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Surge Capacity 

Policy Statement:
Surge capacity is defined as, the ability to expand care capabilities in response to a sudden or more prolonged demand.   Surge capacity includes all aspects of providing care for patients and employees during this period of increased demand.  Planning must include control of entrances and exits, physical space for decontamination of infected or chemically contaminated patients, and a triage area where patients can be screened and assigned to suitable patient care areas.  There may be an increased demand for negative pressure isolation rooms or units, HEPA filters and personal protective equipment (PPE).  Ventilators may be in demand for more patients and for longer periods of time.  

Separate outpatient areas may be required to vaccinate and/or supply medication to patients who do not require hospitalization   Qualified personnel, already in short supply, will be in demand.  Employees, who are asked to stay at work and care for potentially infectious patients, must be assured of priority vaccination or medication as recommended.  

Current Capacity/ Facility Description
Sandhills Regional Medical Center is an acute-care hospital located in a suburban setting.   The hospital has 189 licensed beds and approximately 300 employees. 
Operating Rooms: 4 OR's in the hospital, 1 Cysto room, 1 Endoscopy/Procedure room, and 1 Cesarean Room.
Emergency Department has 9 designated beds.  Could be expanded to three hallway beds in a disaster situation.  Seven beds have built-in monitors and there are three transport monitors.  10 transport monitors are available.
Intensive Care Unit has 10 beds.  All of the beds are private rooms with sliding glass doors.  
Med/Tele Unit 37 single bed rooms/ 6 dual bed rooms
Med/Surg Unit   18 single beds/ 2 dual beds
Joint/Ortho/Neuro Unit- 10 single beds/ 3 dual beds
Maternal-Child Unit - 21 single bed patient rooms (9 Perinatal/3 LDRs/9 Post-Partum/Pediatric beds) 
Pediatric patients requiring ICU level care will be transported to Memorial Hospital at Gulfport or University of South Alabama Medical Center in Mobile, AL.  If transport is not available, pediatric ICU patients will be cared for in ICU by ICU nursing staff with pediatrician support and consultation.
Burn Unit: SRMC has no burn unit.  
Severely burned patients would be stabilized and transferred to University of South Alabama Medical Center in Mobile, AL.
If transfer were not possible, the patient would be cared for in a single ICU room utilizing protective contact precautions.
SRMC is a designated trauma facility.  
The Emergency Room has one trauma room with one bed and one additional room that could be used as a trauma room.  
Severe trauma patients would be transported to appropriate facility in the South Mississippi Trauma Region.
Patients who can not be transported would be cared for in the ICU
Neurosurgery consultation is available on-call.  

Isolation Rooms
ER: There is one negative pressure isolation room in the ER.  Patients suspected of requiring negative pressure isolation will be placed in ER Room #4.
ICU has one negative pressure room (366).
Rooms 301, 401, and 501 are also negative pressure rooms.
The Endoscopy room in Surgery can be used for procedures requiring negative pressure. 

Personnel and Provisions
One source of personnel surge capacity is the National Disaster Medical System (NDMS). NDMS is administered by the Office of Emergency Response (OER).  NDMS teams include nearly 8,000 volunteer health care professionals from around the country who have been organized into general and specialty teams to help local communities respond to a disaster.   There are currently 27 primary care teams who can, under ideal circumstances, respond to an emergency call within 12 to 24 hours Four teams specialize in responding to an incident caused by a chemical or bioterrorism attack. There are also burn teams, mental health teams and disaster mortuary teams that can assist in a mass casualty event. But for the same reasons that a threshold number of nurses may not be available to travel to a disaster, neither may the health care workers who comprise the NDMS teams. 

