Biomedical Engineering Reference
In-Depth Information
two occasions when the use of a shuttered facility
is warranted: mass casualty events and cases where
quarantines must be instituted to guard against
transmission of an infectious agent or communi-
cable disease. Any institution contemplating the
use of a closed hospital to expand surge capacity
should ideally engage in advance planning to thor-
oughly assess the facility, although it must be
acknowledged that in many cases the urgency of
a situation often calls for swifter action. The best
approach might be for an existing hospital or other
health care organization to acquire the shuttered
hospital as a satellite of the medical center so that
patient services such as pharmacy and laboratory
can be extended to the satellite. Whether the site is
a shuttered hospital, or, as is described in Sidebar
1 below, a closed hospital ward, the first staff to
enter the facility should be an environmental crew
that would clean the facility to ensure that the
water, air, and general environment are sanitary
and adequate for their intended use.
medical center, can be adapted into surge hospitals.
These facilities may include sites such as veteri-
nary hospitals, convention centers, exhibition halls,
empty warehouses, airport hangars, schools, sports
arenas, or hotels. Health care organizations can
designate such nearby buildings and equip them
to handle an overflow of patients. Sometimes a
medical facility designed for another purpose, such
as a day surgery center, can quickly adapt into a
surge hospital with minimal cost and effort.
Mobile medical facilities
Another type of surge hospital is the mobile surge
hospital, such as an 18-wheeler truck fitted with
state-of-the-art surgical and intensive care units that
can rapidly deploy to the scene of an emergency.
These mobile intensive care units typically have
six beds and their surgical units contain pre-op and
post-op recovery areas, a centralized nursing station,
and clean and soiled utility rooms. An additional
advantage is that these facilities can be used not
only for disaster management but also as portable
clinics offering preventive services to rural or other-
wise underserved areas. These dual-use facilities
have been referred to as
Thursday hospitals
because
they can be used for patient care in one given
location on a certain day of the week (such as on
a Thursday) and can be used in other locations
the rest of the week, while remaining available
for other purposes of disaster response at all times.
Sidebar 1. An example of “surging in
place”—opening a closed hospital
ward
Baton Rouge's largest public health hospital,
the 200-bed Earl K. Long Medical Center, is a
facility that provides care to the indigent: the
poor, the uninsured, the frail elderly, and pris-
oners from the city's four jails. This hospital's
method of increasing surge capacity to treat
victims of Hurricane Katrina was to open several
closed wards within the hospital. This step
expanded its capacity by 200 beds, effectively
doubling the hospital in size. Jimmy Guidry,
M.D., state health officer of Louisiana and
medical director for Louisiana's Department of
Health &Hospitals (DHH), made the decision to
open the wards, using the strategy of “surging in
place” to increase the hospital's surge capacity.
Portable facilities
An additional answer to the surge capacity problem
is the portable, mobile medical facility that can
be set up quickly and be ready to be used to
provide care in a few hours. Such units, commonly
known as
hospitals in a box
, are fully equipped,
self-contained, turnkey systems designed to be set
up near mass casualty events to treat the most
severely wounded as soon as possible. One soon-
to-be-available protoype, the Advanced Surgical
Suite for Trauma Casualties (ASSTC), is a highly
mobile, lightweight, self-contained surgical facility
that has both military and civilian uses. It can be
set up in less than 30 minutes and is stored in a
5ft
×
5ft
×
10ft. box. Supply cabinets in the unit
Facilities of opportunity
“Facilities of opportunity” are nonmedical build-
ings that, because of their size or proximity to a
