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Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity

Published online by Cambridge University Press:  08 April 2013

Abstract

Health care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed. The use of refined definitions of surge capacity as it relates to space, staffing, and supply concerns during a mass casualty incident may aid phased implementation of surge capacity plans at health care facilities and enhance the consistency of terminology and data collection between facilities and regions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S59–S67)

Type
Concepts in Disaster Medicine
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2009

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References

REFERENCES

1.US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. The Hospital Preparedness Program (HPP). http://www.hhs.gov/aspr/opeo/hpp. Accessed October 21, 2008.Google Scholar
2.Kaji, A, Koenig, KL, Bey, T.Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13:11571159.CrossRefGoogle ScholarPubMed
3.Barbisch, D, Koenig, KL.Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13:10981102.Google Scholar
4.Bonnett, CJ, Peery, BN, Cantrill, SV, et alSurge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25:297306.CrossRefGoogle ScholarPubMed
5.Hick, JL, Hanfling, D, Burstein, JL, et alHealthcare facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44:253261.Google Scholar
6.Hanfling, D.Equipment, supplies, and pharmaceuticals: how much might it cost to achieve basic surge capacity? Acad Emerg Med. 2006;13:12321237.Google Scholar
7.Barbera J, McIntyre A. Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. CNA Corporation Web site. August 2004. http://www.cna.org/documents/mscc_aug2004.pdf Accessed February 28, 2009.Google Scholar
8.Kelen, GD, McCarthy, ML.The science of surge. Acad Emerg Med. 2006;13:10891094.Google Scholar
9.California Department of Public Health Emergency Response Office. Standards and Guidelines for Healthcare Surge During Emergencies. Volume I: Hospitals. 2008. http://bepreparedcalifornia.ca.gov/NR/rdonlyres/0DB13C5F-89DC-4B94-850B-EF12EA221FF3/0/volume1_hospital_FINAL.pdf. Accessed October 21, 2008.Google Scholar
10.Hick, JL, Koenig, KL, Barbisch, D, et alSurge capacity concepts for health care facilities: the CO-S-TR model for initial incident assessment. Disaster Med Public Health Preparedness. 2008;2 (Suppl 1):S51S57.Google Scholar
11.Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive Events: Questionnaire for Health Care Facilities. Agency for Healthcare Research and Quality, Rockville, MD. April 2007. http://www.ahrq.gov/prep/cbrne. Accessed October 21, 2008.Google Scholar
12.Schultz, CH, Koenig, KL.State of research in high-consequence hospital surge capacity. Acad Emerg Med. 2006;13:11531156.Google Scholar
13.Davidson, SJ, Koenig, KL, Cone, DC.Daily patient flow is not surge: “management is prediction.” Acad Emerg Med. 2006;13:10951096.Google ScholarPubMed
14.McCarthy, ML, Aronsky, D, Kelen, GD.The measurement of daily surge and its relevance to disaster preparedness. Acad Emerg Med. 2006;13:11381141.Google Scholar
15.Hick, JL, Chipman, J, Loppnow, F, et alHospital response to a major freeway bridge collapse. Disaster Med Public Health Preparedness. 2008;2 (Suppl 1):S11S16.CrossRefGoogle Scholar
16.Barbera J, Macintyre A. Medical and Health Incident Management System: A Comprehensive Functional System Description for Mass Casualty Medical and Health Incident Management. George Washington University Institute for Crisis, Disaster, and Risk Management. December 2002. http://www.gwu.edu/icdrm/publications/MaHIM%20V2%20final%20report%20sec%202.pdf. Accessed March 1, 2009.Google Scholar
17.Hospital Incident Command System. HICS IV. California Emergency Medical Services Authority Web site. August 2006. http://www.emsa.ca.gov/hics/hics.asp. Accessed April 20, 2007.Google Scholar
18.National Incident Management System. Federal Emergency Management Agency-Department of Homeland Security. http://www.fema.gov/emergency/nims/index.shtm. Accessed April 20, 2007.Google Scholar