The first step in obtaining assistance from NDMS is to contact the Harrison County Public Health Department.  (228) 831-5151.
Identification of required personnel:  All SRMC employees must display their official name badge.  Human Resources can make badges to assist in the identification of employees and volunteers.  Temporary badges are also available in the Plant Operations Office.
Identification of qualifications of required personnel during an emergency
Human Resources will verify provisional credentials of professional staff.  The Medical Staff Office, per Medical Staff Policy, can grant physicians emergency privileges. 
The Medical Staff Office is responsible for contacting physicians if needed during an emergency.
Our Disaster Call-Back Lists includes the employees drive time to SRMC.  
Work and relief response personnel must be scheduled to maintain 24 -hour operations (2-3 work shifts per day) for at least several days.  Human Resources will assist departments with personnel relief and replacement. Off shift employees will be able to rest and eat in a designated area of the Medical Office Building.
Support for families of emergency response personnel.  Contact with employee families will be maintained by telephone, Nextel phones, and the Internet.
Employees may opt to bring family members with them to the hospital in emergency situations.  Every attempt will be made to accommodate employee families.  If needed, a day care area could be set up in the Medical Office Building or Executive Dining Room.  Employees from the disaster labor pool could be assigned to establish and supervise a day care facility. Provisions for pets?
In addition to receiving communications support in reaching family and loved ones; frontline workers need current information about the event in progress.  Maintaining contact with the community, and the world, through the Internet, radio and television can help staff feel a part of the solution and less alone.
Administration office will serve as the Disaster Command Center
TV hook-ups are available in the Medical Staff Office, ER Employee Lounge, Magnolia Room, Azalea Room, ICU and Surgery waiting areas,  and all patient rooms.  
Organization and coordination of volunteers:  Who will organize and coordinate non-professional, non-employee volunteers?
Provision of food and lodging for volunteers, individual health care providers, and emergency response workers during a public health emergency.  Per Title 22 regulations the hospital maintains a 7-day supply of non-perishable foods and a 3-day supply of perishable foods.   In addition, agreements are in place with food vendors to provide the hospital with priority services.  Does this apply in Mississippi?
Disposable dishes and utensils will be used as necessary. 
The CFO would coordinate and manage any donations to the hospital.
Nearby shelters are the ? and the ?.  The SSB, located next to the hospital, could also be utilized as shelter for employees and families  in times of disaster.
 
Outbreak of an Infectious Disease Requiring Isolation  
Infection Control is available 7 days a week, 24 hours a day via cell phone (228-348-1744) and/or telephone.  (228-385-0159)
Patients in existing negative pressure isolation rooms will be assessed by Infection Control or House Supervisor with Infection Control consultation as necessary.  Patients not requiring isolation will be transferred to a standard room.
Two patients with the same organism/diagnosis can be cohorted in one room with the approval of Infection Control or Infectious Disease physician.  
Caring for people in their own homes is an important source of surge capacity, and may be a particularly attractive alternative in the event of a biological attack with an infectious agent. 
Individual ICU, Med/Surg or Med/Tele patient rooms can be made negative pressure by:
Obtaining the HEPA filter from Cardiopulmonary or renting a large construction HEPA filter unit from  ????
Connecting the HEPA exhaust tubing out the patient window (window must be replaced with plywood)
Blocking or HEPA filtering normal room exhaust which returns air to hospital circulation.  
Rooms must be tested for negative pressure by smoke or tell tale (toilet paper or thin strip of paper that shows the direction of air flow) testing.

Radiology 
Hospital Radiology is capable of performing all general procedures including cat scans, ultra sound and nuclear medicine procedures.  

There are 2 portable machines in main hospital
The CT scanner can run on emergency power
There are 3 c-arms in surgery.

Respiratory Therapy
The Respiratory Therapy Department has the following patient ventilation equipment:

Three (3) Puritan Bennett 7200
Three (3) Infrasonics Star
Two (2) Infant Star 950 Puritan Bennett
One (1) Bird 6400ST
One (1) Servoi Ventilator
One (1) Autovent 3000 Transport Ventilator
There are five (5) anesthesia machines available in the hospital Operating Rooms and one (1) in the C-Section Room.
Arterial Blood Gas Machine is located in Cardio-Pulmonary Department.
Rental Equipment
Mediq PRN
Cardiology/Echo
4 EKG machines (two in the department, one in the ER and one in Gulf Oaks)
1- Cardiac Echo machine 
1 EEG Machine

Laboratory Testing: 
SRMC laboratory is located in the main hospital building.  The laboratory is rated Bio-Safety Level 2 and is capable of testing for:

Influenza A & B antigens
Routine cultures and sensitivities

Our laboratory is not equipped to isolate or identify:
SARS
Avian Influenza
Anthrax
Smallpox
Tuberculosis

Specimens for the above diseases and other bio-terrorism or unusual/unknown virus samples will be packaged and sent to the appropriate county, state or federal laboratory for processing.

A blood drawing station is located on the 2nd floor of the hospital next to the lab.
Nursing units have blood glucose meters and blood drawing supplies
Ambulatory Surgery has blood glucose monitors.
Arterial blood gases can be analyzed in the Cardio-Pulmonary Department. 

Medical Supplies
Disaster carts: ER has a basic disaster cart that is stocked for immediate triage only. We have two trauma rooms stocked for approximately two days worth of items.  In the event of a Code Triage - Materials Managements (MM) sub-policy states that we stock one to two disaster carts and bring to the ER.  We stock these in accordance with the type of disaster.

