A Staffing Matrix for Support of Alternate Care Sites

Monday, 9 November 2015

Jean M. Roberts, MSN, RN, PHN, CNL
California Children's Services, Kern County Public Health Services Department, Bakersfield, CA, USA


One approach proposed to fulfill the need for additional hospital beds during emergency and disaster situations has been establishment of alternate care sites.  An alternate care site(ACS) is defined by the State of California as a location typically not intended for provision of medical services that can be quickly converted to enable provision of care after a declared emergency.  CDPH specifies that the need for and authorization to open an ACS are designated by local government, usually as a function of emergency management or public health departments, and that an ACS is not an extension of an existing healthcare facility.  An ACS might include mobile field hospitals, schools, hospitals that were closed previously (“shuttered”), an arena, or any other building capable of housing multiple individuals and meeting basic requirements for health and safety. 

Kern County, California, with a population of about 856,000 and approximately 1,500 hospital beds, is at significant risk for inability to care for the medical needs of its residents in the face of a disaster or an emergency.  Recognizing the need for alternatives to manage hospital surge, the local public health department, the state, and federal officials collaborated with community partners to identify and contract with sites where emergency medical facilities can be established to help deliver medical care in a catastrophe. 

This project was developed to address this gap in disaster response involving staffing of alternate care sites.  A tool was developed based on Hospital Incident Command System (HICS) job positions selected to support medical staffing at an alternate care site.  These job descriptions were coupled with mandatory and recommended training to create a matrix intended to support staffing efforts should establishment of an alternate care site become necessary.  Most of the training is available online, with additional courses that may be offered by states, locally, or the federal government.  The matrix also can serve as guidance for training efforts directed toward staff or volunteers.  The matrix is completed with a sheet for recording of individual contact information and training completed.  This combination allows emergency planners to identify individuals with the training and experience required to fill critical positions in support of alternate care sites.  The matrix supports the training of healthcare providers, governmental entities, volunteer groups, and others who would be expected to participate in emergency activation. 

The project in establishing an ACS program follows a quality improvement approach modeled on the National Response Framework, the Homeland Security Exercise and Evaluation Program (HSEEP), and Plan-Do-Study-Act (PDSA) and is grounded in complexity theory.  Sustainability and maintenance of the developed program is based on ongoing feedback from additional and current ACS partners.  Details of the program components are included as part of an annex emergency plan document explaining the full life cycle of an ACS, updated regularly based on receipt of evidence-based innovations that have proven successful and are evaluated periodically for compatibility with other emergency plans.