Alternate Outpatient Care Area (AOCA)

Strategic Function: To establish temporary ambulatory care areas to handle excess patient volumes 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: AOCAs can increase the efficiency of the delivery of acute care during an incident by handling the less severely injured and ill patients, thus reserving hospital emergency departments for the higher acuity patients.  The mission of the AOCA is to:

• Direct patients affected by the incident, especially those who are non-critical patients, away from hospitals and emergency departments.
• Render basic medical screening and provision of medical care.
• Provide limited treatment.
• Provide distribution of prophylaxis, medication, self-help information, psychosocial support and instruction. .

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 AOCA(s).

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

Where: AOCA(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 AOCA will be based on an assessment of the existing health care infrastructure in the community; and the process for resupply and resource management. 

• Staffing of an AOCA will be structured to process the expected number of patients with personnel assigned based on predefined roles using screening and treatment protocols
• Patients arrive at the AOCA primarily by their own means.
• Patients requiring in-patient care are transported to either a hospital or an Alternate Inpatient Care Area (AICA).
• It is expected that the majority of patients will be discharged home or back into the community.
• Patients determined to be pre-terminal are accommodated, monitored and provided palliative care.
• Deceased patients are pronounced dead and transferred to the AOCA’s temporary morgue.

• 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?
  
  

 

 

A sample tool to identify AOCA space and how it will be used: 

 

 

 

 

Facility	Area/Room	Existing Function	# of Possible Stations	Staffing	Equipment	Capacity
Hospital	Room 7	Conference	2	1 doctor, 2 Nurses,  2 clerks, 1 coordinator	2 small tables, 2 doctor’s chairs, 2 patient chairs, 2 screens, 25 seating capacity (benches, chairs)	25 patients an hour
Hospital	Room 14	Outpatient Infusion	2	1 doctor, 2 Nurses,  2 clerks, 1 coordinator	2 small tables, 2 doctor’s chairs, 2 patient chairs, 2 screens, 25 seating capacity (benches, chairs)	25 patients an hour
Hospital	Auditorium	Lectures	3	1 doctor, 3 nurses, 3 clerks, 1 coordinator	3 small tables, 3 doctor’s chairs, 3 patient chairs,  Auditorium seating	40 patients an hour
Hospital	Hallway to Cafeteria	Corridor	4	1 doctor, 4 Nurses,  4 clerks, 1 coordinator	2 small tables, 2 doctor’s chairs, 2 patient chairs, 2 screens, benches or 50 chairs along walls	50 patients an hour

Summary
The temporary ambulatory care areas set up within existing facilities or in temporary structures outside of existing facilities.

Patient Tracking
Process identified to track location and disposition of patients seeking care and admitted to system.

University of Minnesota: Center for Infectious Disease Research & Policy - Appendix I: Alternate Care and Triage (NY)

Facility Administrator Role in the Alternate Outpatient Care Areas (AOCA):
Define role and responsibilities of the facility administrator specific to AOCA.

Financial Tracking
Relates to tracking lost revenue and costs during incident response. Tracking should include investment in preparedness activities, lost revenue when closing inpatient beds, tracking hospital costs, and recovery after the incident.

Incident Command Positions
Positions include: Operations Section, Planning/records Section, Logistics/Service Support Section, Safety Officer and Other Staff (All NIMS compliant).
Ontario Health Plan for an Influenza Pandemic July 2007 (see page 11) 

Emergency Medical Services Response During Virginia Tech Response 

A basic yet comprehensive source to better understand ICS

Non-Federal, Non-hospital based alternative care sites

Description of Possible AOCA
This describes the physical characteristics and resources required and possible existing spaces that could be used as the AOCA.
Ontario Health Plan for an Influenza Pandemic July 2007 (see pages 2 thru 9) 

Additional Resources to Meet Surge Needs

Ontario Health Plan for an Influenza Pandemic July 2007 (see pages 16, 17, 19, and 20) - Non-Federal, Non-hospital based alternative care sites

AOCA Supplies
A list of the supplies needed for the AOCA.
Additional Resources to Meet Surge Needs

Staffing for AOCA
A. Description of suggested minimum staffing and plans to augment staff.

B. Use of “Just in Time” training approach for job descriptions.
Ontario Health Plan for an Influenza Pandemic July 2007 (see pages 10 thru 14) 

Patient Triage
Ontario Health Plan for an Influenza Pandemic July 2007 - Influenza Assessment, Treatment and Referral Centre Tools

University of Minnesota: Center for Infectious Disease Research & Policy - "Triaging/Screening People"

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