Federal Healthcare Resilience Task Force Alternate Care Site Toolkit Second Edition Product Purpose: This Toolkit is guidance and was developed to help state, local, tribal, and territorial (SLTT) entities address potential capacity and capability gaps in healthcare systems during the 2020 SARS-CoV2 virus (COVID-19) pandemic. It is intended to provide guidance and technical assistance to SLTT entities in establishing and operationalizing Alternate Care Sites (ACS) used to care for COVID-19-positive or presumed positive patients. If an ACS is used to treat non-COVID-19 patients, additional considerations will apply. Intended Audience: State, Local, Tribal, and Territorial Entities FEMA Regional Administrators HHS Regional Administrators Healthcare Systems i KEY UPDATES IN THE SECOND EDITION The Second Edition of the ACS Toolkit provides augmented guidance based on feedback and experience with the national ACS mission. The Second Edition builds upon, but does not change, basic tenets from the original guidance provided in the First Edition. Key updates in the second edition based on lessons learned include: • Streamlined definitions of ACS models for clarification (page 8); • Defined a new hybrid ACS model called the Hospital Care ACS Model (Page 125); • Added an Emergency Resuscitation Capability to all ACS Models (Page 71); • Added a COVID-19 Push Pack for all ACS Models (Page 16); • Included information on understanding the relationship between Federal Medical Station (FMS) and ACS (Page 8); • Included information on funding solutions, including the graphic in Appendix D (Page 13); • Added five key considerations for SLTTs on assessing staffing and ventilator needs (Page 17); • Included a comparison of the three ACS Models (Page 10); • Included the “ACS Model Composition by HHS Standardized Equipment and Supply Caches” table (Page 16); • Included key considerations for oxygen needs (Page 18); • Included key considerations for personal protective equipment (PPE) (Page 18) and a protocol matrix for PPE posture for different levels of staffing (Page 57); • Included key considerations for pulse oximeters (Page 18); • Included Centers for Medicare & Medicaid Services (CMS) waiver information (Page 19); • Included pandemic-specific Health and Safety Plan (HASP) and Hazard Evaluation and Risk Assessment (HERA) information (Page 59); • Revised the tear sheet ACS checklist (Page 236); and • Revised formatting of the toolkit for ease of use and navigation. 4/21/2020 ii Federal ACS Toolkit Second Edition HOW TO USE THIS TOOLKIT BASE DOCUMENT Foundational Alternate Care Site Model APPENDICES Supporting Documents, Tools, and Templates SUPPLEMENT 1 SUPPLEMENT 2 SUPPLEMENT 3 Additional Guidance for Additional Guidance for Additional Guidance for Non-Acute Care ACS Model Hospital Care ACS Model Acute Care ACS Model STAFFING STAFFING STAFFING EQUIPMENT & SUPPLIES EQUIPMENT & SUPPLIES EQUIPMENT & SUPPLIES TEAR SHEET: ALTERNATE CARE SITE CHECKLIST 4/21/2020 iii Federal ACS Toolkit Second Edition TABLE OF CONTENTS Key Updates in the Second Edition ............................................................................. ii 1. Purpose and Scope ................................................................................................. 8 1.1 Concept ........................................................................................................... 9 1.2 ACS Decision Framework ............................................................................... 9 1.2.1 Can your community benefit from an ACS? ............................................... 9 1.2.2 Which ACS model would best meet the needs of your community? ........ 10 1.3 ACS Process Flowchart ................................................................................ 11 2. Procedures ............................................................................................................. 11 2.1 Identify Potential Sites ................................................................................... 11 2.2 Conduct Site Assessment ............................................................................. 11 2.2.1 Physical Considerations ........................................................................... 11 2.2.2 Logistical Considerations ......................................................................... 12 2.2.3 Operational Considerations ..................................................................... 12 2.2.4 Infection Prevention and Control Considerations ..................................... 13 2.2.5 Pharmaceutical Considerations ............................................................... 13 2.3 Secure Funding ............................................................................................. 13 2.3.1 FEMA Public Assistance Program ........................................................... 14 2.3.2 ASPR Hospital Preparedness Program ................................................... 14 2.3.3 CDC Division of State and Local Readiness ............................................ 14 2.4 Secure Property ............................................................................................ 15 2.5 Convert Site for Healthcare Use .................................................................... 15 2.6 Secure Wraparound Services ....................................................................... 15 2.7 Staff, Equip, and Supply Site ......................................................................... 16 2.7.1 Staff ......................................................................................................... 17 2.7.2 Equip........................................................................................................ 17 2.7.3 Supply ...................................................................................................... 18 4/21/2020 iv Federal ACS Toolkit Second Edition 2.8 Operate Site .................................................................................................. 18 2.8.1 Roles and Responsibilities ....................................................................... 19 2.8.1.1 Site Manager ........................................................................ 19 2.8.1.2 Law Enforcement ................................................................. 20 2.8.1.3 Safety Officer ....................................................................... 20 2.8.1.4 Chief Medical Officer ............................................................ 21 2.8.1.5 Public Health Representative ............................................... 21 2.8.1.6 Wraparound Services Contractor ......................................... 22 2.8.1.7 Medical Team ....................................................................... 22 2.8.1.8 Logistics and Administrative Staff......................................... 22 2.8.1.9 Ambulance Services ............................................................. 23 2.8.1.10 Personal Protective Equipment (PPE) Coordinator ............ 23 2.8.1.11 Public Affairs/Information Officer ........................................ 24 2.8.1.12 Case Management Team ................................................... 24 2.8.2 Site Flow Plan .......................................................................................... 24 2.8.3 Site Security Plan .................................................................................... 26 2.8.4 Site Communications Plan ....................................................................... 27 2.8.5 Onsite Plan for Caregivers and Family Members .................................... 27 2.9 Service Animals and Companion Animals .................................................... 27 2.10 Restore Site .................................................................................................. 28 3. Reporting and Records Management Requirements .......................................... 28 3.1.1 Reporting Requirements .......................................................................... 28 3.1.2 Medical Record Requirements ................................................................. 28 4. Contact Information for Technical Inquiries and Lessons Learned .................. 28 Appendix A: Acronyms and Abbreviations .............................................................. 30 Appendix B: Sample ACS Execution Plan ................................................................ 33 4/21/2020 v Federal ACS Toolkit Second Edition Appendix C: Sample Alternate Care Site Assessment Form .................................. 34 Appendix D: Funding Solutions Graphic .................................................................. 36 Appendix E: Sample Right of Entry Permit ............................................................... 37 Appendix F: Wraparound Services Checklist ........................................................... 41 Appendix G: Sample Alternate Care Site Schematic ............................................... 44 Appendix H: Sample Statement of Work for Wraparound Services ....................... 45 Appendix I: COVID-19 Push Pack Recommendations ............................................. 49 Appendix J: Staffing Solution Resource ................................................................... 52 Appendix K: Sample Statement of Work For Medical and Support Personnel ...... 56 Appendix L: Sample PPE Protocol Matrix ................................................................. 57 Appendix M: HASP and HERA ..................................................................................