19.Emergency Management Principles and Practices for Healthcare Systems. The Institute for Crisis, Disaster, and Risk Management (ICDRM) at the George Washington University (GWU); for the Veterans Health Administration (VHA)/US Department of Veterans Affairs (VA). Washington, DC. June 2006. http://www1.va.gov/emshg/page.cfm?pg=122. Accessed October 20, 2008.Google Scholar
20.JrBurkle, FM, Hsu, EB, Loehr, M, et alDefinition and functions of health unified command and emergency operations centers for large-scale bioevent disasters within the existing ICS. Disaster Med Public Health Preparedness. 2007;1:135141.Google Scholar
21.Rubinson, L, Hick, JL, Hanfling, DG, for the Task Force for Mass Critical Care. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26–27, 2007, Chicago, IL. Chest. 2008;133 (Suppl 5):18S31S.Google Scholar
22.Joint Commission EC Note Revision—Revision to Standard EC. 4.12, Element of Performance 6 Note Text. Joint Commission, Oak Brook, IL. 2008. http://www.jcrinc.com/fpdf/pubs/pdfs/JCReqs/JCP-01-08-S5.pdf. Accessed October 21, 2008.Google Scholar
23.Davis, DP, Poste, JC, Hicks, T, et alHospital bed surge capacity in the event of a mass-casualty incident. Prehosp Disaster Med. 2005;20:169176.Google Scholar
24.Kelen, GD, Kraus, CK, McCarthy, ML, et alInpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368:19841990.Google Scholar
25.Church J. Acute Care Center: A Mass Casualty Care Strategy for Biologic Terrorism Incidents. US Army Soldier Biological and Chemical Command. Aberdeen Proving Grounds, MD. December 2001. http://www.nnemmrs.org/resources/surge_capacity_guidance/documents/acute_care_center.pdf. Accessed March 31, 2009.Google Scholar
26.Joint Commission on Accreditation of Healthcare Facilities. Surge Hospitals: Providing Safe Care in Emergencies. 2006. http://www.jointcommission.org/PublicPolicy/surge_hospitals.htm. Accessed October 22, 2008.Google Scholar
27.Rocky Mountain Regional Care Model for Bioterrorist Events: Locate Alternate Care Sites During an Emergency. Agency for Healthcare Research and Quality Web site. December 2004. http://www.ahrq.gov/research/altsites.htm. Accessed October 22, 2008.Google Scholar
28.Hick, JL, O’Laughlin, DT.Concept of operations for triage of mechanical ventilation in an epidemic. Acad Emerg Med. 2006;13:223229.Google Scholar
29.O’Laughlin, D, Hick, JL.Ethical issues in resource triage. Respir Care. 2008;53:190197.Google ScholarPubMed
30.Phillips SJ, Knebel A, eds. Providing Mass Medical Care With Scarce Resources: A Community Planning Guide. AHRQ Publication No. 07-0001. 2006. http://www.ahrq.gov/research/mce. Accessed October 22, 2008.Google Scholar
31.Rubinson, L, Nuzzo, JB, Talmor, DS, et alAugmentation of hospital critical care capacity after bioterrorist attacks or epidemics: recommendations of the Working Group on Emergency Mass Critical Care. Crit Care Med. 2005;33:23932403.Google Scholar
32.Milsten, A.Hospital responses to acute-onset disasters: a review. Prehosp Disaster Med. 2000;15:3245.Google Scholar
33.Auf Der Heide, E.The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:3449.Google Scholar
34.Qureshi, K, Gershon, RR, Sherman, MF, et alHealth care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82:378388.Google Scholar
35.US Department of Health and Human Services. Medical Reserve Corps. http://www.medicalreservecorps.gov. Accessed October 22, 2008.Google Scholar
36.Department of Health and Human Services. National Disaster Medical System. http://www.hhs.gov/aspr/opeo/ndms/index.html. Accessed October 22, 2008.Google Scholar
37.Schultz, CH, Stratton, SJ.Improving hospital surge capacity: a new concept for emergency credentialing of volunteers. Ann Emerg Med. 2007;49:602609.Google Scholar
38.Dacey, MJ.Tragedy and response—the Rhode Island nightclub disaster. New Engl J Med. 2003;349:19901991.CrossRefGoogle Scholar
39.Devereaux, AV, Dichter, JR, Christian, MD, et alDefinitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26–27, 2007, Chicago, IL. Chest. 2008;133 (Suppl 5):51S66S.CrossRefGoogle ScholarPubMed
40.Hick, JL, Rubinson, L, O’Laughlin, DT, et alClinical review: allocating ventilators during large-scale disasters—problems, planning, and process. Crit Care. 2007;11:217.Google Scholar