Hospital Surge Capacity Toolkit - Public Health Department (DEP)

Hospital Surge Capacity Toolkit image

This toolkit is intended to assist healthcare facilities in thinking through critical issues related to healthcare surge and to create comprehensive plans to address these needs including:

Providing medical surge capacity
Patient tracking within the hospital and during patient forwarding activities
Requesting resources
Establishing alternate care sites

How to Use Toolkit

The Hospital Surge Capacity Toolkit is designed to give you easy access to all the documents you will need to create your local plan. Each document is available in its original format (Microsoft Word or Excel) as well as a PDF document.

Click on a chapter link below to view or download the narratives/tools. If you do not have Microsoft Office or PowerPoint on your computer, you will only be able to view documents as a PDF file using Adobe Acrobat Reader. If you do not have the Adobe Acrobat Reader on your computer, you can download it here. The Acrobat Reader will allow you to view and print the documents but you cannot edit or customize them.

Customizing the Documents

The documents on the Hospital Surge Capacity Toolkit can be edited or customized to suit your specific requirements. To edit/customize a document, save it to your computer and open it with Microsoft Word or Powerpoint (you must have Microsoft Word and/or PowerPoint already installed on your computer). These documents can be opened and edited using either PC or Mac versions of the Microsoft software.

Many of the documents have fields where information can be inserted or spaces where information specific to your needs can be added. Most of the documents also have a bar graphic at the top of the page referencing the APC (Advanced Practice Center). This graphic can be removed if necessary by going to the "View" menu in Microsoft Word and highlighting "Header and Footer". Once the "Header and Footer" view is accessed, you can select the graphic and delete it.

The Hospital Surge Capacity Toolkit is arranged in chapters that can become your local plan.

Preface

Table of Contents
Acknowledgments
Introduction
Acronym Guide

Chapter 1 - General Surge Capacity Plan Overview

Planning Assumptions
Communication Systems Fill-in Form
Communication Systems Attachment A Fill-in Form
Risk Communications Fill-in Form
Transportation Fill-in Form

Chapter 2- Patient Management

Patient Tracking Introduction
Patient Tracking Model
HICS 213 Incident Message Form Page 1
HICS 213 Incident Message Form Page 2 Fill-in Form
HICS 254 Disaster Victim/Patient Tracking Form Page 1
HICS 254 Disaster Victim/Patient Tracking Form Page 2 Fill-in Form
HICS 259 Hospital Casualty/Fatality Report Page 1
HICS 259 Hospital Casualty/Fatality Report Page 2 Fill-in Form
Triage Tag & Instructions
Rapid Discharge Plan Introduction
Rapid Discharge Plan Model Fill-in Form
Emergency Response Rapid Discharge Orders Fill-in Form
Emergency Response Rapid Discharge Prescription Order Fill-in Form
Patient Transfer Introduction
Facility Transfer Summary Fill-in Form
Facility Transfer Short Form Medical Record Fill-in Form
Mass Fatality Considerations
Standard Of Care Fill-in Form
Surge Plan Phases 1-5 Fill-in Form

Chapter 3 - Alternate Care Sites

Alternate Care Sites (ACS) Introduction
ACS Facility Assessment Checklist
ACS Facility Assessment Checklist Fill-in Form
ACS Master List Fill-in Form
ACS Expanded Treatment Area Medical Equipment Inventory Fill-in Form
ACS Staffing Fill-in Form
Expanded Treatment Areas (ETA) Introduction
ETA Space Assessment Checklist Fill-in Form
ETA Properties Operated by Hospital Fill-in Form

Chapter 4 - Personnel

Staffing Strategy During Surge
Altered Care Nurse Staffing Ratio Tables
Staff Shortage Plan Introduction
Staff Shortage Plan Model
Pandemic Flu - Staff Contingency Plan Fill-in Form
Staff Support Plan Introduction
Staff Support Plan Model Fill-in Form
Potential Staffing Sources Fill-in Form
Dependent Care Plan Introduction
Dependent Care Plan Model Fill-in Form
Dependent Care Registration Fill-in Form
Pet Care Plan Introduction
Pet Care Plan Model Fill-in Form
Pet Information Fill-in Form

Chapter 5 - Supplies, Equipment, Pharmaceuticals

Facility Resource Assessment (Tool) Fill-in Form
Hospital Mutual Aid System (H-MAS) Memorandum of Understanding (MOU) Introduction Fill-in Form
H-MAS MOU Model Fill-in Form
H-MAS MOU Quick Reference Guide Fill-in Form
MOU Hospital Status Report Fill-in Form
MOU Resource Request Fill-in Form
MOU Resource Accounting Record - Supplies Received Fill-in Form
MOU Resource Accounting Record - Supplies Donated Fill-in Form
Vendor Considerations Checklist

Chapter 6 - Security

Security

Chapter 7 - Actions by Scenario

Overview
Earthquake
Nuclear Incident
Pandemic Influenza

Chapter 8 - Critical Action Sheets

Overview
Mass Casualty
Hospital Evacuation

Appendix

Jurisdiction Reference Material Fill-in Form
Florida Department of Public Health Best Practice
Stanford Hospital and Clinics Model

Contact

To order your own CD-ROM with the same documents, contact:
Advanced Practice Center Coordinator
Public Health Preparedness
Santa Clara County Public Health Department
976 Lenzen Avenue
San Jose, CA 95126
T (408) 792-5040
F (408) 792-5041
or email your request to apc@hhs.sccgov.org