Feds envision temporary medical station network

Rapid deployment to boost local response

Federal health officials are developing a system of temporary health care facilities called "contingency stations" to prepare an overburdened health care system for a mass casualty event.

The first wave of stations is designed to be assembled within existing structures such as gymnasiums. Public health officials envision a network of the stations eventually could be available in various regions of the country, enabling local officials to rapidly increase health care capacity in the event of a disaster or attack.

"As we build out the advance-capability ones, they will actually have walls and tents and floors," noted Robert Claypool, MD, deputy chief medical officer in the office of emergency preparedness in the U.S. Department of Health and Human Services. "The ones that we have — that we’re building initially — will actually go into another facility like a school or gymnasium."

Claypool spoke at a web-assisted conference call on health care system surge capacity sponsored by the Agency for Healthcare Research and Quality in Rockville, MD. The Oct. 26, 2004, conference dealt with the health care system’s ability to rapidly expand beyond normal services to meet the increased demand for qualified personnel, medical care, and public health in the event of bioterrorism or other large-scale public health emergency.

Four of the stations, which can be designed to accommodate 250 hospital beds, were built last year. Depending on funding, the number of stations will be increased gradually.

"Our goal is eventually to get these sited around the country in every one of the health emergency service regions," Claypool said.

In California, for example, having two stations available in the north and two in the south of the state may be sufficient to rapidly reach any city.

"If we could do that, then we should be able to get a contingency station to [for example], the San Diego area, hopefully within a matter of hours," he said. "It may take a bit longer, but that’s what we will be shooting at. This is such a new concept, it’s going to have to be fleshed out as we test this."

The public health system is interested in using the stations for quarantine as well as treatment. For example, a station could be set up inside an airport hanger to house a planeload of passengers who had been quarantined due to an infectious disease risk.

"In the event that there is 747 that needs to be quarantined, you need to take the people and put them someplace. You can’t have them sitting on a tarmac for 24, 48, 72 hours," he said. "So what we’re looking for is to be able to project one of these 250-bed capability units to fill in a hanger. Our target to get to there would be within four hours. In terms of supporting a medical event, we’re probably talking somewhat longer. That will have to be determined as we go out. But it would probably be in the ballpark of 24 to 48 hours."

In addition to treating adult patients, the stations will have pediatric beds, equipment and formulations, he said. Staffing is an unresolved issue. The basic 50-bed unit would need at least two physicians and a support staff "in the 20s" of nurses, assistants, technicians, and the like. Local volunteers inevitably will be needed.

"Although it will be a federally developed system, it’s going to be used locally to support local and regional needs," he said. "It isn’t going to be an independently staffed organization. So we’ll look for continued [medical] input to do that. How do we staff these? I don’t know; that’s a big challenge for us."