30 - Disaster Risk Management

Disaster risk management encompasses a holistic approach to all hazards throughout the disaster cycle of prevention, mitigation, preparedness, response, and recovery. Research during the COVID-19 pandemic highlighted numerous shortfalls globally in disaster preparedness and response within the health care setting. The results of multiple studies suggest that a lack of preparedness and high vulnerability remain significant challenges for health care organizations during disasters. Risk may also need to be reexamined in light of the increasing frequency, duration, and intensity of crisis events. Rather than focusing on an all-hazards approach to disaster risk management, it may be prudent to consider the top hazards an organization may face.

Reduction in Hospital Transfers at a US COVID-19 Alternate Care Site: Maintaining Surge Capacity Support in Imperial County, California.

OBJECTIVE: The transfer rate for patients from an Alternate Care Site (ACS) back to a hospital may serve as a metric of appropriate patient selection and the ability of an ACS to treat moderate to severely ill patients accepted from overwhelmed health-care systems. During the coronavirus infectious disease 2019 (COVID-19) pandemic, hospitals worldwide experienced acute surges of patients presenting with acute respiratory failure. METHODS: An ACS in Imperial County, California was re-established in November 2020 to help decompress 2 local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of 3 L/min (LPM) on admission. Numerous interventions were initiated during a 2-wk period to improve clinical care delivery. RESULTS: The objectives of this retrospective observational study are to evaluate the impact of these clinical and staff interventions at an ACS on the transfer rate and to provide issues to consider for future ACS sites managing COVID-19 patients. CONCLUSIONS: The data suggest that continuous, real-time process-improvement interventions helped reduce the transfer rate back to hospitals from 36.7% to 14.5% and that an ACS is a viable option for managing symptomatic COVID-19 positive patients requiring hospital-level care when hospitals are overburdened.

Utilization of Alternate Care Sites During the COVID-19 Surge and Mass Care: California, 2020-2021.

The coronavirus disease (COVID-19) pandemic caused critical hospital bed and staffing shortages in parts of California for most of 2020 and 2021. Alternate Care Sites (ACS) were established in several regions to alleviate the hospital patient surge and to maximize staffed bed capacity. Over 1900 patients were successfully provided medical care (with physician, nursing, respiratory therapy, oxygen, and pharmacy services) in relatively austere settings. This paper examines the challenges faced at these ACS facilities and how adaptations were incorporated according to the changing dynamics of the COVID-19 pandemic to successfully manage higher acuity patients. ACS facilities were 1 approach to California's surge of COVID-19 patients, despite limited medical supplies and staffing.

Treating an Epidemic During a Pandemic: Experience Treating Opioid Use Disorder at the Baltimore Convention Center Field Hospital.

During the COVID-19 pandemic, access to addiction treatment has plummeted. At the same time, patients with opioid use disorder are at higher risk of COVID-19 infection and experience worse outcomes. The Baltimore Convention Center Field Hospital (BCCFH), a state-run COVID-19 disaster hospital operated by Johns Hopkins Medicine and the University of Maryland Medical System, continues to operate 14 months into the pandemic to serve as an overflow unit for the state's hospitals. BCCFH staff observed the demand for opioid use disorder care and developed admission criteria, a pharmacy formulary, and case management procedures to meet this need. This article describes generalized lessons from the BCCFH experience treating substance use disorder during a pandemic.

Considerations for development of pharmacy support models for COVID-19 alternate care sites.

PURPOSE: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. SUMMARY: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. CONCLUSION: Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.

T-Minus 10 Days: The Role of an Academic Medical Institution in Field Hospital Planning.

Alternate care sites (ACS) are locations that can be converted to provide either in-patient and/or out-patient health care services when existing facilities are compromised by a hazard impact or the volume of patients exceeds available capacity and/or capabilities. In March through May of 2020, Michigan Medicine (MM), the affiliated health system of the University of Michigan, planned a 500 bed ACS at an off-site location. Termed the Michigan Medicine Field Hospital (MMFH), this ACS was intended to be a step-down care facility for low-acuity COVID-19 positive MM patients who could be transitioned from the hospital setting and safely cared for prior to discharge home, while also allowing increased bed capacity in the remaining MM hospitals for additional critical patient care. The planning was organized into six units: personnel and labor, security, clinical operations, logistics and supply, planning and training, and communications. The purpose of this report is to describe the development and planning of an ACS within the MM academic medical center (AMC) to discuss anticipated barriers to success and to suggest guidance for health systems in future planning.

