.	The ACF was purposely co-located within a shelter to bring care to the evacuees. No consideration was given to transportation or evac routes	Don't know situation, it was established in [location] - one of the primary evacuation routes	In the Katrina situation a good choice - many mtg I have been in do not address this
ACF Site Selection Issues?	[name] question	Multiple multi-use facilities on one large property was very helpful and allowed expansion of service provision as the need dictated.	.	Proximity to a operating health care facility particularly if capable of running labs and other diagnostic tests	1. Easy bus routes for the elderly
Social Svc Plan?	.	Yes	Yes - planned jointly between ACF and pub health authority	.	.
Cleaning Plan?	.	.	Yes - planned jointly between ACF and pub health authority	.	.
Recreation Plan?	.	.	Yes - planned by OEM due to shelter operations	.	.
Warehouse Plan?	.	Yes	Yes - planned by OEM due to shelter operations	.	.
Purchasing Plan?	.	Yes	Yes - planned by OEM due to shelter operations	.	.
Other Service Plan?	.	.	Yes - planned by ACF/pub health	.	.
Other Service Detail	[clinic] provided physicians, nurses, clerks, runners, environmental services (janitors), social workers, pharmacy, central supply, and pediatric subspecialty services	.	Evacuee transport to city clinics, dialysis, etc. done by ACF/pub hlth; independent pharmaceutical svc	All managed by locals - we were asked for input	.
Other Service Issues?	.	Above services not checked in question 6 [cleaning, recreational, other] were provided but not planned for in advance - provision as the need identified.	Rehabilitation workers, pharmaceutical svc for drug prescriptions, mental health svc, phone internet-deaf svcs all aided us in bringing svc to our patients	.	.
Case Mix Plan: Acute	[name] question	.	75	.	.
Case Mix Plan: Chronic	[name] question	.	25	.	.
Case Mix Plan: Pediatric	Approx 30	.	20	.	.
Case Mix Plan: Adult	[name] question	.	80	.	.
Case Mix Plan: Nonspecific	[name] question	Unknown as had no information on types of medical needs of population to be sheltered from [location]	.	Entire population	Yes
Case Mix Received: Acute	[name] question	.	10	30	5
Case Mix Received: Chronic	[name] question	.	90	40	95
Case Mix Received: Pediatric	[name] question	.	10	10	10
Case Mix Received: Adult	[name] question	.	90	20	90
Case Mix Received: Nonspecific	[name] question	Data unavailable at this time.	.	.	Rough estimates
Case Mix Plan Changed?	[name] question	.	Yes	Yes	N/A
Case Mix Plan Change Detail	[name] question	N/A	Significant emphasis more along the lies of chronic care issues.	If medical infrastructure is destroyed, chronic care becomes acute care fairly quickly	.
Pediatric Care Plan?	Provided these services but was not invited to help with the planning - we are invited to participate in the planning for future disasters; [name] question but I will tell you that yes they thought about kids but did not consult [name] for help—they provided 2 beds to the response both of which had adults in them when we arrived	Not specified differently than other types of patients	No	Yes	Yes
Pediatric Care Location?	Yes—[name redacted]—initially there was 2 beds, both with adults in them. After the arrival of [name] docs—they took over 4 chairs then within 6-8 hours [name] medical command on site agreed that more was needed and provide a much larger space. [redacted]	Yes	Yes	Yes	No
Pediatric Care Plan: ED Nurse?	[name] question	.	.	Yes	.
Pediatric Care Plan: ED Doc?	[name] question	.	.	Yes	.
Pediatric Care Plan: Midlevel?	[name] question	.	.	Yes	.
Pediatric Care Plan: Ped ED Doc?	[name] question	.	Yes - pediatric physician	Yes	.
Pediatric Care Plan: Ped Nurse?	[name] question	.	Yes	Yes	.
Pediatric Care Plan: Other?	[name] question	.	Yes	Yes	Yes
Pediatric Care Plan: Other Detail	[name] question	Via coordination with community (private) provider for pediatrics services. Please note, pediatrics was considered in general as an important area to be addressed but no in-advance specific plans were in place.	ACF medical command staff, EM physicians, EMS fellows	Pediatricians	Feds plan and on the fly
Pediatric Care Consult: Care Center?	[name] question - but basically NO	.	Yes	.	.
Pediatric Care Consult: Peds Dept?	[name] question - but basically NO	.	No	.	.
Pediatric Care Consult: Other?	[name] question - but basically NO	.	Yes	.	.
Pediatric Care Consult: Other Detail	.	Yes, as above in question 3.	county public health dept	.	.
Equip Provider?	[name] question	Under [name] Medical Branch Operations, with ACF primarily equipped by [hospital].	Majority from the six [garbled] hospitals in town, some from private vendor and/or clinicians	Was standing when we arrived. [College] provided much - SNS eventually arrived	We brought it - Feds. DMAT
Resupply Provider?	[name] question	As above - with additional supplies by private donors, community agencies/ groups, and volunteers.	Majority from the six hospitals in town, some from private vendor and/or clinicians, plus county health dept.	Locals, State of [State] & State of [State], FEMA, HHS	Feds & national stockpile
Federal Cache?	[name] question	No	No	Yes	Yes
Cache Detail	.	.	.	Don't know specifics	SNS
Private Partners?	[name] question - I know that CVS was consulted - and [name] was eventually tapped	Yes	Yes - partnerships developed during the event	Yes—[name] EMS/Health Dept. had MOU's with local suppliers	No - donations came in
Food Supply?	[name] question	Via a contract food supply service at [site].	Patients fed by shelter operations (American Red Cross); workers fed by private vendor on contract to city OEM	Initially local restaurants and then [college] food service all pitched in	We initially had nothing but then used MRE (meals ready to eat). Hard for the elderly.
Family Food Supply?	Yes—[name] question	Yes	No - patients and family members were fed by ARC as a result of residing in the co-located shelter	No	Yes
Separate Dining?	[name] question	Yes	Yes - dining in shelter, treatment in ACF	Yes for staff; No for patients	Yes for us; No for patients
Pediatrics Meds?	Yes	Yes	Yes	Yes	Yes
Enough Pediatrics Meds?	No	Yes	Yes	.	Whatever was donated
Pediatrics Meds Supplier?	Initially the [hospital] provided pharmacy services - the supplies were dramatically under stocked so [name] moved in and opened and resupplied its own pharmacy and central supply	All medications were initially filled by off-site [hospital] pharmacies and eventually transitioned (a few days into the response) to CVS Pharmacy, which provided two mobile pharmacy units at no cost.	Same as for other supplies	Local resources in [location]	.
