Alternate Inpatient Care Area (AICA)

Strategic Function: To establish temporary inpatient care areas to handle a surge in patient volume arising from an incident, acknowledging that due to limited resources and infrastructure, the most reasonable location is within existing healthcare facilities or in temporary structures near existing facilities.

Why: AICAs can increase the efficiency of the delivery of inpatient care during an incident by cohorting patients with similar clinical syndromes. Such patients can be treated through protocol driven care in a single location.

Who: Local emergency managers and healthcare planners including but not limited to hospitals and primary care clinics, will best be able to determine the needs and ideal location(s) for AICA(s).

When: Each community will decide through ongoing assessment, plan development and exercises, the trigger or threshold for the activation of the AICA(s).

Where: To the extent possible, AICA(s) should be within or adjacent to existing healthcare facilities to enable the redirection of patient flow and utilize existing staffing and resources.

How: The planning and establishment of an AICA will be based on an assessment of the existing health care infrastructure in the community; and the process for resupply and resource management.

Planning assumptions for AICA include:

• The best place (economy of personnel and infrastructure needs) for sick or injured patients to be treated is within the existing health care infrastructure.
• During overwhelming medical surge, the goal of response will be to optimize the use of available resources to provide a reasonable level of healthcare to those affected by the incident.
• The AICA facilities, as well as medical personnel and supplies, will be most efficient if directed to patients of the catastrophic incident only.
• The type of incident and availability of resources will determine the staffing of the AICA. The number of patients expected to survive will dictate the allocation of medical staff.
• The AICA will function more efficiently and require fewer dedicated specialized resources if located within, adjacent to or in close proximity to a supporting hospital(s).
  

• Does the hospital or primary care clinic in the community have an identified alternate care location to direct a high volume of non-critically ill patients?
• Has the hospital or primary care clinic identified a trigger or threshold when alternate care areas needs to be established? What is the trigger and protocol for shutting the AICA down?
• Is there a plan to staff the alternative care area?
• Have supplies been identified (and or cached) to provide limited treatment and patient stabilization in the AICA?
• Does your community have a mass fatality plan?
• Is your community’s chief elected official involved in emergency operations planning?
  
  

 

There is no Tool for the AICA Function yet.

 

 

 

 

Summary
The temporary inpatient care areas established during overwhelming patient surge.

Patient Flow Protocols
These are protocols describing the discharge-admission movement between hospitals, primary care, long care and home healthcare, designed to maximize surge capacity.
Ontario Health Plan for an Influenza Pandemic July 2007: Patient Flow Protocols
Ontario Health Plan for an Influenza Pandemic July 2007: Acute Care Services

Standing Admission Orders and Treatment Protocols
Instructions for patient management that are to be followed.
Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Communicable Diseases of Urgent Public Health Concern (NY) 

Command and Control
AICA command and control needs to fit the local emergency command structure….NIMS compliant

• IS-700 National Incident Management System (NIMS) 
• A basic yet comprehensive source to better understand ICS 
• NIMS IS-700 Study Guide 

Patient Care Areas or Units Within the AICA
Specific areas are suggested for the AICA include: general layout, traffic pattern, bed spacing, and provisions for oxygen
University of Minnesota: Center for Infectious Disease Research & Policy - Alternate Care Facilities Project Concept Paper
Critical Capacity Module III Healthcare Systems - Public Health Department, Santa Clara Valley Health and Hospital System

Staffing for AICA
Description of suggested minimum staffing and plans to augment staff.
Additional Resources to Meet Surge Needs

Use "Just in Time" training approach for job descriptions.
Human Capital Management Policy for Influenza Pandemic - U.S. Office of Personnel Management
Influenza Care Centers (ICC) (CA) - University of Minnesota: Center for Infectious Disease Research & Policy

Guidelines for Documentation
Guidelines are needed to determine discharges from AICA.

Other Operational Considerations
Influenza Specialty Care Units (MA) University of Minnesota: Center for Infectious Disease Research & Policy - Alternate Care Facilities Project

Clinical Options for Patient Isolation
Additional Resources to Meet Surge Needs
California Dept. of Public Health - Payer Considerations For Hospitals During a Medical Surge Crisis
Hospital Tools and Guidelines

Patient Tracking
New Mexico Acute Care Center Job Action Sheets - NM MEMS Advisory Committee, Summer 2007
Emergency Response Patient Tracking Model

Other
(available links will be added here)

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