In the aftermath of Hurricanes Katrina and Rita and other natural disasters, the United States has gained more experience with the concept of ACFs than in the previous several decades. In an attempt to synthesize the collective knowledge learned from these experiences, an extensive literature review was undertaken. More than 60 articles from peer-reviewed and other literature were reviewed (Appendix A). These articles were used as a guide for the development of our questionnaire to further elucidate issues not discussed or incompletely covered by these articles.
Establishment of Advisory Panel
To guide this project, an advisory panel was established consisting of subject matter experts in the field of surge capacity and ACFs (Appendix B-1). This panel included members from the private, public, and government sectors. Three meetings were held with the advisory panel to provide input and direction. The participation and guidance provided by the panel members are gratefully acknowledged.
Questionnaire Development and Administration
In an attempt to acquire a standardized data set regarding experience with ACFs, the decision was made to develop a questionnaire that would be circulated to a limited number of groups who had either extensive real world experience with setting up, operating, or planning for ACFs. Due to limitations from the Federal Office of Management and Budget, a maximum of only nine groups could be queried without incurring a lengthy Federal approval process that was inconsistent with the time frame of our task (Paperwork Reduction Act – 44 U.S.C. Chapter 35). Eight of the groups selected had established and operated ACFs during Hurricanes Katrina and Rita and one group had extensive experience planning for the establishment of ACFs. The groups with experience operating an ACF included Baylor College of Medicine (Houston, TX), University of Texas Southwestern Medical Center (Dallas, TX), Illinois Medical Emergency Response Team (Baton Rouge, LA), Texas Disaster Medical Assistance Team (New Orleans, LA), Carolinas MED-1 (Waveland, MS), Federal Medical Stations (multiple sites), Earl K. Long Medical Center (Baton Rouge, LA), and University of Texas Health Center (Tyler, TX). The State of Florida also was included because of its extensive work in planning for and operating ACFs.
Based on our literature review and input from the advisory panel, a 28-page questionnaire was developed (Appendix C). The questionnaire had seven sections:
- Descriptive data (ACF use, dates of service, structure utilized, etc.).
- Command structure used.
- ACF advance planning.
- ACF logistics.
- ACF operations.
- ACF finance.
- ACF facility selection tool comments.
The survey instrument was designed to allow respondents to use fill-in-the-blank answers. In many cases this allowed people to expand on their answers and give much more detail than would have been possible with yes/no questions or a "bubble sheet" type questionnaire.
This instrument was approved by our institutional review board (IRB) and submitted to representatives of the groups listed above. The responses were compiled. These data were used in developing the tools and conclusions presented in this report.
Because of the restrictions placed by the IRB, the individuals who were surveyed were assured that neither they nor the site that they operated would be specifically identified in the final manuscript. As a result, the data presented in this report lists "Site 1" through "Site 9" instead of the name of the actual site.
Patient Selection Tool Development
As discussed previously, one of the potential uses for an ACF is as a hospital decompression site. In this scenario, less ill patients who cannot be discharged from a hospital to home potentially could be transferred to an ACF, freeing up their hospital bed and resources to augment that institution's surge capacity. As an addendum to our initial task order, we were charged with attempting to develop a tool to assist in this patient selection process. After a review of the applicable literature, we convened a sub-panel of subject matter experts to address this task (Appendix B-2). This panel met multiple times via conference call to develop and refine the Patient Selection Tool.