Other Pediatrics Supplies?	[name] question - same answer as the pharmacy question	Yes	Yes	.	Yes
Enough Other Pediatrics Supplies?	.	Yes - unknown but likely so	Yes	.	No
Other Pediatrics Supplier?	.	If so, via clinical providers and likely donated by them as well.	Same as for other supplies	Minimal supplies initially - after 72 hours or so received quantities from Fed.	We brought them in the Fed cache
Most Important Supplies?	See attached document [article]	Medications for chronic medical conditions (such as HTN, DM, etc.) were critical as were a constant re-supply of necessary equipment to run an ACF (such as wheelchairs, lab supplies, needles, gloves, gowns, masks, etc.).	Wound care supplies, point-of-care laboratory capabilities, and free standing pharmacy which stood up within the first 3-4 days of our operation. A local pharmacy chain built, de novo, a full service operation just outside the ACF site	Point of care testing: only had 2 glucometers when we arrived, EKG & other diagnostic tools. IV fluids and starter kits. Patient gowns, sheets, blankets etc.	1. Sheets - stretchers bed pans hand sanitizer diapers (young and old) chronic antiHTN and DM meds
Supplies Unavailable?	We had everything we needed once [name] took over	Eventually everything was provided for - the issue was time and determining how to get the supplies in need.	.	After 48 hours desperately needed capability for dialysis - local resources were brought in.	Oxygen was difficult
General Logistics Issues?	let the regional resource do what it does every day - don't recreate the wheel	.	We offered on-site general dentistry and refraction for eyeglasses which was a great value to our patients. Also working narcotic addicted and dialysis patients into pre-existing care patterns within the community.	Once the Federal supplies arrived a forklift was needed to move pallets, break them down, and repackage for use. A strong, young non-medical labor pool was essential.	.
Set Provider Shifts?		.	Yes	Yes	Yes
Shift Type	8 hour 12 hour 24 hour	.	8 hour 12 hour 4 hour	12 hour	12 hour
Shift Type Detail	This is for the [Clinic] only - housed within the much larger [name] response ACF residing in the [site] - [name] will have to answer the questions from their perspective	.	All scheduling based upon volunteer availability	.	Eventually we had shifts
Different Day/Night Staffing?	Yes	.	Yes	It varied by number of volunteers	No
Docs on Shift?	Varied from day one to day 14—[identifying details redacted: summary: 4 trained medical directors, 4 scheduled specialist physicians], lots of extra volunteers	.	16 am/4 pm	Varied - generally 25/more in the beginning but specialists who really were not comfortable with general medicine.	Unable to answer
Midlevel on Shift?	Not sure - were not scheduled but many came	.	None	20	Unable to answer
Nurses on Shift?	Same as docs above	.	20 am/6 pm	50+	Unable to answer
EMT on Shift?	[name] did not supply any EMTs	.	8 am/6 pm	50+	Unable to answer.
Pharmacy on Shift?	One around the clock (12 hour shifts)	.	2 am/1 pm	6+ (all from USHPS)	2-3
Additional Staffing Detail	.	.	.	.	Initially we had ~ 90 people 2/3 direct patient care so they had MD/nurse/ML/EMT; 1/3 transport & holding (3 nurses 1 MD >700 pt) and 20 people offloading helicopters. Eventually increased the number of MDs/nurses (mostly) and EMT when support arrived
Clerks/Admins?	Yes	.	Yes - medical records, mental health	Yes	Yes
Clerk/Admin Detail	One around the clock (8hour shifts)	.	5 am/1 pm - much admin work done by medical command staff due to limited admin support	Well over 50, they were college students & staff	Each team has 1-2 admin folks plus there is support from NDMS
Outside Providers?	Yes	Yes	Yes	Yes	Yes
Outside Provider Issues?	Most pediatricians came from [name] or its referral source ([identifying detail redacted])- so they were credentialed through our hospital - did have some issues at time with [name] IC - most were resolved without incident	Communication was continual issue so daily briefings/ updates were important.	No	Very few problems - there was so much to do no time for turn battles. We always held change of shift reports within nursing - including numbers of pts., etc.	Each team has its own. In another situation we had Marines, VA nurses & public health - they stayed together but were under a command system and understood that
Licensing Issues?	Yes	.	No - credentialling consisted of a visual check of providers professional ID badge to verify identity and job function (RN, MD, EMT, etc)	USPHS managed these issues	Yes - for narcotic refills
Interpreter Services?	Yes	.	Yes	No	No
How Interpreted?	Trained interpreters Bilingual/ multilingual care providers Family members Other	.	Bilingual/ multilingual care providers Family members Other	.	.
Interpreter Detail	.	.	Deaf video phone system	.	.
Volunteer Types?	Medical Non-medical	Medical Non-medical	Medical Non-medical	Medical Non-medical	Non-medical
Volunteer Coordinator?	Yes—[name] used its own coordinator but [name] had its own also	Yes	Yes	Yes - college professors from campus	Not initially
Volunteer Lessons?	They were essential	.	Pre-plan their job function (role), teach them the role, and always direct oversight of their activities	We would've failed without them. Convene a meeting, explain the prioritized issues/problems & let volunteers choose what they can help with.	They need to be given tasks as well as coordinated as a group - in [location] we had yellow shirts and if I remember correctly orange shirt folks - all faith based.
Credentials Verified?	[name] used its own credentially process—[name] used its own system	.	We did not	USPHS did this	90% were all Federal
Worker ID?	Yes	.	Yes	Yes	No
Worker ID Detail	[name] used its IDs but [name] also tried numerous cards - none were successful	.	A make-shift badge maker	Actually used wrist bands the university had thousands for special events	Already had some
Worker ID Lessons?	Yes - early identification - prior to the response	.	Nothing different	.	.
Imposters?	Yes	.	No - not that we are aware of	No - but we had a person from the media impersonate a priest to get in	Not that I was aware
Out-of-State Profs?	They allowed instant licensure with sponsorship - our section at [name] provided that sponsorship	.	The State of [State] did not assist in this issue.	Don't know. But as part of a pre-existing State team sent via EMAC we came with verified credentials	Ask [name] [email] - he coordinated with the State
Pre-Event Training?	Yes	Yes	No	.	Yes
Pre-Event Training Detail	only a few	Mass medication dispensing (for health department staff).	.	Nothing could have prepared us and we only prepared for field response - and only for 72 hours	Drills
Other Staff Issues?	Credentialing must occur but a balance between rapid recruitment to meet rapid enormous need must be reached	.	Logistic/supply officer and medical records personnel very important. Pharmacists very important. We want to have a record of who (which providers) were present at given times. No easy way to credential, even now	Labor pool essential - college students particularly well suited. They all have IDs, can be verified by college. Professors & staff also extremely useful (counselors admin asst., etc.) A number of MDs with unique specialties found themselves out of the [redacted]	MDs are not the best people to have in charge - nurses are better at shifts - jobs - and people coordination
ACF Admin Agency?	[name] question	No	No	Yes and no	No
ACF Admin Agency Detail	.	.	.	Initially locals have to get things going but as other assistance arrives a collaborative approach (like Unified Commerce) developed and was very effective	.
