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COVID-19 Alternate Care Site Resources
Topic Collection
November 14, 2023

Topic Collection: COVID-19 Alternate Care Site Resources

This Topic Collection focuses on plans, tools, templates, and other immediately implementable resources to help with COVID-19 preparedness, response, recovery, and mitigation efforts, focusing on the establishment and operation of Alternate Care Sites.

ASPR's Federal Healthcare Resilience Task Force Alternate Care (ACS) Toolkit can help state, local, tribal, and territorial entities establish an ACS.

This Resource Collection was reviewed in Fall 2023. Please refer to CDC’s Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID-19 outbreak management.

If you have COVID-19 best or promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area. Resources specific to Alternate Care Sites can be placed under the COVID-19 Alternate Care Site Resources Topic.

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Must Reads

ASPR TRACIE. (2020). ACS Funding Summary: Establishment and Operationalization.
This tip sheet summarizes the funding available through various sources to establish and operationalize alternate care sites.
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ASPR TRACIE. (2020). Baltimore Convention Center Field Hospital: One State's Experience during COVID-19.
ASPR TRACIE met with the joint leadership team from the Baltimore (MD) Convention Center Field Hospital (BCCFH), a joint effort to establish an alternate care site (ACS) created to help manage the patient surge from the COVID-19 pandemic. This case study highlights their experiences standing up and maintaining this ACS and includes challenges and considerations by category in the hopes that the information can be helpful to stakeholders engaged in similar planning and response efforts.
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ASPR TRACIE. (2020). Funding Sources for the Establishment and Operationalization of Alternate Care Sites.
Speakers discuss funding options for establishing ACSs, the operation and ongoing administration of ACS, and for direct patient care costs.
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ASPR TRACIE. (2020). Use of Telemedicine in Alternate Care Sites (Webinar).
The COVID-19 pandemic and the associated community mitigation efforts enacted have altered the delivery of and access to healthcare across the U.S. Healthcare providers are looking for new and innovative ways to deliver patient care to accommodate social distancing and community mitigation measures. The use of telemedicine has grown significantly in recent months. In addition to being used by outpatient providers, telemedicine plays an integral role in Alternate Care Sites (ACS). ACS are one of many alternate care strategies intended to provide additional hospital surge capacity and capability. HHS ASPR and ASPR TRACIE hosted this webinar where speakers discussed operations, management, and lessons learned from using telemedicine in these settings.
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COVID-19 Healthcare Resilience Working Group. (2020). Surge Roadmap: Strategies for Managing a Surge in COVID-19 Cases.
The speakers provide an overview of the "Surge Roadmap" and related COVID-19 patient management strategies.
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Federal Healthcare Resilience Task Force. (2020). Alternate Care Site (ACS) Toolkit: Third Edition.
This Toolkit was developed to help state, local, tribal and territorial (SLTT) entities to address potential shortages in medical facilities during the 2020 COVID-19 pandemic. It is intended to provide technical assistance to SLTT entities in establishing and operationalizing Alternate Care Sites (ACS).
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  • Bridget Kanawati Thank you for your additional comments and we have sent them to the ACS Task Force.
    4/13/2020 4:23:52 PM
  • Matthew Tybor Considerations for the law enforcement section: If the ACS site is planning to accept patients from the respective Department of Corrections.
    4/13/2020 3:37:20 PM
  • Bridget Kanawati Thank you for your feedback on the Toolkit. We have passed your suggestions on to the ACS Task Force for consideration.
    4/11/2020 10:31:18 AM
  • Matthew Tybor This document was helpful. For communicating at a higher level accomplishments and problems with site development I would consider breaking it down into four categories of Building the Site, Staffing the Site, Supplying the Site, and Sustaining the Site (BS3). I have found that using the BS3 during the planning process helps with collaboration with all applicable stakeholders.
    4/10/2020 2:18:47 PM

