1. Rural communities are unlikely to have a large enough shuttered hospital to serve as a surge facility (most closed rural hospitals are very small), and would not have the spare equipment, supply and personnel capacity to open such a facility within a week of a disaster.
2. These issues are discussed in Appendix D of this report.
3. Boston University. Boston Herald: SMG prof offers solutions to hospital ER crunches. Bridge, January 18, 2002. Accessed at http://www.bu.edu/bridge/archive/2002/01-18/in-the-news.html
4. Nursing Home Licensed Beds and Occupancy. Managed Care Digest. Accessed at http://www.managedcaredigest.com/edigests/is2001/is2001c03s01g02.shtml
5. (Rubin J, Recurring Pitfalls in Hospital Preparedness and Response, Journal of Homeland Security, Jan 2004).
6. National Defense Industrial Association. Hospital and Healthcare Healthcare Systems, June 3, 2003. Accessed at http://www.dtic.mil/ndia/2003terrorism/barb.pdf.
7. Massachusetts Department of Public Health. Saturation/Gridlock Response Plan, December 2002. Accessed at http://www.mass.gov/dph/dhcq/pdfs/final_response_plan_12_13_02.pdf.
8. Massachusetts Department of Public Health. Surge Capacity Workgroup, September 19, 2003. Accessed at http://www.state.ma.us/dph/bioterrorism/advisorygrps/surge_minutes_9_03.htm.
9. Testimony of Stuart H. Altman, Ph.D. FTC/DOJ Hearings on Health Care and Competition Law and Policy. Accessed at http://www.ftc.gov/ogc/healthcarehearings/docs/altmanstuart2.pdf.
10. District of Columbia Hospital Association. Data and Publications. Accessed at http://www.dcha.org/Data%20and%20Pub.htm.
11. District of Columbia Department of Health, Press Release. "DOH and its Partners Announce the Opening of a New Urgent Care Center at DC General Health Campus." Accessed at http://app.doh.dc.gov/news_room_dsf/release.asp?id=146&mon=200304.
12. In addition to this list, two Veterans Health Administration (VHA) inpatient acute care hospitals in the Boston area have been converted to other purposes during the past decade. We discussed the appropriateness of these facilities with Bill Burney, a Boston area VHA official. He advised that neither facility would be appropriate for our purposes. One continues to do outpatient surgery in a small surgi-center but the rest of the space has been converted to offices and would be no more appropriate than any other office building. The other facility is now a long-term care facility; those patients have nowhere else to go so the facility does not meet our criteria. A third VHA facility in Boston continues to operate as an acute care hospital; it is old and rapidly becoming obsolete, but it is in full use. We thus do not have an appropriate former VHA hospital to use for study purposes, although such might exist in other communities.
13. The hospitals will not be named in this report due to political considerations affecting the future of these facilities.
14. A surge facility cannot safely offer operating rooms or intensive care. Patients with advanced or intensive medical procedures and needs would remain at (or be returned to) the tertiary medical centers, while patients with lesser needs would be moved to the surge facility.
15. Telephone Discussion, February 2005, Sales Director Aramark.
16. Williams, Scott. Houston staffs slosh, dive into evac mode. NurseWeek, June 25, 2001. Accessed at http://www.nurseweek.com/news/features/01-06/flood.html
17. Powell, Andy. Contracting out Hospital Services, May 16th. Leicester Royal Infirmary.
18. We noted, however, that both former hospitals in Massachusetts had large "dead zones" where handheld wireless devices could not be used.
19. Cisco Systems, Inc. Wireless Systems and RF Safety Issues. Accessed at http://www.cisco.com/en/US/products/hw/wireless/ps430/products_white_paper09186a0080088791.shtml
20. The augmented supplies and equipment list for Scenario 2 will be similar to that used in a traditional ICU.
21. One facility had a single well-equipped patient room among dozens of completely empty rooms. We learned that equipped room was used for filming both advertisements and training videos for a local HMO.
22. Andrew Madden, personal communication, 10/01/04.
23. Burns, LR, and Wharton School Colleagues. The Health Care Value Chain: Producers, Purchasers, and Providers. Jossey-Bass: 2002.
24. IDEM, Burns, LR.
25. Owens and Minor. "O+M Disaster Contingency Plan for Partners Healthcare." December 5, 2001.
26. Andrew Madden. Materials Management Department, Brigham and Women's Hospital, Boston, Massachusetts. Personal communication. December 2004.
27. Andrew Madden. Materials Management Department, Brigham and Women's Hospital, Boston, Massachusetts. Personal communication. December 2004.
28. Brigham and Women's Hospital personnel indicated that they would be able to provide up to 25% of their existing inventory of critical equipment and supplies to the surge facility while the facility was awaiting a shipment, even during a mass casualty event in which BWH was operating beyond 100% capacity.
29. Note: some or all of the legal requirements could potentially be waived by State health officials. These issues are explored in Appendix D, which covers legal and regulatory issues for opening a shuttered hospital for use as a surge facility.
30. Karen Purdy-Reilly. Food Services Department, Brigham and Women's Hospital, Boston, Massachusetts Personal communication. January 21, 2005.
