Equipment and Supplies

1. Preplanning

Description: The equipment and supplies team must lay the groundwork for procurement prior to a surge event. Key decisions include: determining whether to outsource staffing and procurement of the equipment and supplies, deciding which critical items to pre-order and which to create a standby purchase order for, deciding which items to lease and which to buy, and detailing the procurement process (i.e., how much inventory should be held, how often items should be restocked).

Timeframe: As soon as a decision is made to pursue the use of area shuttered hospitals for surge capacity and a facility has been selected.

Action Checklist

• Identify all hospital staff members, and any state, local and federal public health officials from the following areas who are interested in participating in the surge capacity planning process. Preference should be given to those with knowledge about operating under emergency conditions.
  • Environmental Engineering (i.e., cleaning and disinfecting, environmental regulations).
  • Disposable equipment and supplies.
  • Biomedical equipment and supplies.
  • Pharmacy services.
  • Dietary services.
• Refine equipment and supply procurement process in surge situation for all areas.
  • Determine whether equipment will be bought new or used or leased.
  • Determine financing of equipment acquisition.
• Determine outsourcing needs and identify partnering companies. Decisions made on the following needs in all equipment and supply areas:
  • Staffing.
  • Information technology and inventory management.
  • Equipment and supply procurement.
  • On-site management.
• Team members develop and refine disaster contingency plans ensuring all contracts with vendors are created and remain up to date.
• Team members prepare training materials for staff members if surge staffing needs are not outsourced.
• Team determines licensing and certification issues with opening surge facility and identify relevant government contacts and time needed for certification.
• Team arranges for contracted vendors to tour shuttered facility.
• Each team member to conduct a status check with all vendors or other providers for every advance contract or formal arrangement under their area of focus.
• Non-vendor partner organizations are contacted for a status check.
• Team meets annually to review the overall surge facility plans and scenarios and determine whether plans or contracts need updating.
• Team members are replaced as needed if a member changes jobs, is unable to fulfill duties, etc.

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2. Ramp-Up

Description: Once the catastrophic event occurs, facility opening efforts will be underway through the efforts of individual management team members overseeing their area of focus (staffing, security, supplies, etc.). Key activities include: mobilizing staff, maintaining communication with vendors, and troubleshooting.

Timeframe: As soon as the catastrophic event occurs, through implementation of planned arrangements to opening the facility, and the facility opening day.

Action Checklist

• Team identifies and mobilizes staff for each equipment and supplies category.
• Team leader ensures that delivery of equipment and supplies is running smoothly and team contacts vendors if necessary.
• Team leader acts as liaison between vendors and entity leading the surge facility operation.
• Team leader checks in with each team member to ensure that facility opening activities are underway.
• Team leader assists with problem troubleshooting or procuring additional assistance/resources as needed.
• The complete team meets on-site at the beginning of opening day.

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3. Ongoing Operations

Description: Once needed staffing, equipment, and supplies are in place, and the facility has accepted patients, efforts will be needed to maintain fully operational status. Individual management team members will continue overseeing their area of focus. Key activities should focus on ensuring that deliveries are made in a timely manner, and that equipment and supplies are in working order.

Timeframe: The operations activities listed below will occur between opening day and until the facility is closed.

Action Checklist

• Team leader conducts periodic checks with each team member to ensure continuation of effective facility operations.
• Management team leader assists with problem troubleshooting or procuring additional assistance or resources as needed. Particular attention should be paid to the following areas:
  • Inventory management (ensuring deliveries are being made with appropriate frequency and that equipment and supplies are stocked in a timely manner on patient wards).
  • Quality control (ensuring that equipment is functioning properly).
  • Staffing (ensuring that adequate numbers and type of staff are present).

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4. Closure

Description: Shutdown of the surge facility will require removal of equipment and termination of on-going contracts or arrangements. Key decisions include: disposal or return of leftover equipment and supplies and ensuring that equipment and supplies have been paid for.

Timeframe: Once all patients can be discharged or transported back to the major hospital for continued care, and no ongoing surge capacity is needed, the facility can be closed. The shutdown should be expedited so that the facility can be returned to the control of the existing owners quickly, and should be possible within a matter of days.

Action Checklist

• The team arranges for return, disposal, or absorption or supplies into the medical system or to vendors. Particular attention should be paid to environmental or pharmaceutical inventory, as special disposal requirements exist.
• The team leader arranges for final payments to vendors.
• An environmental services team member arranges for and oversees cleaning of facility.