Plans, Tools, and Templates

American Hotel and Lodging Association and American Society for Health Care Engineering. (2021). Hotel-Hospital COVID-19 Response Playbook.
This playbook offers information to guide the conversion of hotels into alternate care sites for COVID-19 response.
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American Institute of Architects. (2020). Alternative Care Sites Preparedness.
This page includes a downloadable ACS Assessment Brief, Frontline Perspective whitepaper and Preparedness Assessment Tool. The assessment tool, which is also available in French, Spanish and Vietnamese, is expected to help identify appropriate adaptive reuse sites for occupancy during the pandemic. A project database and survey contain additional project information and encourage information sharing for the development of best practices for responding to pandemics.
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American Society for Health Care Engineering. (2020). Converting Alternate Care Sites to Patient Space Options. (Added 4/29/2020.)
This page includes resources on how to increase patient space through alternate care sites. It includes links to federal guidance, videos, diagrams, and additional design considerations.
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American Society of Health-System Pharmacists. (2020). Patient Surge Management During a Pandemic: Toolkit for Hospital and Health System Pharmacy. (Added 6/12/2020.)
This toolkit highlights lessons learned related to executive emergency orders, drug utilization, pharmacy workforce management, facility surge, and pharmacy service lines along with resources created in response to COVID-19.
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AMI Health (in support of ACS San Diego). (2020). Sample ACS Provider Intake Assessment and Clinical Progress Notes.
This form can be used by ACS staff to document patients at intake and throughout clinical progression.
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ASHRAE and U.S. Army Corps of Engineers. (2021). Alternate Care Site: HVAC Guidebook. (Added 1/11/2021.)
This illustrated guidebook was developed for alternate care sites established in response to a surge in COVID-19 cases and situations where hospital capacity has been reached. Certain chapters of the guidebook are written specifically for the COVID-19 pandemic, but may also be relevant for similar viruses transmitted via infectious aerosols and through droplets.
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ASPR TRACIE. (2020). ACS Funding Summary: Establishment and Operationalization.
This tip sheet summarizes the funding available through various sources to establish and operationalize alternate care sites.
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Dhagat, P., Madad, S., Pati, R., et al. (2021). Infection Prevention and Control and Environmental Health and Safety for COVID-19 Isolation and Quarantine Hotels: Tailoring Existing Recommendations and Implementing Innovative Strategies Within the Hotel Setting. (Added 3/25/2021.) New York City Health + Hospitals.
This overview of the environmental health and safety and IPC measures implemented in the New York City COVID-19 isolation and quarantine hotel programs, is intended for individuals working in infection prevention, healthcare worker safety, emergency management, public health, and social work, and for those selecting and setting up COVID-19 isolation or quarantine hotels.
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District of Columbia Department of Health, Heath Emergency Preparedness and Response Administration. (2010). Alternate Care Site Pandemic Surge Optimization Plan. Braintree Solution Consulting, Inc.
This template was developed to help the D.C. Department of Health develop a comprehensive and prescriptive response plan. It includes guidance for site selection, operations, staffing, low acuity care CONOPS, community-focused ambulatory care clinic CONOPS, and primary triage point CONOPS. Appendices include sample emergency legislative orders, alternate care site admission orders, and site selection matrix.
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East-West Gateway Council of Governments. (2016). East-West Gateway Council of Governments Regional Alternate Care Site Plan.
This plan contains documents that fully detail the St. Louis Area Regional Response System (STARRS) approach to Alternate Care Sites (ACS). It highlights how ACS can be used to alleviate the burden caused by a surge of patients entering the healthcare system.
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Federal Healthcare Resilience Task Force. (2020). Alternate Care Site (ACS) Toolkit: Third Edition.
This Toolkit was developed to help state, local, tribal and territorial (SLTT) entities to address potential shortages in medical facilities during the 2020 COVID-19 pandemic. It is intended to provide technical assistance to SLTT entities in establishing and operationalizing Alternate Care Sites (ACS).
Favorite:
2
You must Login to add a comment
  • Bridget Kanawati Thank you for your additional comments and we have sent them to the ACS Task Force.
    4/13/2020 4:23:52 PM
  • Matthew Tybor Considerations for the law enforcement section: If the ACS site is planning to accept patients from the respective Department of Corrections.
    4/13/2020 3:37:20 PM
  • Bridget Kanawati Thank you for your feedback on the Toolkit. We have passed your suggestions on to the ACS Task Force for consideration.
    4/11/2020 10:31:18 AM
  • Matthew Tybor This document was helpful. For communicating at a higher level accomplishments and problems with site development I would consider breaking it down into four categories of Building the Site, Staffing the Site, Supplying the Site, and Sustaining the Site (BS3). I have found that using the BS3 during the planning process helps with collaboration with all applicable stakeholders.
    4/10/2020 2:18:47 PM
Florida Department of Health. (n.d.). Alternate Care Site Operations Guide. (Accessed 4/14/2023.)
Designed as a planning and operational resource, this guide includes information on the purpose of alternate care sites and describes activation triggers, establishment steps, site organization, operations, logistics, and finance and administration considerations. Also included is an Alternate Care Site Quick Start Guide that includes checklists, role-based task lists, and other operational resources.
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Florida Department of Health. (2020). Alternate Care Site Local Plan Development Guidance.
This guidance provides an introduction to alternate care sites (ACSs) and outlines the steps to develop a local ACS plan.
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Hassol, A. and Zane, R.. (2006). Reopening Shuttered Hospitals to Expand Surge Capacity: Surge Tool Kit and Facility Checklist. Agency for Healthcare Research and Quality.
This toolkit addresses the management, legal, facilities, staffing, security, equipment and supplies, and patient transport issues to consider when planning to reopen a closed hospital within three to seven days, operations, and re-closure.
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Inyo County Health and Human Services - Health Division. (2011). Government Authorized Alternate Care Site (GAACS) Plan.
This plan guides a county's activation and management of a government authorized alternate care site to decompress its local healthcare system. The plan includes numerous appendices with organizational charts, process flows charts, job action sheets, forms, checklists, sample layouts, supply lists, and standing orders. It also includes detailed information on oxygen delivery alternatives and fatality management.
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Northwest Portland Area Indian Health Board. (2021). Alternate Care Sites. (Added 6/21/2021.)
This page provides links to statements of work, concept of operations, plans, templates, guidance, and other documents relevant for establishing alternate care sites, recovery and isolation centers, and federal medical stations.
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General Resources