ACF Purpose?	[name] question Shelter care Medical treatment facility	Shelter care	Shelter care (ACF colocated within a shelter); Medical treatment facility (operated as a standalone facility)	Shelter care Medical treatment facility Both at first then became strictly medical	Shelter care Medical treatment facility
ACF Goal?	Primary receiving facility	Primary receiving facility	Primary receiving facility	Primary receiving facility	Hospital decompression Primary receiving facility
Daycare?	[name] question	Don't think we addressed via Medical Branch Operations.	No service provided. Volunteers were responsible for arranging this themselves.	N/A	N/A
Patient Childcare?	[name] question	No	No - the shelter provided this service	Yes—[college] students	No
ICU Patients?	No	No	No	Yes	Yes
ICU Reasonable?	Yes—[name] question	No	No	No	Yes - with supplies skilled people and ability to place in comfort care if necessary
Rounds System?	.	No - of note, no inpatient care was provided at the ACF / although an observation/ isolation unit was set-up	Not applicable	Nursing did; medicine did not - formally	Yes
Visitor Limit?	[name] Question - in the [clinic] we did not limit	No	Not applicable	No - family were also evacuees, though they were provided different space	Unknown
Auxiliary Care?	.	N/A	Not applicable	Yes	Yes
Outside Integration?	[name] question	Yes	Yes—[State] State guard (medical branch) provided security and lab technicians and logistical support	Yes	We were a DMAT but other ACS did use DMATS
Integration Lessons?	.	Yes	Yes	Yes	N/A
Integration Detail	.	Federal response agencies worked best when they integrated into the already set-up local incident command structure.	Assisted us in understanding their capabilities	We split up teams/ integrated shifts with folks from all groups which resulted in a wonderful collaborative consciousness. Included student leaders as well.	.
Pets Allowed?	[name] question	No - pets were housed outside the facility in a separate shelter	No	No - but there was a place on campus for them	Yes
Facility Issues?	Yes—[name] question	Yes	No	Yes	Yes
Issue Detail	lack of ample plumbing	Environmental issues related to exhaust fumes, noise, etc. due to vehicular traffic and leaving vehicles on.	.	Gymnasiums are large and noisy - it really never was quiet. Other treatment areas as well were loud & light.	Lighting (not NO but other shelters) and noise control - also bathroom access
Any Other Issues?	See attached file. [redacted]	.	.	.	There needs to be a troubleshooting expert group who can be called to come in and help with problems esp. when the operations people become overwhelmed and unable to make good decisions
Self-Presenting?	Yes - But [name] tried to prevent this	No	Yes	Yes	Yes
Ambulance Route?	Directly to ACF	N/A	Hospital first	Hospital first - not possible in this circumstance, though EMS did manage to take true criticals to hospitals	Directly to ACF
Mental Health?	Yes	Yes	Yes	Yes	Yes
Futility of Care?	[name] question	.	No	No	Yes
Futility of Care Details	.	Do not understand question.	Not applicable to our operation since we performed no in-patient or ICU care	It didn't come up	0 guidelines it had to do with logistics and transportation and staffing
Pediatrics Care: ED Nurses?	Yes	.	.	Yes	Yes
Pediatrics Care: ED Docs?	Yes	.	Yes	Yes	Yes
Pediatrics Care: Family Docs?	Yes	.	.	Yes	Yes
Pediatrics Care: Pediatrics ED Docs?	Yes	.	.	Yes	Yes
Pediatrics Care: Pediatrics Midlevel?	Yes	.	.	Yes	Yes
Pediatrics Care: Pediatrics Nurses?	Yes	.	Yes	Yes	Yes
Pediatrics Care: Pediatricians?	Yes	Yes	Yes	Yes	Yes
Pediatrics Care: Other?	Yes	Yes - handled by another agency so cannot speak fully to this question	.	.	Yes
Pediatrics Care Other Detail	Answer pertains to the [clinic] only - almost every combination	Via coordination with community (private) provider for pediatrics services.	.	.	Paramedics
Immunizations?	Yes	Yes	Yes	Yes - but only for fire service and law enforcement coming from various parts of the country on the way to [location]	Yes - tetanus
Infectious Disease Surveillance?	Yes	Yes	Yes	Yes	Yes
Infectious Disease Surveillance Detail	Both the [name] public health and [name] provided this surveillance - in fact [name] was the first to identify and DNA type the organism responsible for the GE outbreak	Cot-to-cot surveys in shelter areas by Epidemiology Task Force was conducted nightly to assess for symptoms that may correlate with certain disease patterns.	County public health epidemiologist reviewed cases	Monitored trends	Walk rounds. & informal look arounds. Other facilities I know had a stronger PH component.
Hospital Transfer System?	Yes	Yes	Yes - only 2-3% of ACF patients were transferred to hospital ED's (out of >10,000 patient encounters)	Yes	Initially no! After a while yes but limited. In other ACFs I have had an ambulance on standby for transfer
Surge: Early Discharge?	Yes	.	No local hospitals used these strategies	Yes	Unknown
Surge: Hospital Transfer?	.	.	No local hospitals used these strategies	.	Unknown
Surge: ICU to Ward?	Yes	.	No local hospitals used these strategies	.	Unknown
Surge: Interhospital Transfer?	.	.	No local hospitals used these strategies	Yes	Unknown
Surge Criteria Detail	.	Unknown	None of these strategies were employed	We were informed by local health that beds were becoming available especially after NDMS kicked in	Unknown
Special Medical Needs (SMN)?	Yes	Yes	Yes	Yes	In NO all comers
SMN: Dialysis?	Yes	.	Yes	Yes	.
SMN: Mental Health?	Yes	.	Yes	Yes	.
SMN: Ventilator?	.	.	.	.	.
SMN: Other?	Yes	Expanded definition for what was considered MSN population - so a diabetic without insulin for few days with need to store insulin, dispose of sharps, ADA diet, etc. became a patient with MSN.	.	.	.
SMN Other Detail	hemonc/ transplant/ CF/ shunts/ etc	Other such patients included those morbidly obese, mental health needs, patients on chronic dialysis, etc.	.	.	.