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5. Review/Replanning

Description: In the unfortunate event that a terrorist incident or disaster occurs, and the facility must be opened for surge use, valuable lessons will be learned during operations as a surge facility. This important information should be captured so that surge facility readiness and operation plans can be improved in preparation for any future surge use.

Timeframe: Immediately following actual surge use of the facility.

Action Checklist

• Team leader conducts debriefs with team members to identify any problems or suggested improvements.
• Team reviews actual usage of equipment and supplies to identify needed vendor contract modifications.
• Team reviews performance of any outsourced services (food preparation, laundry, laboratory) for problems or suggested improvements, or to see if in-house capacity should be developed for future surge use.

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Patient Transport

1. Preplanning

Description: Patient transport services required for surge use of the shuttered hospital will necessitate the set-up of advance arrangements including identification of providers and contracts.

Timeframe: As soon as a potential surge facility or facilities have been selected based on the inspection of shuttered hospitals, these preparedness arrangements should be initiated. Once finalized, these arrangements should be reviewed every 6 months to ensure that readiness is maintained.

Action Checklist

Advance Contracts or Formal Arrangements Needed

• Ambulances: Advance contracts will need to be set up with private ambulance services. If the major hospital is assuming management of the surge facility, the hospital will already have existing contracts with private ambulance services. If another entity is assuming management of the surge facility, new contracts will need to be developed.
  • Determine whether private ambulance staff has been outfitted with appropriate respiratory protection for patient transport under the bioterrorism scenario.
  • Question the service about competing contractual obligations to ensure their availability when needed.
• Buses: In the unlikely event that the local transit authority is unwilling to provide buses, contracts with private bus companies must be set up.

Communication or Confirmation of Pre-existing Arrangements Needed:

• Buses: The local transit authority will likely have preexisting agreements to provide transportation under emergency/disaster conditions with the local emergency planning authority. Advance communications with the transit authority and the local emergency planning authority are needed to confirm these plans.
• Wheelchair vans: The local quasi-public wheelchair van services will likely have pre-existing agreements to provide transportation with the local emergency planning authority under emergency/disaster conditions. Advance communications with these wheelchair van services and the local emergency planning authority are needed to confirm these plans.

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2. Ramp-Up

Description: As necessitated by a catastrophic event, the surge facility must progress from the planning phase to an actual operating facility. The steps listed below must occur for this process to be successful.

Timeframe: As soon as the catastrophic event occurs, planned arrangements for the surge facility should be activated so that it can be opened as a functioning hospital within 7 days.

Action Checklist

• Notify all patient transportation service providers of the planned date(s) for patient transport, and the expected number of patient transports needed.
• Notify discharging hospitals of patient transport date(s), and coordinate patient discharge activities with this hospital.

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3. Opening Day and Ongoing Operations

Description: Once the surge facility is ready for operations, patients must be transported from the major hospitals to the surge facility. Most or all of the patients will be transported within the first few days, but continued patient transport to the facility might occur, and discharged patients may also require transport.

Action Checklist

Opening Day and First Days of Operation

• Portable medical records and instructions for each patient must be prepared at the discharging facility.
• The discharging facility must ensure that the necessary medications and equipment are available at the surge facility prior to transport.
• The discharging facility must determine the level of transport needed for each patient (bus, wheelchair van, basic life support, advanced life support, etc.).
• The security expert must assess whether security escorts are needed for patient transport vehicles.
• Vehicle drivers must be provided with maps and route information to the surge facility.
• Vehicle drivers must be apprised of communications protocols.
• Necessary medical staff must be at transport vehicles to assist in patient boarding, and must be on board during patient transport.
• Vehicle trips are conducted until transport of all patients is completed.

On-Going Facility Operations

• Limited additional patient transport may be needed on an ongoing basis. All patient transport will follow the steps outlined above.

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4. Closure

Description: Shutdown of the surge facility will require transport of patients requiring continued care back to major hospitals or to other facilities. Also, termination of on-going contracts or arrangements must occur.

Timeframe: When it has been determined that the surge facility is no longer needed, all patient transport out of the facility should occur as soon as possible so that the facility can be closed.

Action Checklist

Transport of Patients Requiring Continued Care:

• The portable medical records and instructions for each patient must be prepared at the surge facility prior to discharge.
• The surge facility medical staff must determine the level of transport needed for each patient.
• Necessary medical staff must be at transport vehicles to assist in patient boarding, and must be on board during patient transport.
• All patients must be transported.

Termination of Current Use of Contracts/Formal Agreements:

• Notify all transportation providers that their services in response to the current catastrophic event are no longer needed.

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