31. The frequency of deliveries is due to the lack of storage space at the hospital facility, an issue that would most likely be found at the surge facility as well.
32. 42 CFR §482.22-482.28
33. 42 CRF §483.30
34. 42 CFR §483.35
35. Ibid.
36. Ibid.
37. 42 CFR §483.15(g)
38. Title 105 in Code of Massachusetts Regulations (CMR) chapter 130.310
39. 105 CMR 130.311
40. 105 CMR 130.312
41. 105 CMR 150.007
42. San Mateo County Emergency Medical Services Agency. The Hospital Emergency Incident Command System. Third Edition, June 1998.
43. San Mateo County Emergency Medical Services Agency. Hospital Emergency Incident Command System Update Project. Accessed at http://www.emsa.ca.gov/Dms2/HISTORY.HTM
44. U.S. Department of Defense, 2001. A Mass Casualty Care Strategy for Biological Terrorism Incidents—Neighborhood Emergency Help Center, Prepared in response to the Nunn-Lugar-Domenici Domestic Preparedness Program, May 1, 2001.
45. U.S. Department of Defense, 2001. A Mass Casualty Care Strategy for Biological Terrorism Incidents—Acute Care Center, Prepared in response to the Nunn-Lugar-Domenici Domestic Preparedness Program, December 1, 2001.
46. Estimate based on 5 nursing subunits or 250 beds to allow comparison with model surge facility.
47. Massachusetts Comprehensive Emergency Management Plan, September 2004.
48. Department of Health and Human Services, PHS Personnel Instruction, PHS-CC 644, Chapter CC23.5, Section E, p.4-5. 10/7/99.
49. Federal Emergency Management Agency (FEMA), Urban Search and Rescue (US&R). Accessed at http://www.fema.gov/emergency/usr/index.shtm
50. There is one team from Arizona; eight from California; one from Colorado; two from Florida; two from Virginia, and one each from Indiana, Maryland, Massachusetts, Missouri, Nebraska, Nevada, New Mexico, New York, Ohio, Pennsylvania, Tennessee, Texas, Utah, and Washington State.
51. Corporation for National and Community Service, FY 2004 Performance and Accountability Report, Washington, DC. 2004.
52. Nursing programs are available at Boston College, Northeastern University, Bunker Hill Community College, Emmanuel College, Massachusetts College of Pharmacy and Health Sciences, Simmons College.
53. U.S. Department of Labor, Bureau of Labor Statistics. Occupational Outlook Handbook. 2004-2005. Accessed at http://www.bls.gov/oco/home.htm
54. Ibid.
55. Ibid.
56. U.S. Department of Labor, Bureau of Labor Statistics. Occupational Outlook Handbook. 2004-2005. Accessed at http://www.bls.gov/oco/home.htm
57. Go to Appendix D on Legal and Regulatory Issues.
58. Galt, KA. 2004. Credentialing and Privileging for Pharmacists. American Journal Health-Systems Pharmacists. 61(7): 661-70.
59. Ibid.
60. Ibid.
61. Ibid.
62. Ibid.
63. Hamilton, TE. 2004. Memo to State Survey Agency Directors, Centers for Medicare & Medicaid Services. Ref: S&C-05-04, November 12, 2004.
64. The AMA Physician Masterfile includes current and historical data on all physicians, including AMA members and nonmembers, and graduates of foreign medical schools who reside in the United States and who have met the educational and credentialing requirements necessary for recognition as physicians. The data base includes students in 125 Liaison Committee on Medical Education (LCME)-accredited medical schools, 7,900 Accreditation Council on Graduate Medical Education (ACGME)-accredited graduate medical educational programs; 1,600 teaching institutions, 820,000 physicians, and 19,000 medical group practices.
65. Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Idaho, Indiana, Iowa, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Texas, Utah Vermont, Virginia, and Wisconsin.
66. VA clinicians and those from the Public Health Service might not need state-specific licensure during emergency response.
67. National Council of State Boards of Nursing, Inc. Nurse Licensure Compact Implementation. Accessed at http://www.ncsbn.org/nlc/rnlpvncompact_mutual_recognition_state.asp
68. Policy Statements—Hospital Disaster Privileging, 2003. Annals of Emergency Medicine 42:4. October 2003.
69. Carter-Yamauchi, CA. 1996. Volunteerism—A Risky Business? Report #1, Legislative Reference Bureau, State Capitol, Honolulu, Hawaii. Available at http://www.hawaii.gov/lrb/rpts96/vol/voldoc.html
70. Mass General Laws Ann. Chapter 111C, Section 14 Liability of emergency medical technicians, police officers or firefighters.
71. Mass General Laws, Chapter 112: Section 12B Emergency care of injured persons; exemption from civil liability.
72. Mass General Laws, Chapter 112: Section 12C Immunity of physician or nurse.
73. Beavers, JP. 2000. The Federal Volunteer Protection Act of 1997. Bricker & Eckler LLP Attorneys at Law. Available at www.bricker.com/publications/articles/148.asp.
74. These issues are discussed in an appendix to this report.