Special ACF Group?	Yes	No	No	Yes	Yes
Special ACF Group Detail	Ventilator dependent	In operation such as ours, integrated services worked best esp. due to fact that patient characteristics were unknown in advance of operation initiation.	.	Infectious - it wasn't an issue for us, but if we were dealing with flu etc, should have separate ACF. Also hospice/palliative care	Chronic ventilator patients with respiratory therapists
Multiple Ventilators?	Yes	No	No	No - not without extraordinary resources - which are better left in the hospital	Yes
Other SMN/Patient Care Issues	With Hurricane RITA which came at the heels of Katrina we had appx 30 ventilator dependent children arrive at our EC - we had to open a floor just for these patients - as a result, we are working with the [State] to create a regional location [redacted]	.	Avoid segmenting patients according to medical diagnoses	We did not have many deaths - but hospice/ palliative care patients that were evacuated did come through and sent to a different facility	Morbidly obese/mobility issues are huge problems for hygiene and skin breakdown
Patients In ACF?	[name] question	Very limited information known.	Visual head count only	We counted every 2 hours / kept track on a grease board	Walking around
Patient Location?	[name] question	Very limited information known.	Medical record form indicated the location within the ACF where care was rendered (adult, ped, mental lhth, dental, OB, ... etc.)	Had charge nurses & team leads at each treatment area keeping track	Walking around
Patient Disposition?	[name] question	Discharge/ transfer information was limited except for perhaps those who were transferred via the regional medical operations center	Handwritten medical record	Local EMS & social workers took care of this	Initially too many patients to too few staff
Patient Tracking System?	[name] question	No	No	No—[college] students went bedside to bedside with laptops to develop database	Yes
Medical Records?	EMR - took 2 days to perfect but it was quite good once it overcame the sudden rush of patients - [name] question	Not handled by our agency.	Developed de-novo a paper medical record - all completed records were scanned and stored. Data entry clerk created database (name and chief complaint) which was searchable.	Initially - just one sheet of paper taped to the cot	Couldn't initially then ran out of supplies
Records Ownership?	[name] question	Not handled by our agency.	County public health dept.	Records were sent with the patient when transferred and/or given to them with a discharge summary. Local EMS kept copies of discharge/transfers	Feds
Adult/Peds Together?	Families kept together Adult/peds separated	Families kept together	Adult/peds separated - moms typically took children needing care to the pediatric section	Families kept together - as much as possible	Families kept together
Spouses Separated?	[name] question	No	No	No	No
Families Together?	Yes	Yes	No	Yes	Yes
Patient Privacy?	.	Depends on emergency scenario but in general the preference due to the high anxiety of such scenarios is to keep families together as much as possible.	.	Tough to do in a gymnasium. We used sheets & other barriers when possible. Far more important to allow access to patients as most families were also evacuees and separating families at the time would have just made things worse.	Family takes precedence over privacy in a disaster
Active Finance Section?	Yes—[name] financed its own efforts in the hope that it would be reimbursed - I don't think it was reimbursed	Yes - handled through overall County Government, not our agency specifically.	No	No - all done by locals/I do not have the info	No
Volunteer %?	not sure	Unknown	20	.	.
Charitable Donation %?	not sure	Unknown	10	.	.
Institution/System %?	not sure	Unknown	40	.	.
Private Corporation %?	not sure	Unknown	10	.	.
Local Gov %?	not sure	Unknown	10	.	.
State %?	not sure	Unknown	.	.	.
Federal %?	not sure	Unknown	10	.	.
Other %?	not sure	Unknown	.	.	.
Other % Detail	not sure	Unknown	.	.	.
Federal Invoice?	Yes	Yes - County Government did.	No	.	.
Federal Reimbursement?	No	Yes	.	.	.
Reimbursement Secrets?	yes - create an agreement before the response	.	Not applicable	.	.
Worker Illness/Injury?	Yes	Unable to quantify.	No - not that we were aware of	No	Yes
Workers' Comp Issues?	[name] question	N/A	No - not that we were aware of	No	Yes
Workers' Comp Detail	.	.	.	.	Their commander dealt with it through the Federal Government
Other Finance Issues?	Pay the resource if you want them to return	.	ACF financing will now go through the finance section of the city entity which has requested a medical support function.	.	.
General Comments		Advanced planning and development of relationships with partners in advance is critical to the success of any large-scale operation.	See two documents [attached] describing our ACF operations	[From included cover letter] ... I am an advocate of college campuses as ACF for many reasons. This is a short list: 1. handicapped accessible; 2. large crowds can generally be accommodated; 3. there is already a security presence, and a perimeter can be	Can not be rigid - flexibility important. Red Cross volunteers. Family together. Palliative care areas. Animals need to be considered. Uniforms very helpful. Understand limitations in your mission.

Survey Question/Topic	Site 5	Site 6	Site 7	Site 8	Site 9
ACF Planned?	.	.	.	.	Yes
ACF Actual?	Yes	Yes	Yes	Yes	.
ACF Location?	[REDACTED]	[REDACTED]	[REDACTED]	[REDACTED]	.
ACF Dates?	Sept. 2—Oct. 14, 2005	September 2005	August 05	September/ October 2005	.
Number of ACF patients?	7500	200	700	340	.
Number of ACF staff?	60-100 at any one time	100	Volunteers—several hundred Medical staff, in total given ~300 (some were transiently involved)	plus or minus 200	.
Structure of Opportunity ACF?	.	Yes	Yes	Yes	Yes
Structure of Opportunity Detail	.	Closed VA hospital	Former [redacted] box store	College gymnasium.	.
Portable ACF?	.	.	.	.	Yes
Mobile ACF?	Yes	.	.	.	.
Inpatient Augmentation: Adult?	.	Yes	Yes	Yes	Yes
Inpatient Augmentation: Pediatric?	.	Yes	Yes	.	Yes
Inpatient Augmentation: Special Populations?	.	Yes	.	.	.
Inpatient Augmentation: Special Populations: Detail	.	Special needs population that required routine medical support. The acuity was similar to a nursing home.	.	COPD, asthma, diabetes	.
Inpatient Augmentation: Special Medical Needs?	.	.	.	.	.
Inpatient Augmentation: Special Medical Needs: Detail	.	.	.	COPD, asthma, diabetes	.
Inpatient Replacement: Adult?	Yes	.	.	.	Yes
Inpatient Replacement: Pediatric?	Yes	.	.	.	Yes
Inpatient Replacement: Special Populations?	Yes	.	.	.	Yes
Inpatient Replacement: Special Populations: Detail	Chronic disease—patients without meds or care for 1 week post-storm	.	.	.	If an incident such as pan flu or a hurricane strike necessitates it we would utilize an ACF for possible temporary replacement.
Inpatient Replacement: Special Medical Needs?	.	.	.	.	.
Inpatient Replacement: Special Medical Needs: Detail	.	.	.	.	.
Ambulatory Augmentation: Adult?	.	Yes	.	.	Yes
Ambulatory Augmentation: Pediatric?	.	Yes	.	.	Yes
Ambulatory Augmentation: Public Health?	.	.	.	.	Yes
Ambulatory Replacement: Adult?	Yes	Yes	.	.	Yes
Ambulatory Replacement: Pediatric?	Yes	Yes	.	.	Yes
Ambulatory Replacement: Special Populations?	Yes	.	.	.	.
Ambulatory Replacement: Special Populations: Detail	Chronic disease—patients without meds or care for 1 week post-storm	.	.	.	.
Ambulatory Replacement: Special Medical Needs?	.	.	.	.	.
Ambulatory Replacement: Special Medical Needs: Detail	.	.	.	.	.
Ambulatory Replacement: Shelter Support?	Yes	Yes	.	Yes	.
Governance: Institutional/HC System?	Yes	.	.	.	Yes
Governance: Nonprofit/Volunteer?	.	.	.	.	.
Governance: Local?	.	.	.	Yes	Yes
Governance: Local: OEM?	.	.	.	.	Yes
Governance: Local: Public Health?	.	.	.	Yes	Yes
Governance: Local: Other?	.	.	.	.	Shared responsibility between the hospitals, Emergency Management and Public Health with the use of State Medical Response Teams (similar to Federal DMAT) serving in a command role.
Governance: State?	.	.	Yes	.	Yes
Governance: Federal?	.	.	.	.	.
Governance: Federal: DHHS?	.	.	.	.	.
Governance: Federal: PHS?	.	Yes	.	.	.
Governance: Federal: NDMS?	.	.	.	.	.
Governance: Federal: DoD?	.	.	.	.	.
Governance: Federal: Other?	.	Yes—and VA staff managed & support.	.	.	.
