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Hospital Surge Capacity Toolkit

hospital surge capacity toolkit locoThis toolkit is intended to assist healthcare facilities in thinking through critical issues related to healthcare surge and to create comprehensive plans to address these needs including:







  • Providing medical surge capacity
  • Patient tracking within the hospital and during patient forwarding activities
  • Requesting resources
  • Establishing alternate care sites

How to Use Toolkit

The Hospital Surge Capacity Toolkit is designed to give you easy access to all the documents you will need to create your local plan. Each document is available in its original format (Microsoft Word or Excel) as well as a PDF document.

Click on a chapter link below to view or download the narratives/tools. If you do not have Microsoft Office or PowerPoint on your computer, you will only be able to view documents as a PDF file using Adobe Acrobat Reader. If you do not have the Adobe Acrobat Reader on your computer, you can download it here. The Acrobat Reader will allow you to view and print the documents but you cannot edit or customize them.

Customizing the Documents

The documents on the Hospital Surge Capacity Toolkit can be edited or customized to suit your specific requirements. To edit/customize a document, save it to your computer and open it with Microsoft Word or Powerpoint (you must have Microsoft Word and/or PowerPoint already installed on your computer). These documents can be opened and edited using either PC or Mac versions of the Microsoft software.

Many of the documents have fields where information can be inserted or spaces where information specific to your needs can be added. Most of the documents also have a bar graphic at the top of the page referencing the APC (Advanced Practice Center). This graphic can be removed if necessary by going to the "View" menu in Microsoft Word and highlighting "Header and Footer". Once the "Header and Footer" view is accessed, you can select the graphic and delete it.

Contact

To order your own complimentary CD-ROM with the same documents, contact:
National Association of County and City Health Officials
Advanced Practice Center
1100 17th Street, NW, Second Floor
Washington, DC 20036
Phone: (202) 783-5550
Fax: (202) 783-1583
E-mail: apc@naccho.org

Or visit the NACCHO toolbox - a free, online collection of local public health tools produced by members of the public health community.

Hospital Surge Capacity Toolkit

  • Table of Contents Word iconPDF icon
  • AcknowledgmentsWord IconPDF Icon
  • IntroductionWord IconPDF Icon
  • Acronym GuideWorid IconPDF Icon
  • Planning AssumptionsWord IconPDF Icon
  • Communication Systems Fill-in FormWord IconPDF Icon
  • Communication Systems Attachment A Fill-in FormWord IconPDF Icon
  • Risk Communications Fill-in FormWord IconPDF Icon
  • Transportation Fill-in FormWord IconPDF Icon
  • Patient Tracking IntroductionWord IconPDF Icon
  • Patient Tracking ModelWord IconPDF Icon
  • HICS 213 Incident Message Form Page 1Word IconPDF Icon

  • HICS 213 Incident Message Form Page 2 Fill-in Form
    Word IconPDF Icon
  • HICS 254 Disaster Victim/Patient Tracking Form Page 1
    Word IconPDF Icon
  • HICS 254 Disaster Victim/Patient Tracking Form Page 2 Fill-in FormWord IconPDF Icon
  • HICS 259 Hospital Casualty/Fatality Report Page 1Word IconPDF Icon
  • HICS 259 Hospital Casualty/Fatality Report Page 2 Fill-in FormWord IconPDF Icon
  • Triage Tag & InstructionsWord IconPDF Icon
  • Rapid Discharge Plan IntroductionWord IconPDF Icon
  • Rapid Discharge Plan Model Fill-in FormWord IconPDF Icon
  • ​Emergency Response Rapid Discharge Orders Fill-in FormWord IconPDF Icon
  • Emergency Response Rapid Discharge Prescription Order Fill-in Form​Word IconPDF Icon
  • Patient Transfer IntroductionWord IconPDF Icon
  • Facility Transfer Summary Fill-in FormWord IconPDF Icon

  • Facility Transfer Short Form Medical Record Fill-in Form
    Word IconPDF Icon
  • Mass Fatality ConsiderationsWord IconPDF Icon
  • Standard Of Care Fill-in FormWord IconPDF Icon
  • Surge Plan Phases 1-5 Fill-in FormWord Icon
  • Alternate Care Sites (ACS) IntroductionWord IconPDF Icon
  • ACS Facility Assessment ChecklistWord IconPDF Icon
  • ACS Facility Assessment Checklist Fill-in FormPDF Icon
  • ACS Master List Fill-in FormWord IconPDF Icon
  • ​ACS Expanded Treatment Area Medical Equipment Inventory Fill-in FormWord IconPDF Icon
  • ACS Staffing Fill-in FormWord IconPDF Icon
  • Expanded Treatment Areas (ETA) IntroductionWord IconPDF Icon
  • ETA Space Assessment Checklist Fill-in FormPDF Icon
  • ETA Properties Operated by Hospital Fill-in FormWord IconPDF Icon
  • Staffing Strategy During SurgeWord IconPDF Icon
  • Altered Care Nurse Staffing Ratio TablesWord IconPDF Icon
  • Staff Shortage Plan IntroductionWord IconPDF Icon
  • Staff Shortage Plan ModelWord IconPDF Icon
  • Pandemic Flu - Staff Contingency Plan Fill-in FormWord IconPDF Icon
  • Staff Support Plan IntroductionWord IconPDF Icon
  • Staff Support Plan Model Fill-in FormWord IconPDF Icon
  • Potential Staffing Sources Fill-in FormWord IconPDF Icon
  • Dependent Care Plan IntroductionWord Icon
  • Dependent Care Plan Model Fill-in FormWord IconPDF Icon
  • Dependent Care Registration Fill-in FormWord IconPDF Icon
  • Pet Care Plan IntroductionWord IconPDF Icon
  • Pet Care Plan Model Fill-in FormWord IconPDF Icon
  • Pet Information Fill-in Form Word IconPDF Icon
  • Facility Resource Assessment (Tool) Fill-in FormWord IconPDF Icon

  • Hospital Mutual Aid System (H-MAS) Memorandum of Understanding (MOU) Introduction Fill-in FormWord IconPDF Icon  
  • H-MAS MOU Model Fill-in FormWord IconPDF Icon
  • H-MAS MOU Quick Reference Guide Fill-in FormWord IconPDF Icon  
  • MOU Hospital Status Report Fill-in FormWord IconPDF Icon  
  • MOU Resource Request Fill-in FormWord IconPDF Icon  
  • MOU Resource Accounting Record - Supplies Received Fill-in FormWord Icon  
  • MOU Resource Accounting Record - Supplies Donated Fill-in FormWord IconPDF Icon
  • Vendor Considerations ChecklistWord IconPDF Icon
  • OverviewWord IconPDF Icon 
  • EarthquakeWord IconPDF Icon  
  • Nuclear IncidentWord IconPDF Icon  
  • Pandemic InfluenzaWord IconPDF Icon 
  • Jurisdiction Reference Material Fill-in Form
  • Florida Department of Public Health Best Practice  
  • Stanford Hospital and Clinics Model  ​
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