Public Health Practices

In 2009, the Chicago Fire Department (CFD) identified a need to simultaneously treat multiple stable fire and inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of any building, hospital, health care facility or treatment facility, due to fires or other hazards. The solution needed to be mobile, allowing responders to provide oxygen services during emergencies anywhere in the Chicago area.

The California Department of Public Health has outlined a process for dealing with the complex issues of clinical care surge capacity during a public health emergency. The tools could serve as an educational model for other states that are attempting to address this challenging topic.

An online educational tool from the University of Minnesota Preparedness and Emergency Response Learning Center provides comprehensive just-in-time training for volunteers working at an alternate care site during a major emergency.

The Surge Capacity Guidelines and Templates provide a broad and interconnected approach to managing patient overload in hospitals, medical clinics, and alternate care sites. The overall structure of each document is similar, yet each focuses on specific areas that are germane to each response strategy.

The Santa Clara Clinical Triage Guidelines include a protocol and a flow chart that use a modified pneumonia severity index to triage influenza patients. Patients are stratified by objective criteria (e.g., blood pressure, oximetry, age) to hospital admission, Influenza Care Center admission, palliative home care, or recovery at home.

A variety of educational materials introduce the benefits of lateral thinking/six hats techniques and apply this approach to collaborative planning for multi-agency pandemic influenza projects. The materials were developed by the Tarrant County, Texas, Advanced Practice Sessions, with funding from NACCHO and the CDC.

A concept of operations for setting up alternate care sites details the plan for establishing Influenza Special Care Units (ISCUs) in Massachusetts. The documents indicate that hospitals should collaborate and develop one ISCU for a cluster of hospitals in every region. These documents constitute an option for a local public health agency, a state health department or even private sector health services, because they provide a concept of operations for developing alternate care statewide.

Fraser Health's toolkit outlines key parameters for establishing alternate triage and care centers by providing guidance for selecting a site, organizing personnel, conducting triage and process flow, and discharging patients. The materials are still in draft form, and any triage or care site would need to modify the materials to fit its individual needs.