Hospital patient care departments have a par level of supplies available. Additional supplies can be obtained one of two ways.  During working hours, the ER has only to notify Materials Management and we will do whatever is appropriate for the situation.  Secondly, after hours, the Nursing Supervisor always has access to all supplies and equipment in both the warehouse and Central Supply.
Infection control has one box of small and one box of regular size 3M N-95 respirators available for emergency use.  High-risk departments have designated fit-testers who can fit test employees if needed. MM keeps a couple boxes of the N-95 masks in stock at all times.  We always have cases of gloves, masks, isolation gowns.  In addition to what we have in the warehouse, we also have 5 isolation carts stocked with more of the same items.  

We need a list of the special disaster equipment that is stored and how to get it.

Medical Transport Vehicles
The Biloxi Fire Department is the local hazmat team 
Ambulance Companies are AMR(phone #) and Acadian

Mortuary Space
The mortuary is located on the first floor of the hospital across from the staff elevators.  

Engineering, Housekeeping, House Supervisors and Administration have the key to the locked room.  
The refrigerator will hold two bodies.  Any additional refrigeration space???Dietary?
Extra body bags are available from AMR.

Protection of Environment
Engineering/Plant Ops is responsible for surveying the environment to assess safety and levels of contamination resulting from natural or terrorism events.
The Safety Officer and the Housekeeping Department will coordinate removal of debris. 
The Safety Officer and the Housekeeping Department will coordinate transport and disposal of hazardous waste.  Stericycle is our designated hazardous waste hauler (800) 345-2362

Facility Security and Crowd Control
The Director of Plant Operations is the facility Safety Officer and is responsible for securing the facility and gaining crowd control.  

Engineer on Duty will contact Fire Dept/Police Department
Safety Officer will obtain additional Security personnel to secure the area.  Swetman Security Agency (phone #)
In emergency situations involving hazardous chemicals or infectious organisms, All doors and entrance ways will be secured with the exception of the Loading Dock doors.
All patients and personnel will enter the facility through the Loading Dock, which will be  unlocked but secured. Security personnel at doorways must wear appropriate personal protective equipment.  Contact the Infection Control Coordinator or Safety Officer for information on personal protective equipment.

Roadways
The Safety Officer will work with police and fire personnel to secure hospital access roadways.  If a roadblock is necessary it will be manned by Security and designated labor pool participants.

Pharmacy
A push pack is promised within 12 hours of request, pharmaceutical supplies from the Strategic National Stockpile (SNS) may take up to 48 hours to reach the locations in which they are needed. DHHS suggests that hospitals maintain enough antibiotics on hand to supply hospital staff, their families, first responders and patients for the first 48 hours of an emergency. 
How will prophylactic antibiotics be supplied to employees at work? Do we have enough for the employee families?  
Where will they be dispensed?  Need an area away from the Pharmacy and a pharmacist to staff? 
Are there information sheets printed/available on the most likely antibiotics to be used?

Power/Utilities
Plant Operations is responsible for back up generators.  
Biloxi Fire Dept. has a generator truck which may be available
Battery powered light units are available in all critical areas. 

Recovery
Monitoring of mental health care needs in emergency response personnel will be done by Therapists and Staff from Gulf Oaks Hospital.
Monitoring of air quality ENV Services (800-345-6094)
Monitoring of water quality  -Mississippi Department of Health in conjunction with City of Biloxi 
The Director of Food Services working with Mississippi Department of Health will monitor food quality.
Monitoring of soil quality 
Vector control Redd Pest Control 

Ensuring Care for the Other Patients
In a massive disaster, there is the potential that many chronically and acutely ill patients could lose access to their physicians or settings where they usually receive care or obtain medications. In the wake of an emergency, hospitals may cancel scheduled surgeries and defer other planned diagnostic, therapeutic and rehabilitative activities. This may buy time, but it will not buy long-term capacity. Scheduled surgeries have been scheduled for sound reasons and cannot be delayed indefinitely.  Delivering mothers will still need access to hospital obstetric and neonatal units, cancer patients to radiotherapy units, stroke patients to rehabilitative services, and so on. In the face of the requirement for a sustained response to an emergency, and once every option has been exercised for the transfer and treatment of patients in various settings and at various levels of care, something less than the usual standard of care in the affected community must become acceptable. 

Case management will work with physicians to send patients home or to skilled nursing facilities.