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No Vacancy: Healthcare Surge Capacity in Disasters. John L. Hick, MD MDH/HCMC July 22, 2004. Capacity vs. Capability. Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’

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No Vacancy: Healthcare Surge Capacity in Disasters

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no vacancy healthcare surge capacity in disasters

No Vacancy: Healthcare Surge Capacity in Disasters

John L. Hick, MD


July 22, 2004

capacity vs capability
Capacity vs. Capability
  • Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’
  • Surge Capability – ‘the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions’
          • Barbera and Macintyre
different types of surge
Different types of ‘surge’
  • Unexpected vs. expected
  • Timeline and potential for secondary cases (anthrax vs. plague)
  • Static vs. dynamic
  • Triage / field treatment
  • Healthcare facility-based
  • Community-based
concepts and principles
Concepts and Principles
  • Standardization
    • Incident Management System
    • Multiagency Coordination System
    • Public Information Systems
    • Interoperability (eg: personnel and resource typing)
  • Scalability
  • Flexibility
  • Tiers of capacity (spillover to next level)

Tiers of Response – Patient Care

Federal Response

(Regional & National)

6th Tier

Federal Response

5th Tier

State / Interstate Coordination (MDH)

State A

State B

4th Tier

Coordination of Intrastate Regions (MDH)

Jurisdiction I

(PH/EM/Public Safety)

Jurisdiction II

(PH/EM/Public Safety)

3rd Tier

Jurisdiction Incident Management (County)

Medical Support

2nd Tier

Healthcare “Coalition” (Compact)




Non-HCF Providers

1st Tier

Healthcare Facility

hrsa grant






minnesota hospital resources
Minnesota Hospital Resources
  • 140 acute care hospitals
    • State total 16,414 licensed beds
    • Less than 50% of these operating
  • Loss of 36 hospitals, 3000 beds in past 20 yrs
  • Nearly half of MN hospitals are either ‘critical access’ or considering such designation
  • Staff shortages, particularly nursing staff
metropolitan hospital compact
Metropolitan Hospital Compact
  • Since April 9, 2002
  • 27 hospitals, approximately 4800 operating beds
  • 7 counties
  • Agreement provides for:
    • Staff and supply sharing
    • Staffing off-site facilities for first 48h
    • Communications, JPIC
    • Regional Hospital Resource Center (HCMC)
regional coordination
Regional Coordination
  • Regional Hospital Resource Center (RHRC)
    • Acts as ‘broker’ for patient transfers
    • Coordinates hospital response and requests within region
    • Represents hospital needs and issues to RCC
  • Regional Coordination Center (RCC or MAC)
    • Multi-agency coordination center for policy and strategic guidance
    • NO jurisdictional authority
    • Functions and scope determined by incident
hospital response
Hospital Response
  • At least 50% arrive self-referred
  • On average, 67% of patients in any given disaster are cared for at the hospital nearest the event (range 41-97%)
  • Redistribution from the hospital closest to the incident scene to other facilities may be as (or more) important than transport from the scene
facility based surge
Facility-based Surge
  • Usually can free up 15% of beds at a given facility
  • Get ‘em up and get ‘em out (ED, clinics)
  • Discharges and transfers (eg: nursing home)
  • Board patients in halls
  • Cancel elective procedures
  • Convert procedure/PACU areas to patient care
  • Accommodate vents on floor (or BVM or austere O2 flow powered ventilators)
  • Supply and staffing issues (72h ahead)
per 1000 patients injured
Per 1000 patients injured
  • 250 dead at scene
  • 750 seek medical care
    • 188 admitted
    • 47 to ICU
  • ‘Rule of 85/15%’ has applied to all disasters thus far inc NYC 9-11
community based surge
Community-Based Surge
  • Clinics
  • Homecare
  • Nursing homes
  • Procedure centers
  • Family-based care
  • Off-site hospitals (Acute Care Center)
  • Off-site clinics (Neighborhood Emergency Help Centers) (assessment and clinic level care)
  • Local / Regional referral / NDMS
potential alternative care sites
Aircraft hangers

Military facilities


National Guard armories

Community/recreation centers

Surgical centers / medical clinics

Convalescent care facilities

Sports facilities / stadiums



Government buildings




Meeting halls

Potential Alternative Care Sites
factors to consider
Ability to lock down/Security


Lab/specimen handling



Loading Dock

Equipment storage

Oxygen delivery capability

Waste disposal


Communications capability

Patient decon

Door size

Pharmacy areas

Electrical power with backup

Proximity to hospital

Family areas


Food supply / prep area

Water supply

Wired for IT/Internet access

Factors to consider
off site hospital
Off-site hospital
  • Triage / admission criteria
  • Level of care – basic nursing, drip meds, IVs, NG feeds
  • Medications
  • Documentation / order management
  • Laboratory
  • Food / water / sanitary
  • Linen and medical waste handling
  • Oxygen?
personnel augmentation
Personnel Augmentation
  • Hospital personnel
  • Clinic personnel
  • Medical Reserve Corps
  • Non-clinical practice professionals
  • Retired professionals (eg: HC Medical Society)
  • Trainees in health professions
  • Ski patrol, civil air patrol, other service organizations
  • Lay public (CERT teams, etc)
  • Federal / interstate personnel
sample site19


Staff rehab areas


HVAC system specs

Paging /messaging /radio


Phone, T1 lines, etc.

City owned!

Sample Site
  • Off-site matrix:
  • MaHIM:
  • Model hospital planning:
  • Off-site facilities and community planning:
  • Annals of Emergency Medicine ‘articles in press’ (left side)