Critical Path Network

Tool locates alternative sites during bioterrorism

Initiative draws from integrated network process

Early this summer, several factors brought renewed attention to the possibility of terrorist attacks and appropriate responses on the part of the health care profession.

To help prepare for an effective response for such an event, the Agency for Healthcare Research and Quality (AHRQ) has released a tool to help state and local officials quickly locate alternate health care sites if hospitals are overwhelmed by patients due to a bioterrorism attack or other public health emergency. The alternate care site selection tool, produced by Denver Health, one of AHRQ’s Integrated Delivery System Research Network (IDSRN) partners, was shared with emergency response planners at the 2004 Summer Olympics in Athens, Greece.

In the aftermath of a bioterrorism event or other public health emergency, hospitals may be overwhelmed by a sudden influx of patients, AHRQ explains.

The new alternate care site selection tool is designed to allow regional planners to locate and rank potential alternative sites — stadiums, schools, recreation centers, motels, and other venues — based on whether they have adequate ventilation, plumbing, food supply, and kitchen facilities, for example.

It is available free as an Excel spreadsheet on AHRQ’s web site:

The effort to develop the tool began in October 2002, recalls Stephen Cantrill, MD, associate director in the department of emergency medicine at Denver Health Medical Center.

"It started with a task order from AHRQ that dealt with regional planning for bioterrorism," he notes. "We brought together partners from all of Federal Region 8 [Colorado, Utah, Wyoming, Montana, North Dakota, and South Dakota]."

The team included representatives from state departments of health, medical societies, and all the large hospital groups in the Denver metro area. Federal partners included the Public Health Service; the U.S. Northern Command in Colorado Springs, CO; the Department of Veterans Affairs; and the Federal Emergency Management Agency.

"We built on some of the earlier work that had been done by the command in terms of criteria," Cantrill says.

"We enhanced those, developed a kind of a grading scale to be used to look at facilities to be able, in a gross way, to determine the acceptability of potential alternative care sites — i.e., whether they fulfilled specific needs." The tool includes a list of about 30 different attributes, such as availability of toilet facilities, availability of communication lines, availability of a food service area, and so on.

"Basically, it’s a big spreadsheet," he explains. "You go down, put your potential sites on one axis, your needs on another, rate them on a 0-5 scale [5 being the highest], add up your total, and see if it makes logical sense." This process aids in prioritizing different potential sites, to see which would be best to use, Cantrill adds.

"In an ideal situation, you do this as part of your advanced planning," he advises, so you are prepared if traditional health care sites are overwhelmed in a bioterror event.

While much of the data were specific to his region, Cantrill says the new tool demonstrates an approach of assessment of resources in any given region.

"We tried to develop some generalized tools. Naturally, there are variables, like the time of year, the nature of the incident," he points out. "If it’s summertime, you may not care if you have heating, but you will want air conditioning. In Northern Montana, you want heating."

Therefore, there is no magic number in terms of a total score for a given alternative site. "What the tool does is give you the ability to do relative scaling," Cantrill adds.