Converting alternate care sites to patient space options

Note: During emergencies, it is important that activities be coordinated through the organization’s incident command system. Activities outside of an organization’s command structure should be coordinated with the local, county and state incident command systems. This enables effective and efficient incident management within common organizational structures.
 

ASHE Definition of Alternate Care Site (ACS)

An Alternate Care Site (ACS) is any building or structure not currently being used for health care that is temporarily converted or constructed for health care use during an urgent need in capacity to provide additional capability for an affected community, outside the walls of a health care facility.

Informative Notes

An ACS includes spaces such as, but not limited to: hotels, arenas, barracks and dorms, tents, closed hospitals, and modular units. ACS does not include the conversion of non-patient care space within the walls of a current hospital converted for use during a surge event, nor does it include equipment stored and ready for deployment in a site outside of the walls of a current hospital. A health care facility is defined in 2012 NFPA 99 3.3.71.

Making Space for Patients

As a result of the COVID-19 pandemic, our nation’s hospitals are preparing for an exponential number of patients in need of care. But the approximately 920,000 staffed hospital beds in the U.S. currently cannot accommodate the estimated millions of patients who will require medical care. It is vital that we seek and implement ways to increase patient capacity across the country by making additional spaces for our patients. The American Society for Health Care Engineering (ASHE) is compiling guidance to help you and your health care facilities create those spaces. Please review these resources, featuring work from The Center for Health Design, USACE and more.

Thank you for your tireless efforts to combat this pandemic. If your facility is finding success with alternate care sites, please let us know by emailing ashe@aha.org or calling (312) 422-3800. We are committed to sharing your successes, advice and stories across the health care community.

Resources

• Alternate Care Sites HVAC Guidebook
  The United States Army Core of Engineering was tasked with the design and construction of Alternate Care Sites (ACS) to relieve the strain on the healthcare system during the coronavirus pandemic. To help with future design and construction of ACS’s, the ASHRAE Alternate Care Sites Task Force was convened upon the request to the ASHRAE Epidemic Task Force to provide engineering recommendations, solutions and guidance to address the HVAC systems for ACS. The ASHRAE Alternate Care Task Force that ASHE participated on, developed a guide specific to COVID-19 patient care but would be generally applicable to similar viruses transmitted as airborne infectious aerosols and through droplets.
   ASHRAE, US Army Corps of Engineers
   
• CMS Releases Alternate Care Site Payment Resource
  The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet regarding payment for care in hospital alternate care sites. 
  Centers for Medicare & Medicaid Services
   
• VIDEO: A Balancing Act: Housing COVID-19 Responders and the Return of Guest Demand
   
• AHA/ASHE Webinar Recording: COVID-19 Alternative Sites of Care Conversations
  Recorded Thursday, April 9
  As hospitals and health systems prepare for COVID-19 patient surge, alternative sites of care can offer space and capacity. University of Maryland Medical Center shared their experiences on setting up a field hospital at the Baltimore City Convention Center to create surge capacity. HGA and the Boldt Company discussed using prefabricated modules as an option for alternative sites of care and their partnership to deploy this solution.
   
• VIDEO: ASHE COVID-19 Alternate Care Site Mini Series_ Town Hall - Lessons Learned 
   
• CDC Recommendations for Alternate Sites
  Centers for Disease Control and Prevention
   
• HHS Recommendations for Alternate Sites
  Assistant Secretary for Preparedness and Response
   
• Alternate Care Sites
  USACE materials for helping states and municipalities address potential shortage in medical facilities
  US Army Corps of Engineers
   

Additional Considerations

• IAHSS Security Design Guidelines for Healthcare Facilities (2020)
  IAHSS
   
• Medical Air and Oxygen Capacity Tools
  The COVID-19 Surge Planning: Piped Medical Gas Consumption Evaluation Tool was designed to help hospitals and health systems evaluate piped medical gas system capacity.
  • Ventilator capacity for existing medical gas systems
    A tool, provided by Kaiser Permanente National Facilities Services, provides ventilator capacity based on piping sizes to assist in determining how many ventilators can be served by an existing medical gas system in a given patient care area.
    Kaiser Permanente National Facilities Services
     
  • Sizing of medical gas systems for alternate care sites
    A tool, provided by Beacon Medaes, provides guidance on the sizing of medical gas systems for COVID-19 emergency units.
    BeaconMedaes
     
  • VIDEO: Handling and Connecting Medical Gas Cylinders Safely
    BeaconMedaes
     
  • Medical Air and Oxygen Capacity Assessment Tool
    During the global pandemic many health systems and hospitals were evaluating the capacity of the medical gas system in their facilities in order to treat afflicted patients with the SARS-CoV-2 virus.  The COVID-19 Surge Planning: Piped Medical Gas Consumption Evaluation Tool was designed to help hospitals and health systems evaluate piped medical gas system capacity.  The tool is able to show the usage of a particular medical gas system while different types of therapies are in use.
      
• Structures Used for Temporary Healthcare Use
  ICC provides guidance on temporary use health care structures such as tents, membrane structures and existing buildings and the code implications regarding the Centers for Medicare & Medicaid Services (CMS) additional flexibility in hospital standards to aid in the expansion of services to fight the COVID-19 pandemic.
  International Code Council
   
• NFPA responds to the coronavirus
  As the pandemic stresses the health care system, critical fire and life safety needs must be balanced with patient care in hospitals as well as new temporary makeshift facilities. 
  NFPA
  • Maintaining safe health care facilities in extraordinary times | Fact sheet 
     
  • Temporary compliance options for code modifications, alternate care sites and facilities related to health care | White paper
     

View More COVID-19 Resources