Do you know where your alternate care site is?

In Northern Montana, you want heating’

The Agency for Healthcare Research and Quality (AHRQ) has created 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. The IDSRN program links the nation’s top researchers with some of the largest health care systems to conduct fast-track research on cutting-edge issues in health care.

In the aftermath of a bioterrorist 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.

Old West has new ideas

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. We brought together partners from all of Federal Region 8 [Colorado, Utah, Wyoming, Montana, and North 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 VA; and FEMA.

"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 spread sheet," Cantrill 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 you in prioritizing different potential sites, to see which would be best to use, he says. "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 and you need alternative sites to give limited care to patients.

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," he notes. "Naturally, there are variables, like the time of year, the nature of the incident. 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, he notes, there is no magic number in terms of a total score for a given alternative site. "What the tool does," says Cantrill, "is give you the ability to do relative scaling."

(Editor’s note: The alternate care site selection tool is available free of charge as an Excel spreadsheet on AHRQ’s web site at It also is included in a report — Rocky Mountain Regional Care Model for Bioterrorist Events. Copies of this report are available on the AHRQ Web site at