ALTERNATE CARE SITE PLANNING

TEMPORARY MEDICAL TREATMENT STATIONS

Why TMTS? In Illinois, we have adopted the TMTS terminology instead of Alternate Care Site (ACS) as this is a better descriptor.

T=Temporary, these are temporary operational facilities

M=Medical, describes the function of the space

T=Treatment, describes the type of service provided

S=Station, emphasizes the interim nature of the care

This guide was developed with input from experienced disaster healthcare responders, community and regional partners, and subject matter experts from many disciplines. The forms were taken directly from substantiated sources as well as from disaster response teams from various areas of the country.

Like any other operations document, it is most important to review BEFORE you need it. Moreover, your review and subsequent feedback can help us make this even more useful in future versions.  Comments and suggestion should be sent in via this webpage.

THE GUIDE

The subject of providing emergent medical care in non-hospital settings is complicated. The need for such measures would likely only be because of a catastrophe that requires the evacuation of a population or an event that paralyzes or destroys the local health care infrastructure. The set-up and operation of a Temporary Medical Treatment Station (TMTS) requires collaboration with local, regional and state healthcare providers, stakeholders and officials. A disaster declaration will usually be required.  Scope of care (acuity level of patients) should be pre-determined and based on a well-defined mission. For instance, cohorting stable isolation patients.  This guide is only for adult patients.

This provisional guide is meant to be a resource for healthcare providers and emergency managers to use as a resource to set-up and operate a Temporary Medical Treatment Station in response to a catastrophic emergency.  The guide is specifically designed to be useful during TMTS training or an actual event.

You can download the entire TMTS guide or visit the sections of the site to get more details and download the individual pieces you need.  These documents are constantly evolving and should be considered a draft to serve as a starting point for your individual needs.  As you review and use these documents, please comment here on this site or send your feedback to us.  We are always making changes and improvements based on feedback.

Full TMTS Guide for you to explore

Full TMTS Guide

ORGANIZATIONAL TOOLS

In this section there are multiple forms that will be critical for keeping operations organized. The use of the Hospital Incident Command System works well, though some modifications are necessary for field operations in a TMTS.  Included are a collection of forms that cover the TMTS operations and Job Action Sheets (JAS) for each position.  A sample organization chart that is used by IMERT has been provided as an example.  It is very clinically focused and meant to organize resources around the patient care process.  Also included, as examples, are copies of the IMERT Triage and Treatment record, doctors’ orders, nurses notes, etc.

These forms are all provided as examples only, and can be modified to fit various operational roles and needs.  For example, one can add, subtract or double up on assigned tasks as needed and modify the Hospital Incident Command System (HICS) forms accordingly.

HICS FORMS

JOB ACTION SHEETS

ORG CHARTS

SAMPLE MEDICAL FORMS

Executive Summary

An epidemic caused by influenza or other infectious disease outbreak, a WMD or naturally occurring catastrophe could result in “mega casualties”. The customary health care infrastructure may become insufficient or completely incapacitated. Vital resources of health care personnel, materials, and equipment will likely be in short supply. One method to manage a massive influx of patients or to decompress saturated hospitals is the utilization of temporary medical treatment stations (TMTS).


There are two distinct event categories that could require the utilization of a TMTS

EMERGENT

Likely to require a rapid deployment in response to a sudden catastrophe.  Mutual aid will likely be available, although on an unknown time schedule.  Potential scenarios include an evacuated population and infrastructure function paralyzed or destroyed.  The scope of care provided will be fluid and based on responder medical skill level, leadership and organizational capability, available mobile supplies, as well as the specific patient needs. The extent of the mission will likely be short term, with the acute needs phase lasting less than 2 weeks. Though certain circumstances, like an earthquake impacting multiple states, may require a longer time frame.

STRATEGIC

Likely last step in managing an extended medical surge event due to an outbreak or Bio-Terrorism (BT) event. Mutual aid will likely be nonexistent. Scope of care (acuity level of patients) should be pre-determined and based on a well-defined mission, for instance, cohorting stable isolation patients.   This determination will help with focusing clinical providers and in defining essential equipment and supply needs. The TMTS may be needed for many weeks to months.

Given the range of planning requirements to develop contingencies for epic events like those listed above, the aim of this guide is to provide fundamental samples of operational principles as an interim plan until a more comprehensive tool becomes available.

RESOURCES

This link from US Health and Human Services provides a collection on ACS topics of lessons learned, tools and promising practices for developing and activating alternate care sites. We will be adding more resources as they become available.

ASPR TRACIE