ICS?	Yes	No	Yes	Yes	Yes
ICS Model	HICS & NIMS	.	Not a formal one. [respondent identifying information redacted] Responsibility was divided with a "deputy" in charge of nursing, medicine, facility setup/management	NEMS	NIMS
IAP?	Yes	No	Do not know what this is but if it involved a form, no.	Yes	Yes
IAP Frequency	.	.	.	.	Daily
IAP Frequency—Other	.	.	.	.	If needed one would be established for each 12 hour operational period (12 hours).
IAP Type	Previously prepared form	.	.	A form we created	Previously prepared form
Command Problems	Yes	Yes	No	No	No
Command Problem Detail	1st time tested; learning curve	No problem internal to the shelter—confusing command structure outside of the shelter	.	.	.
Transfer of Command	Verbal report	Verbal report Written report	Verbal report	Verbal report Written report	Verbal report
Transfer of Command Detail	.	N/A	.	.	.
How Open?	Request via EMAC	N/A	Ask to do so by the State	E.O.C. contacted the M.O.C who contacted the Public Health Department	Assessment of surge impact.
Who Decides?	State of [State Redacted]	N/A	An assistant to the Governor	Health Authority. After being asked by the fire chief.	Collective decision between the Incident Commander, the Emergency Manager, the Medical Director and the Health Department Director with hospital input.
How Close?	Demobilization plan prepared between [State] Office of EMS & [State] Dept. of Health	N/A	The expected surge was directed elsewhere.	Once all evacuees had a safe place to be transferred to.	Collective decision between the ACF Commander, the Emergency Manager, the Medical Director, the Health Department Director and the hospitals.
Pre-Close Check?	Rebuilding and increased service delivery of the affected community hospital.	Patient load, discharge philosophy, shelter occupants desire to go home ASAP	There were no predetermined requirements	All evacuees had to have a safe home.	N/A
CONOPS?	Yes	Yes	Yes—although not written	Yes	Yes
NIMS/HICS Training?	No	Yes	No	Yes	Yes
Training %?	.	20	.	20	UND
EMTALA?	No	No	No	No	Yes
EMTALA Detail	.	.	.	.	We anticipate there will be issues related to the use of non-hospital facilities and issues if hospitals send people to an ACF without a full assessment first.
Info Issues?	Yes	No	Yes	No	Yes
Info Issue Detail	Multiple news agencies conducting stories/interviews. We had our own PIO which facilitated this.	.	Volunteers were carelessly photographing patients. We stopped this.	.	Since in almost every major incident there are public information issues we anticipate there will be when an ACF is open and operational.
Dispatch?	AMR was the local provider. We became part of their receiving facility network. They provided communications to us.	N/A	.	Local EMS was coordinated through the incident command	Through the Incident Commander and appropriate ESFs at the EOC.
Behavior Rules?	Yes	Yes	Yes	Yes	No
Behavior Rule Detail	8:00 PM community curfew. No alcohol sold.	.	No weapons. Lights out.	1) No weapons 2) lights out at 22:00 3) No alcohol 4) No drugs - except for home meds. All medicines dispensed by onsite nurses & pharm.	These will be developed with enhancement of the CONOPS for ACFs.
Other Command Issues?	Should be a physician (IC) - not hospital administrator.	The structure was similar to the management structure @ VA hospital	Need adaptability. Need "connectors" who can marshal resources and/or know where to seek them. Suspend rules and take risks. Never say no to a disaster related need if no one else can address that need.	Ensure before the shelter is established that there is a clear organizational structure & that this information is available to the evacuees & local community. All command staff should wear ID clothing to identify them.	There will have to be accords reached between the command of the ACF and the medical operations decision making portion of the ACF.
Security Personnel?	Yes	Yes	Yes	Yes	Yes
Armed Security?	Yes	Yes	Yes	Yes	Yes
Violence Issues?	No	No	No	No	Do not anticipate any but that is why armed security from law enforcement is part of the plan.
Other Security Issues?	We used our own local police - they travel with us. All on SWAT team and all sworn as US Marshals (allows jurisdiction over county lines).	We anticipated the need of visible security presence and requested additional support. The enforcement staff came slowly and with much confusion. We also gave staff sensitivity training before they were deployed.	Have a metal detector.	Local State guard, campus police & city police very helpful.	There needs to be a commitment from law enforcement to support ACF operations. Oftentimes they State that they will be too busy to assist with security issues but it will be key for them to provide resources during an ACF activation.
ACF Advance Plan?	Yes	No	No	Yes	Yes - State guidelines have been written and work is being done to get counties to develop their own local plans for ACF operation.
ACF Site Selection?	When need arose	When need arose	When need arose	Determined in advance	When need arose Determined in advance Some local sites have been identified but the plan is open for sites to also be selected as the need arises.
RMBT Tool?	No	No	No	No	Yes
RMBT Tool Use?	.	.	.	.	Yes
RMBT Tool Help?	.	May be.	.	.	.
ACF Transport Location?	Located at intersection of 2 main highways - 1 mile from local hospital (which was closed due to damage).	N/A	Extreme consideration.	Very important	Consideration was given to this aspect since it will be important to have quick ingress and egress along with traffic routes that are not bottled up.
ACF Site Selection Issues?	Did not set-up on hospital grounds. This was to allow access of building crews, logistics, etc. so facility could be rebuilt.	[Location] is in rural [State], there was a lack of medical support as well as social support.	What was available.	Caution with gymnasiums: college is very protective of their floors & equipment.	We are planning to use one of four different locations for ACFs. First would be near the scene, such as near a stadium that may have been hit to avoid having to transport large numbers of people. Second would be sites midway between the scene and hospital
Social Svc Plan?	Yes	Yes	No	Yes	.
Cleaning Plan?	Yes	Yes	No	Yes	Yes
Recreation Plan?	.	Yes	No	Yes	.
Warehouse Plan?	Yes	Yes	No	Yes	Yes
Purchasing Plan?	Yes	Yes	No	Yes	Yes
Other Service Plan?	Yes	.	No	Yes	Yes
Other Service Detail	Clinical engineering (biomed equip) and security as mentioned.	.	.	.	Food service, Linen service
Other Service Issues?	.	Pet service, schooling for children, meals	Make up rules/solutions on the fly.	.	.
Case Mix Plan: Acute	20	.	50	.	.
Case Mix Plan: Chronic	40	.	50	.	.
Case Mix Plan: Pediatric	5	.	20	.	.
Case Mix Plan: Adult	80+	.	80	.	.
Case Mix Plan: Nonspecific	.	.	.	Yes	Yes
Case Mix Received: Acute	10	.	0	20	.
Case Mix Received: Chronic	60	30	100	80	.
Case Mix Received: Pediatric	10	.	5	25	.
Case Mix Received: Adult	90	.	95	75	.
Case Mix Received: Nonspecific	.	.	.	.	Yes
Case Mix Plan Changed?	No	Yes	.	Yes	.
Case Mix Plan Change Detail	.	.	I am not involved with ACF planning	Recognized that cute care should be handled at regional hospitals.	.