Providing pharmacy services in a basketball arena: Reflections on building a pharmacy in a COVID-19 surge facility.

PURPOSE: As Coronavirus disease 19 (COVID-19) has spread globally, hospital systems have seen an increasing strain on their ability to accommodate the growing caseload. This demand has led countries to adopt varying surge-facility or alternate care site (ACS) models to manage patient overflow. This report describes the experience of setting up pharmacy services at a city-run surge facility in Philadelphia. SUMMARY: The COVID-19 Surge Facility at the Liacouras Center (CSF-L) was initially developed to serve as a site for patients convalescing from acute inpatient stays in order to free up healthcare resources in surrounding hospitals. The CSF-L site required a distinct set of services to provide the desired level of care. This report details the preparations and challenges faced by the CSF-L pharmacy team in this endeavor, including identifying a pharmacy location that met regulatory requirements, obtaining proper licenses, coordinating drug procurement, filling staffing requirements, developing a formulary, defining the pharmacy and medication management workflow, and ensuring safety protocols were followed. This report explains the rational for developing certain processes and suggests alternative options and ideal plans for developing future pharmacy services in an ACS. CONCLUSION: Identifying a pharmacy leadership team early in the ACS planning process can lead to more efficient plans for pharmacy services. This report details the important steps taken, decisions made, and challenges faced in setting up pharmaceutical services at a COVID-19 field hospital.

Dedicated area within the emergency department versus an outside dedicated area for evaluation and management of suspected coronavirus disease 2019.

BACKGROUND: The circumstances of the coronavirus disease 2019 pandemic necessitated an alternate operations strategy for efficient patient management. Alternate care sites were a viable option for managing emergency department (ED) surge in previous epidemics and disasters. OBJECTIVE: This study describes the development of an alternate care site and evaluates efficiency by comparing key performance indicators between an ad hoc nested respiratory evaluation unit (NRU) within the ED and an alternate care site outside the ED. METHODS: This was a cohort study of 2 care models in the same ED during 2 different time periods. As coronavirus disease 2019 surged in March 2020, potential treat-and-release patients with fever or respiratory symptoms were triaged to a dedicated ED area (NRU). As ED volume grew, these low-acuity patients were triaged to an ACS. We compared ED length of stay, elopement, and left without being evaluated rates and ED recidivism between the 2 care models: NRU patients presented to the ED from March 16, 2020, to March 31, 2020, and ACS patients presented from April 1, 2020, to April 15, 2020. Continuous variables were compared using independent t test or Mann-Whitney test. Categorical variables were compared using χ2 test. RESULTS: There were 414 NRU patients and 146 alternate care site patients with no significant differences in sex or age. The mean ED length of stay was shorter for alternate care site patients: 155 versus 45 minutes (P < 0.01). Elopement and left without being evaluated rates were higher in the NRU. There was no significant difference in ED recidivism between groups: 10% versus 6% (P = 0.15). CONCLUSIONS: An alternate care site provided an efficient resource for the evaluation of patients with fever or respiratory symptoms during the coronavirus disease 2019 pandemic.

Development of a COVID-19 alternate care site from ground zero: A nursing perspective.

The novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak rapidly generated an unprecedented global, national, and state public health crisis with the need to rapidly develop alternate care sites (ACS) to care for COVID-19 patients within an overburdened health care system. A hospital care model ACS to increase the health care capacity, provide care for mild to moderately symptomatic patients, and offer local self-sustainment for a surge of patients was developed in Memphis, Tennessee located in Shelby County. We completed a temporary conversion of a large unused newspaper publication building to a health care facility for COVID-19 patients. Developing an ACS from ground zero was met with many challenges, and throughout the process important lessons were learned. With the goal to complete the building conversion within a 28-day timeframe, collaboration among the numerous governmental, health care, and private agencies was critical and nursing leadership was key to this process. The purpose of this paper is to describe the development of a COVID-19 ACS in Memphis, TN, which has a large at-risk population with limited access to health care. Specifically, we will discuss the strong leadership role of nursing faculty, key challenges, and lessons learned, as well as provide checklists and models for others in similar circumstances.