In today’s unprecedented pandemic, hospitals and healthcare systems are strained to meet the ever-growing needs to treat patients and protect staff, and teams across the world are working tirelessly to increase their ability to treat patients. In a non-pandemic world, hospitals, healthcare systems and regional healthcare coalitions have surge strategies to optimize their ability to meet a sudden increase in patient needs or numbers due to scenarios such as evacuations or epidemics. Each facility identifies the appropriate response through detailed, unit-specific analysis and data collection. Any of these plans, which include increasing capacity by making single rooms into doubles, re-purposing operating rooms as ICUs, or even converting cafeterias to new in-patient units, are now being executed to prepare for COVID-19 surges in their communities.
Given the projected impact of COVID-19 on hospital admissions, even the well-prepared hospital may be challenged to meet the needs of a surge, despite best efforts to plan for a worst case. Because of this, states and provinces, regions, and in some cases healthcare systems, are developing alternate care sites (ACS), or non-traditional healthcare temporary sites in Canada, to provide medical care for sick patients. The current and ongoing models for this include the use of hotels, motels, and dormitory spaces, and the conversion of large open facilities, such as convention centers and arenas, to serve as temporary environments under these extreme circumstances.
In the United States, implementation of alternate care sites is a state-led and managed process; however, the U.S. Army Corps of Engineers and the U.S. Department of Health and Human Services are supporting states and municipalities in assessing, and then building these sites, to support their medical requirements during the COVID-19 pandemic. In Canada, local health care authorities or networks are engaging directly with potential facility owners to begin the conversion.
Emergency Management of Alternate Care Sites
In both the United States and Canada, hospitals and healthcare systems operate under strict guidance to maintain fire and life safety through code compliance. For a facility manager, much of the work setting up an alternate care site is in developing the logistics and execution of the space, stuff, systems, and staff, the 4 S’s of alternate care sites:
● Space: The alternate care site must have adequate space for patients, patient care, and support services, such as nurses’ stations and housekeeping.
● Stuff (equipment): Can the facility support the equipment needed to meet the needs of the expected patient population? Is the alternate care site going to be populated by COVID-19 patients, high acuity or low acuity? Or are the patients going to be those relocated from long term care?
● Systems: What systems can be used in the facility? Access to electronic medical records, patient monitoring equipment, and even simple nurse-call bells are important to continuous patient care.
● Staff: Can the facility accommodate the needs of the staff such as physicians, licensed independent practitioners, nursing and support staff, including environmental services, engineering, and others?
The teams responsible for bringing these sites online also need to focus on a fifth S: safety. Ensuring the safety of staff and patients, who may be incapable of self-preservation, as well as of visitors to the site, is just as critical a part of managing alternate care sites as managing the logistics.
Although heath, building, and fire authorities have loosened some regulations so that alternate care sites don’t have to meet the same code requirements as hospitals, these facilities must still ensure patient safety and should consider involving subject matter experts to provide insight and guidance around such important safety issues as:
● Life safety: Does the layout meet the minimum life safety code requirements and local building code life safety provisions (e.g., appropriate number of exits, accessibility compliance, passive and active fire protection features, and fire response procedures)?
● Fire evacuation planning: Are the protocols for fire response and staff and patient movement adequate and in accordance with the fire regulations?
● Emergency management: Has a baseline hazard vulnerability assessment been completed to identify potential risks and threats to the alternate care site? This process determines the priorities for developing policies, procedures, and training.
● Disaster-specific responses: What are the documented rapid responses to events such as a bomb threat, civil disturbance, earthquake, fire, flooding, loss of central services (including emergency power systems), or severe weather; and how can these be adapted to the new alternate care site environment?
● Training: Online or on-site training for staff to support immediate needs.
Security Planning at Alternate Care Sites
From the onset of site planning, security also needs a seat at the planning table. In order to be considered as an alternate care site, security considerations have to be addressed as they touch every part of an alternate care site from patient transportation and intake, delivery of food and medical supplies, storage of supplies from medications to personal protective equipment to linens, location of administrative offices, and processes and procedures to control access of staff, patients, and delivered supplies. These day-to-day facility accommodations and practices must be viewed through a security-focused lens — one that considers the use of people, process, and technology to establish a prevention-oriented approach to protecting medical staff, patients, and the machinery and medicines required to provide proper care.
The first stage of establishing security at an alternate care site is the concept of operations or CONOPS, which should be part of the earliest discussions regarding how the site will be set up. This is a time for security and the planning team, typically consisting of facility managers, real estate, government officials, clinical staff, human resources, and legal subject matter experts, to initiate their collaboration. Though there will be many suggested changes and modifications to the decisions made during that first planning meeting, CONOPS is an essential time for security to discuss potential risks, vulnerabilities, and threats to the alternate care site with the planning team before plans are finalized.
The goal is to address security-related risks at each decision point in the planning process. The end result is security master plan that focuses on prevention, enables the medical operation to function smoothly and safely without being restrictive, and provides patients and staff the assurance and confidence that risk is being managed.
Non-traditional care sites are being built and readied at an unbelievable speed. Making sure your facility can support both the emergency response and security needs is key to a swift build- or fit-out and opening sites without delay. With guidance from local authorities and experts, your facility could help support our front-line in this unprecedented pandemic. Additionally, it is also important to prepare your facility for a transition back to its original use. Experts recommend during the transition period that facility managers arrange fire building inspections and fire and life safety reviews, in addition to investing in developing security and all emergency plans, prior to occupancy to ensure ongoing resilience and safety of their facilities.
Nicholas Gabriele (nicholas.gabriele@jensenhughes.com) is vice president, director of healthcare operations, with Jensen Hughes. John Orloff (john.orloff@hillardheintze.com) is senior vice president, security risk management, with Hillard Heintze. Amal Tamim (atamim@jensenhughes.com) is senior consultant, Canadian operations, Jensen Hughes.