Pediatric Care Plan?	Yes	No	Yes	Yes	Yes
Pediatric Care Location?	Yes	No	Yes	Yes	Yes
Pediatric Care Plan: ED Nurse?	.	Yes	.	Yes	.
Pediatric Care Plan: ED Doc?	Yes	Yes	.	Yes	Yes
Pediatric Care Plan: Midlevel?	.	.	.	Yes	.
Pediatric Care Plan: Ped ED Doc?	.	Yes	Yes	.	.
Pediatric Care Plan: Ped Nurse?	.	.	Yes	.	.
Pediatric Care Plan: Other?	.	.	.	Yes	.
Pediatric Care Plan: Other Detail	.	.	.	Family medicine residents from [location]. PharmD residents.	.
Pediatric Care Consult: Care Center?	.	.	No	.	.
Pediatric Care Consult: Peds Dept?	.	.	No	Yes	.
Pediatric Care Consult: Other?	.	.	No	Yes	.
Pediatric Care Consult: Other Detail	None	.	.	Family medicine doctors.	.
Equip Provider?	Self	Public health service and VA	Donation from hospitals and a purchased "kit"	Health department.	State regional ACF caches.
Resupply Provider?	ESF-8 (FEMA) and donations	VA	N/A	Health department. Local direct medical equipment.	Additional State resources as well as community and possibly Federal resources.
Federal Cache?	Yes	Yes	No	No	Yes
Cache Detail	ESF-8 (FEMA) as above. We were the first to deploy the SNS-VMI!!!	.	.	.	Plan to make use of NDMS resources and Federal Medical Stations as well as Strategic National Stockpile resources.
Private Partners?	No	Yes - Wal-Mart	Yes	Yes	Yes
Food Supply?	Local faith-based group on-site, then FEMA logistics	Contract	Restaurants/catering services supplied food	Local restaurant provided food. Food bank. College cafeteria.	Plan involves using ESF - Mass Care resources to accomplish this.
Family Food Supply?	No	Yes	Yes	Yes	No
Separate Dining?	Yes	Yes	Yes	Yes	Yes
Pediatrics Meds?	Yes	Yes	Yes	Yes	Yes
Enough Pediatrics Meds?	Yes	Yes	Yes	Yes	.
Pediatrics Meds Supplier?	SNS-VMI	Wal-Mart	Industry, hospital, NGO. (pharma)	Local pharmacies. Samples from doctors.	.
Other Pediatrics Supplies?	Yes	.	Yes	Yes	Yes
Enough Other Pediatrics Supplies?	Yes	.	Yes	Yes	.
Other Pediatrics Supplier?	ESF-8 (FEMA)	.	Industry, hospital, NGO. (pharma)	Local hospitals.	.
Most Important Supplies?	Chronic meds (insulin, anti-hypertensives, pain mgt.) and antibiotics	.	Cots, chronic disease meds such as insulin	1) beds & cots with special mattresses. 2) dispensary run by pharmacist - antibiotics, nebulizations. 3) nebulizers & O2 supplies. 4) glucose monitoring equipment. 5) crash carts. 6) radios for communication	.
Supplies Unavailable?	None	Difficulty time with narcotics. Lack of DEA # for the shelter.	0	None.	.
General Logistics Issues?	We were self-supporting for 72 hours.	.	Need portable shower/toilet facilities	Identify before the disaster who will provide logistics.	.
Set Provider Shifts?	Yes	Yes	Yes	Yes	Yes
Shift Type	12 hour	12 hour	Other	8 hour	12 hour
Shift Type Detail	.	.	As available	As per availability of community resources	.
Different Day/Night Staffing?	Yes	Yes	Yes	Yes	.
Docs on Shift?	4-5	4	4	2-3	Use military recommended guidelines.
Midlevel on Shift?	1-2	5	3	2-3	.
Nurses on Shift?	8-10	20	10	20-30	.
EMT on Shift?	8-10	.	1-2	10	.
Pharmacy on Shift?	2-3	2	1-2	1-2	.
Additional Staffing Detail	.	.	.	.	.
Clerks/Admins?	Yes	No	Yes	Yes	Yes
Clerk/Admin Detail	1-2	.	~6	[name] State guard medical rangers 20.	.
Outside Providers?	Yes	Yes	Yes	Yes	Yes
Outside Provider Issues?	None	Initially with staff from DHS. Minimal command control issue	No	No - the shelter manager & health authority kept command over the shelter.	.
Licensing Issues?	Yes	Yes	No	No	.
Interpreter Services?	No	No	No	No	Yes
How Interpreted?	.	.	.	.	.
Interpreter Detail	.	.	.	If we did, we would use volunteers.	.
Volunteer Types?	None	Non-medical	Medical Non-medical	Medical Non-medical	Medical Non-medical
Volunteer Coordinator?	No	No	Yes	Yes	Yes
Volunteer Lessons?	N/A	good support.	They are invaluable. Running an ACF requires acquisition of supplies, communications, plant management, security, etc. Non-medical people may be expert in those fields	Their availability is haphazard.	.
Credentials Verified?	EMAC took care of that	not done, however they all came from VA with proper credentials	We did not	Local hospitals. Medical society. [name] State guard.	State is about to implement a credentialing system.
Worker ID?	Yes	No	No	Yes	Yes
Worker ID Detail	Yes (owned by [State] office of EMS)	US VA ID card	.	.	.
Worker ID Lessons?	No	Yes, a standardized system	We had 48 hours to become operational. Worker ID's was a nicety	Identify credentials of workers prior to any event.	.
Imposters?	No	No	No	Yes	.
Out-of-State Profs?	Again - EMAC handled everything	None, no need.	To give blanket reciprocity and malpractice coverage to MDs and RNs from other States	Volunteer nurses were screened through the [State] nursing association.	.
Pre-Event Training?	Yes	Yes	No	Yes	Yes
Pre-Event Training Detail	2 years of team training on [clinic]	Some has emergency disaster training and HICS training	.	Health department trained in disaster management. [State] State guard medical brigade trained in disaster management.	.
Other Staff Issues?	Emergency medicine, trauma surgery, orthopedic surgery, anesthesiology at first (2-3 weeks), then more primary care (FP, IM, Peds, etc.)	.	.	After action report - established a list of local physicians available in time of disaster. Established a medical reserve corp of volunteers. Utilize State guard.	.
ACF Admin Agency?	No	No	No	No	.
ACF Admin Agency Detail	.	.	.	.	.
ACF Purpose?	Medical treatment facility	Medical treatment facility	Shelter care Medical treatment facility	Shelter care	Medical treatment facility
ACF Goal?	Primary receiving facility	Primary receiving facility	Hospital decompression	Hospital decompression Primary receiving facility	Hospital decompression Primary receiving facility May serve as both
Daycare?	N/A	N/a	N/A	Community resources. Church groups.	.
Patient Childcare?	No - other than our staff assisting when needed	No	No	Yes	Yes
ICU Patients?	Yes	No	No	No	No
ICU Reasonable?	Yes	No	Depends	No - this would have to be a fully operational field hospital.	No
Rounds System?	Yes	Yes	.	Yes	.
