Many places are suitable for conversion to a TMTS.  Schools, particularly local community colleges or high schools are excellent sites. The desirable features on a campus often include: accessibility for wheelchairs and gurneys, multiple class rooms and gymnasiums for patient care, multiple bathrooms and showers, a loading dock, IT connectivity, HVAC, parking, food prep areas and much more.

The site selection tool is meant to be used to catalog these features to assist planners and responders in converting a non-traditional arena into a patient care environment. This tool has been utilized many times, revised and reviewed by multiple subject matter experts. It is highly recommended that this form be filled out as soon as possible upon arrival to any site that will be used as a TMTS. Prompt assessment of the site will identify gaps and vulnerabilities that can then be remediated to provide a safe and sustainable TMTS.

Download the Site Selection Tool


AHRQ also provides a Disaster Alternate Care Facility Selection Tool, which can be found here.  Additional resources are available online at http://www.ahrq.gov/prep/.  Another tool is AHRQ’s Reopening Shuttered Hospitals to Expand Surge Capacity.  Although this document examines shuttered, hospitals, the principles can be applied to general site assessment.

Site Security


Many facilities can be secured with adequate manpower, however, security personnel may be in short supply during a disaster scenario. Choosing a building which is easily securable may reduce the number of security personnel required and/or enhance security performance.  The following characteristics can assist with creating a secure TMTS facility.

  • Secured entrances and exits
  • Adequate outdoor flood lighting
  • A building which can easily secure and separate the nursing subunits and administrative sections from the admissions/registration area
  • The ability to lockdown the facility

Infastructure


Doorways and Corridors

  • • Doors should be wide enough to easily accommodate wheelchairs and wheeled stretchers as well as any intravenous poles that may be attached.
  • • Corridors should be wide enough to allow two-way traffic of stretchers.

Electricity Supply

  • • Must be surge protected to protect computers and electronic equipment
  • • Medical equipment and computers must have access to emergency power
  • • If not present on site, emergency generators and uninterruptible power supply (UPS) units should be included in the TMTS supply list
  • • Ideally, would have specialized electrical outlets required to provide critical care-level medicine

Heating and Air Conditioning.  The site should have climate control

Lighting

  • • Clinical areas must have adequate artificial lighting in order to perform procedures, assessments, and other forms of direct patient care.
  • • Natural sunlight can minimize patient and staff disorientation.

Floor Coverings should be durable, non-slip (no carpeting) , and impermeable to water and bodily fluids

Potential Sites


Any TMTS site selected will have advantages and disadvantages. Possible sites include:

  • Aircraft hangers.
  • Churches or schools.
  • Community centers, recreation centers or meeting halls.
  • Community colleges
  • Convalescent care centers
  • Detention facilities
  • Fairgrounds.
  • Hotels or motels.
  • High schools
  • Government buildings, military facilities, or National Guard armories.
  • Same-day surgical centers or clinics.
  • Shuttered hospitals.
  • Sports facilities (including stadiums).
  • Trailers or tents (military or other)
  • Warehouses

 

Schools: High schools and middle schools generally offer a better layout with more on site facilities than elementary schools.

  • Potential Advantages
    • Schools have parking lots, long wide corridors, large separated classrooms, private administrative offices, and other immediately available resources such as tables and chairs and offer an ideal physical structure that can meet most clinical needs.
    • Schools also have cafeterias, bathrooms, lounge facilities, backup generators, shower facilities, public address systems, laundry facilities, loading ramps, and communication links.
    • Considering that most high schools are public facilities, they may be easier to commandeer in an emergency or make MOU arrangements with.
  • Potential Disadvantages
    • •When needed, they may have a school population present, which can complicate logistics
    • (evacuation of school will mean an influx of parents; may need to wait until each child has left
    • the building before any inpatient services can begin)
    • • There may be a lasting stigma attached to any future use of a building which has been used as a TMTS where communicable pathogens/agents were potentially present. This effect will likely be amplified because children are involved. Additional decontamination measures may be necessary to satisfy the community of the building’s safety.

Enclosed Large Scale Spaces (Convention Centers, Sports Arenas, etc.)

  • Potential Advantages
    • •Easily identifiable and well known to the public
    • •Large gathering space sufficient to accommodate high volume traffic
    • •Pre-existing public transportation links and large parking areas
    • •Offers the possibility of centralizing the TMTS into one large facility
    • •Have food preparation areas, large capacity restrooms, backup generators, climate control, public address systems, and advanced communication links, such as satellite and broadcasting capabilities.
    • •Sports arenas have laundry and shower facilities in their team locker rooms
  • Potential Disadvantages
    • •Securing the site and all of its areas may be challenging because of the large size
    • •Large potentially uncontrollable central space may be susceptible to stampeding in the case of a riot or general panic

Hotel Conference Rooms

  • Potential Advantages
    • •Has access to beds, tables, and chairs
    • •Large open space
    • •Climate control, backup generators, various amenities, large storage space, access to laundry facilities, kitchens, and large capacity restrooms.
  • Potential Disadvantages
    • • Private hotels may not be willing to serve as a TMTS and may be difficult to commandeer in an emergency.
    • • Patients and stretcher traffic may find it difficult to access the conference room from the hotel entrance.

Churches / Religious Spaces

  • Potential Advantages
    • •Easily identifiable and well known to the public
    • •May have large event halls
  • Potential Disadvantages
    • •Layout may not be ideal. Pews may obstruct the flow of patients / staff and limit the utility of the main worship area
    • •Churches already provide an important function in a time of crisis and they may be needed by the community to offer support for those affected

University Gymnasiums

  • Potential Advantages
    • •May already be situated near a university hospital
    • •Large open space
    • •Likely to have shower facilities
    • •Has access to extra man power (university athletic teams)
  • Potential Disadvantages
    • • May not be willing to serve as an TMTS site unless it is a public institution

Veterinary Hospitals/Day Clinics

  • Potential Advantages
    • •Will likely have preexisting medical facilities (sterile environments, medical gas pipelines, medical equipment, electrical capacities, etc.) which can easily be converted patient care purposes.
  • Potential Disadvantages
    • •Readying a veterinary facility will likely require evacuating all animals on site. Finding a temporary shelter for all animals on site may be a challenge

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