Not Your Father’s M*A*S*H:Establishing Alternate Medical

Treatment Sites

K.C. Rondello, M.D., M.P.H.Adelphi University

June 6, 2012

A presentation prepared for the15th Annual Emergency Management Higher Education Conference

Defining Our Terms

Alternate Medical Treatment Site (AMTS) or Alternate Care Facility (ACF) ◦A non-medical facility temporarily

adapted to render medical care in a disaster

Point of Distribution/Dispensing (POD)◦A non-medical facility temporarily

adapted to administer vaccines or prophylactic medications in a disaster

Hurricane Ike AMTSSpecial Needs Shelter

(formerly Albertsons Supermarket)

Recent AMTS/POD Usage in the U.S.

Joplin Tornado (May 2011)Great Tennessee Flood (May 2010)Hurricanes Gustav, Hanna and Ike (September

2008)California Wildfires (October 2007)Hurricane Katrina (August 2005)Anthrax Attacks (October 2001)Terrorist Attacks (September 2001)

So… why do Emergency Managers in higher education need to know?

A University Campus as an AMTSMost universities have a mission to support

their communitiesCampuses are designed with space to

accommodate many peopleCampuses often also have large parking

areas, widespread utility availability and many support personnel

“If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. ... We need not wait to see what others do.” - Mahatma Ghandi

ConsiderationsLogistical IssuesClinical IssuesAdministrative Issues

Challenges and Pitfalls

Logistical Site Issues

SizeSecurity & SafetyUtility SupportLocationMedication and MaterielWaste Disposal and SanitationFatality Management

Size(it turns out it matters after all…)

Clinical AreasAdministrative AreasSupply Areas

◦Unsecured / SecuredNutrition/Hydration/Sleeping

AreasMental Health/Quiet AreasMedia Area

Pre-Disaster PreparationA Federal Medical Shelter

Security & SafetyStructural integrityProtection of stockpile and staff

◦Magnetometers?Fire SuppressionEmergency Exits/Evacuation

RoutesEffect on behaviorLarge numbers in confined space

Security Support

Utility SupportElectricityWater

◦Potable /Non-PotableSanitation

◦Handwashing/Disinfecting Gel◦Bathrooms/Latrines◦Infectious /Non-Infectious

Climate ControlCommunications

◦Redundancy!

Climate Control

Communications

Location, Location, Location!

FamiliarityPhysical AccessParkingRoutesModes

Medication and Medical Materiel

Disaster Stockpile (Federal, State, Local)

Strategic National StockpileLocal Hospitals and Pharmacies

Strategic National Stockpile

Waste Disposal and Sanitation

Infectious vs. Non InfectiousHuman ExcretaBathing FacilitiesLaundering Clothes and Linens

Laundry and Waste Disposal

Bathing Facilities

Fatality ManagementRemoved from clinical care areasRefrigeration for long term storageCDC/FBI involvement

Clinical Issues

Infection ControlPatient FlowRecordkeepingMental Health

Infection Control

Surfaces◦Nonabsorbent

Air Filtration◦HEPA standard

Anti-microbials◦For hands◦For surfaces

Power-free Hand Washing Station

Patient FlowFlow ControllersSignageUnidirectionalPatient Management

Bed Board

Record Keeping

Less robust than usual

Must be able to track them down!

Electronic vs. PaperEpidemiologic needs

Electronic Medical Record

Mental Health Monitoring

For staff and patientsAssigned personnelMonitoring system

Quiet Room

Administrative IssuesPersonnelPolicies for OperationsNutrition / Hydration /

Sleeping Accommodation

Personnel

Clinical◦MD, RN, EMT, NA, etc.

Non-Clinical◦Security, Reception/Records, Flow

Controllers, Logistics, PIO, Volunteer Coordinator, etc.

CredentialingMunicipal and Non-municipal

sources

Policies for Operations

SimplicityStandardizationTestedDisseminated

Nutrition / Hydration / Sleeping Accommodation

Available 24/7◦Scheduled meal times

Isolated from clinical careLogging in and out

Mass Feeding

Home Sweet Home

Challenges and Pitfalls

Special Needs PatientsPolitical IssuesAdverse Environmental

ConditionsPublic RelationsComplianceTimeline

Special Needs Patients

Limited Mobility / Non-Ambulatory

Sensory deficitsLanguage barriersPatients with dependents

Political Issues

Regular communication with decision makers is key!

Use of layman’s termsDistilled informationCharts, graphs, maps

Adverse Environmental Conditions

Road/Rail/Airport closuresUtility outagesFlooded facilitiesCommunications failures

Public Relations

Manage them or they will manage you!

Specific briefing areaSingle source of informationScheduled, frequent updates

Compliance

Use the mediaMulti-pronged approachCommunicate honestly

Timeline

Always less time than you wantEarly identification and

inspection of potential sites helps

Pre-training and drills are key for personnel

SummaryLogistical IssuesSizeSecurity & SafetyUtility SupportLocationMedication and

MaterielWaste Disposal and

SanitationFatality

Management

Clinical IssuesInfection ControlPatient FlowRecordkeepingMental Health

Summary

Challenges & PitfallsSpecial Needs

PatientsPolitical IssuesAdverse

EnvironmentPublic RelationsComplianceTimeline

Administrative Issues

PersonnelPolicies for

OperationsNutrition /

Hydration / Sleeping Accommodation

Questions? Comments?

Thank You!

K.C. Rondello, M.D., M.P.H.Academic Director, Department of Emergency

ManagementAdelphi University1 South AvenueGarden City, NY 11530516-877-4544Rondello@adelphi.edu