Visitor Limit?	No	No	No	No	Yes
Auxiliary Care?	Yes	Yes	Yes	Yes	No
Outside Integration?	No	No	Yes	Yes—[State] medical rangers	Yes
Integration Lessons?	.	.	Yes	Yes	.
Integration Detail	N/A	.	Be flexible. Learn. Respect, adapt	Need strong incident command to manage multiple levels of outside input.	.
Pets Allowed?	Yes - limited	Yes	No	No	No
Facility Issues?	No	Yes	Yes	No	.
Issue Detail	Cell communications at first. Then satellite delivered with phones.	Drinking water, meds preparation, lack of phones	No toilets, inadequate electrical support, no air condition	(Used a gymnasium - required reassurance to college administrators that we would not damage floors)	.
Any Other Issues?	.	The nearby VA support was a major reason for our success.	.	Bed triage & labeling helpful. Use dieticians/ licensed diabetic educators to arrange diabetic management teams. Needlesticks are hazardous.	.
Self-Presenting?	Yes	No	Yes	Yes	Yes
Ambulance Route?	Directly to ACF	.	Depends on patient acuity	Hospital first	Directly to ACF
Mental Health?	Yes	Yes	Yes	No	Yes
Futility of Care?	No	.	No	No	.
Futility of Care Details	.	.	.	.	.
Pediatrics Care: ED Nurses?	Yes	.	.	Yes	.
Pediatrics Care: ED Docs?	Yes	.	.	Yes	Yes
Pediatrics Care: Family Docs?	.	.	.	Yes	.
Pediatrics Care: Pediatrics ED Docs?	Yes - limited	.	.	.	.
Pediatrics Care: Pediatrics Midlevel?	.	Yes	.	.	.
Pediatrics Care: Pediatrics Nurses?	.	.	Yes	.	.
Pediatrics Care: Pediatricians?	.	Yes	Yes	Yes	.
Pediatrics Care: Other?	.	.	.	.	.
Pediatrics Care Other Detail	.	.	.	.	.
Immunizations?	Yes	Yes	Yes	Yes - tetanus	No
Infectious Disease Surveillance?	Yes	Yes	No	Yes	No
Infectious Disease Surveillance Detail	[State] Public Health rotated teams that interacted with [State] Epidemiology.	.	.	Minimal disease surveillance - diarrhea, respiratory tract infections were monitored	.
Hospital Transfer System?	Yes	Yes	Yes	Yes	Yes
Surge: Early Discharge?	Yes	.	.	Yes	Yes
Surge: Hospital Transfer?	Yes	.	.	Yes	Yes
Surge: ICU to Ward?	.	.	.	.	.
Surge: Interhospital Transfer?	.	.	.	.	Yes
Surge Criteria Detail	Guesstimations only	.	.	If patients met minimal criteria for discharge they were discharged home or back to the shelter.	.
Special Medical Needs (SMN)?	Yes	No	Yes	Yes	No
SMN: Dialysis?	.	.	Yes	.	.
SMN: Mental Health?	Yes	.	.	.	.
SMN: Ventilator?	.	.	.	.	.
SMN: Other?	Yes	.	.	Yes	.
SMN Other Detail	Chronic health prob.	.	.	COPD, diabetes patients, Alzheimer/ geriatric patients	.
Special ACF Group?	No	.	.	Yes	No
Special ACF Group Detail	.	.	.	Ventilator patients	.
Multiple Ventilators?	Yes	No	Depends on staffing and resources	No - unless the personnel (nurses/ respiratory technicians) are available.	No
Other SMN/Patient Care Issues	Dialysis was not an issue, but could have been. Also we had 8 obstetric patients that we transferred out (luckily).	.	.	.	.
Patients In ACF?	Electronic system tracking tool	paper process	Database	Daily patient census recorded on Excel program. All patients signed in & out of facility.	Patient recording and tracking.
Patient Location?	Computer board	a room roster started when they admit.	Generally	XY grid coordinates for bed placement.	.
Patient Disposition?	Same computer tracking system	daily count and discharge process include informing patient administration	Database	Developed an Excel program. College students assisted.	.
Patient Tracking System?	Yes	No	No	No	Yes
Medical Records?	Paper/file cabinets	Electronic VA record	Paper	(Electronic for monitoring patient status.) In clinic & shelter used a paper record. Patient chart created & attached to bed.	.
Records Ownership?	[State] Public Health	VA?	State	Public health department.	Have not given thought to this issue. Good point.
Adult/Peds Together?	Families kept together	Families kept together	Families kept together	Families kept together	Families kept together
Spouses Separated?	No	No	No	No	Yes
Families Together?	Yes	Yes	Yes	Yes	Yes
Patient Privacy?	Limited	Each family unit had private room	Did not	.	.
Active Finance Section?	Yes	No	No	Yes	Yes
Volunteer %?	.	.	25	Not sure.	.
Charitable Donation %?	.	.	15	Not sure.	.
Institution/System %?	.	.	10	Not sure.	.
Private Corporation %?	.	.	.	Not sure.	.
Local Gov %?	.	.	.	Not sure.	.
State %?	.	.	25	Not sure.	.
Federal %?	100	.	25	Not sure.	.
Other %?	.	.	.	Not sure.	.
Other % Detail	.	.	.	Not sure.	.
Federal Invoice?	Yes	.	Yes	Yes	Yes
Federal Reimbursement?	Yes	.	Yes	No - uncertain	.
Reimbursement Secrets?	None	.	No	No	.
Worker Illness/Injury?	Yes	No	No	Yes - 1 needlestick injury	.
Workers' Comp Issues?	Yes	No	No	No	.
Workers' Comp Detail	Handled by parent hospital	.	.	.	.
Other Finance Issues?	.	.	Buy on credit, keep receipts, if it is reasonable, it will eventually be reimbursed	Health Department was not reimbursed at the State or local level. Most work was voluntary. [Name] State Guard was paid a daily stipend.	.
General Comments	.	Any plan that developed needs to be flexible. A cook book approach would not work well in a disaster situation. VA being a national system has enough resources to sustain a shelter for a "period" of time (no more than 3 months).	Have good leadership. Tap into churches for volunteers. Help others and they will accommodate/assist you.	Plan in advance of disaster. We have subsequently identified a university campus with a nursing school to be a ACF for 240 people. We have run [illegible] exercises & call down events to ensure that we can stand up the facility.	We have had to approach planning from a couple of different angles. Our most likely scenario would be a situation whereby the ACF is used for a short fused- short duration event. On the other hand, we are also approaching the issue with the thought in mind

Facility Selection Tool Questionnaire Results: Alternate Care Facility Factors

The table below summarizes the responses, by site, of the evaluation of the importance of the factors in the original RMBT site selection tool in the selection of an alternate care facility.

Factor	Site 1	Site 1'	Site 2	Site 3	Site 4	Site 5	Site7	Site 8	Site 9
Doors/corridors: ACF	3	.	2	3	3	2	3	3	3
Floors: ACF	3	.	3	3	3	3	3	3	3
Loading dock: ACF	3	.	1	3	3	1	3	2	2
Parking: ACF	3	.	2	1	3	2	3	1	2
Roof: ACF	3	.	3	3	3	3	3	3	3
Toilet/showers: ACF	3	.	3	3	3	3	2	3	3
Ventilation: ACF	3	.	3	3	3	3	3	3	3
Walls: ACF	1	.	3	3	3	3	3	3	3
Infrastructure Other: ACF	.	.	.	Helipad and/or landing area	.	Air conditioning	.	.	.
Infrastructure Other: ACF Rating	.	.	.	2	.	3	.	.	.
Infrastructure Other2: ACF	.	.	.	Ramps vs. stairs	.	HEPA filtration for OR	.	.	.
Infrastructure Other2: ACF Rating	.	.	.	3	.	3	.	.	.
Auxiliary space: ACF	2	.	2	3	2	1	2	3	3
Equipment/supply: ACF	2	.	2	3	3	2	3	3	3
Family area: ACF	3	.	2	2	2	2	2	2	1
Food supply/prep: ACF	2	.	3	3	3	3	3	3	2
Lab area: ACF	3	.	3	3	1	3	2	2	1
Mortuary: ACF	2	.	3	2	1	3	2	3	0
Patient decontamination: ACF	3	.	2	3	0	3	2	3	3
Pharmacy: ACF	3	.	3	3	3	3	3	3	1
Staff area: ACF	2	.	3	3	3	2	2	2	2
Space/Layout Other: ACF	.	.	.	.	Comfort care	.	.	.	.
Space/Layout Other: ACF Rating	.	.	.	.	3	.	.	.	.
Air conditioning: ACF	3	.	3	3	3	3	3	2	3
Electrical power: ACF	3	.	3	3	3	3	3	3	3
Heating: ACF	3	.	3	3	3	3	2	3	3
Lighting: ACF	3	.	3	3	3	3	2	3	2
Refrigeration: ACF	3	.	3	3	1	2	2	3	1
Water (hot?): ACF	3	.	3	3	2	3	3	3	2
Utility Other: ACF	.	.	.	.	.	.	.	.	.
Utility Other: ACF Rating	.	.	.	.	.	.	.	.	.
Communication: ACF	2	.	3	3	3	3	2	3	2
Two-way radio: ACF	3	.	3	3	3	3	2	3	1
IT/Internet: ACF	3	.	3	3	2	2	0	2	2
Communications Other: ACF	.	.	.	.	.	.	.	.	.
Communications Other: ACF Rating	.	.	.	.	.	.	.	.	.
Lockdown: ACF	3	.	3	3	2	3	3	3	3
Public transport: ACF	3	.	2	2	3	3	1	2	1
Biohazard/waste: ACF	3	.	3	3	3	3	3	3	1
Laundry: ACF	3	.	3	2	1	3	1	3	0
Ownership: ACF	3	.	3	3	3	3	3	3	3
Oxygen: ACF	3	.	3	1	3	3	2	3	1
Hospital proximity: ACF	3	.	3	3	3	2	2	3	2
Misc Services Other1: ACF	.	.	.	.	.	.	On main thoroughfares	.	.
Misc Services Other1: ACF Rating	.	.	.	.	.	.	2	.	.
Misc Services Other2: ACF	.	.	.	.	.	.	Easily found	.	.

Facility Selection Tool Questionnaire Results: Shelter Factors

The table below summarizes the responses, by site, of the evaluation of the importance of the factors in the original RMBT site selection tool in the selection of a shelter site.

Factor	Site 1	Site 1'	Site 2	Site 3	Site 4	Site 5	Site 7	Site 8	Site 9
Doors/corridors: shelter	3	.	0	3	3	3	1	3	.
Floors: shelter	3	.	2	3	3	3	1	3	.
Loading dock: shelter	3	.	1	2	3	1	2	2	.
Parking: shelter	3	.	2	1	3	2	3	1	.
Roof: shelter	3	.	3	3	3	3	3	3	.
Toilet/showers: shelter	3	.	3	3	3	3	1	3	.
Ventilation: shelter	3	.	3	3	3	3	3	3	.
Walls: shelter	1	.	3	3	3	3	3	3	.
Infrastructure Other: Shelter	.	.	.	Helipad and/or landing area	Generators	Air conditioning	.	.	.
Infrastructure Other: Shelter Rating	.	.	.	1	3	3	.	.	.
Infrastructure Other2: Shelter	.	.	.	Ramps vs. stairs	Communication	HEPA filtration for OR	.	.	.
Infrastructure Other2: Shelter Rating	.	.	.	3	3	1	.	.	.
Auxiliary space: shelter	2	.	2	2	2 (hard to do because not all religions are the same - reference OK bombing)	2	2	1	.
Equipment/supply: shelter	2	.	2	2	3	2	3	2	.
Family area: shelter	3	.	1	2	2	2	2	2	.
Food supply/prep: shelter	2	.	0	3	3	3	3	2	.
Lab area: shelter	0	.	2	2	1	2	2	2	.
Mortuary: shelter	0	.	1	1	1	3	0	1	.
Patient decontamination: shelter	3	.	1	1	0	3	2	1	.
Pharmacy: shelter	0	.	3	2	3	3	2	1	.
Staff area: shelter	0	.	1	3	3	2	2	1	.
Space/Layout Other: Shelter	.	.	.	.	Comfort care	.	.	.	.
Space/Layout Other: Shelter Rating	.	.	.	.	3	.	.	.	.
Air conditioning: shelter	3	.	2	3	3	3	3	2	.
Electrical power: shelter	3	.	3	3	3	3	3	2	.
Heating: shelter	3	.	3	3	3	3	2	2	.
Lighting: shelter	3	.	3	3	3	3	2	2	.
Refrigeration: shelter	3	.	2	3	1	2	2	2	.
Water (hot?): shelter	3	.	3	3	2	3	3	2	.
Utility Other: shelter	.	.	.	.	.	.	.	.	.
Utility Other: Shelter Rating	.	.	.	.	.	.	.	.	.
Communication: shelter	1	.	3	3	3	3	2	2	.
Two-way radio: shelter	2	.	3	3	3	3	2	2	.
IT/Internet: shelter	1	.	3	3	2	3	0	2	.
Communications Other: shelter	.	.	.	.	.	.	.	.	.
Communications Other: Shelter Rating	.	.	.	.	.	.	.	.	.
Lockdown: shelter	3	.	0	3	2	3	3	3	.
Public transport: shelter	3	.	2	2	3	3	1	2	.
Biohazard/waste: shelter	3	.	3	3	3	3	3	2	.
Laundry: shelter	3	.	3	3	1	3	1	2	.
Ownership: shelter	3	.	3	3	3	2	3	2	.
Oxygen: shelter	3	.	1	1	3	3	1	1	.
Hospital proximity: shelter	3	.	1	2	3	2	1	2	.
Misc Services Other1: shelter	.	.	.	.	.	.	On main thoroughfares	.	.
Misc Services Other1: Shelter Rating	.	.	.	.	.	.	2	.	.
Misc Services Other2: shelter	.	.	.	.	.	.	Easily found	.	.
Misc Services Other2: Shelter Rating	.	.	.	.	.	.	2	.	.

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Disaster Alternate Care Facilities: Report and Interactive Tools