American Society of Health-System Pharmacists. (2020). Planning and Preparation Considerations for Alternate Care Site/Field Hospital Operations.
This checklist identifies issues to consider when planning to establish an alternate care site or field hospital.
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ASPR TRACIE. (2020). Alternate Care Site (ACS) Resources.
This ASPR TRACIE TA Response includes several plans for key recommendations for ACS staffing (and typical skilled nursing facility staffing for comparison).
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  • Audrey Mazurek Thank you Ms. Mitchell for your comment. ASPR TRACIE recently responded to a technical assistance request related to ACS sources of additional staff and we included your comment below in that response: https://files.asprtracie.hhs.gov/documents/aspr-tracie-ta---covid-19-acs-sources-of-additional-staff.pdf.
    4/2/2020 5:11:07 PM
  • Megan Mitchell I don't understand how large groups of available practitioners are being left out of these plans. The physical therapist is qualified to mobilize patient, deep suction, teach and train in breathing strategies, strength train and most importantly get patient functional enough to return home. We are not going to have enough of any one discipline to cover both hospital systems let alone additional off-site locations. We need to include everyone who has useful skills.
    3/31/2020 9:03:03 AM
ASPR TRACIE. (2020). Alternate Care Sites (ACS) Sources of Additional Staff.
This ASPR TRACIE TA response document includes comments from ASPR TRACIE Subject Matter Expert Cadre members and resources related to potential sources for additional staffing for an ACS.
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ASPR TRACIE. (2020). Alternative Care Sites-The Federal Experience in New York City.
Throughout the spring of 2020, COVID-19 ravaged the City of New York. State and city authorities worked with the Jacob K. Javits Convention Center to create an alternate care site where healthcare providers could solely treat COVID-19 patients. ASPR TRACIE met with several members of the federal medical teams deployed to the Javits Center to learn more about their experience.
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ASPR TRACIE. (2020). COVID-19 Alternate Care Strategies (Webinar).
The speaker in this short webinar describes an alternate care site and a federal medical station, and explains resources and steps for standing up these resources.
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ASPR TRACIE. (2020). Designated COVID-19 Hospitals: Case Studies and Lessons Learned.
Between September 9, 2020 and October 20, 2020, the ASPR TRACIE team interviewed decision makers and lead physicians at four designated COVID-19 hospitals. The interviews focused on the facilities’ decision-making processes, operations and logistics (space, staff, stuff), and general lessons learned. These facilities were already operational or existing hospitals; they were not “Alternate Care Sites.” Additionally, the entire facility was designated to solely treat COVID-19 positive patients; all other patients were transferred or directed to nearby hospitals.
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ASPR TRACIE. (2020). Funding Sources for the Establishment and Operationalization of Alternate Care Sites.
Speakers discuss funding options for establishing ACSs, the operation and ongoing administration of ACS, and for direct patient care costs.
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ASPR TRACIE. (2020). Use of Telemedicine in Alternate Care Sites (Webinar).
The COVID-19 pandemic and the associated community mitigation efforts enacted have altered the delivery of and access to healthcare across the U.S. Healthcare providers are looking for new and innovative ways to deliver patient care to accommodate social distancing and community mitigation measures. The use of telemedicine has grown significantly in recent months. In addition to being used by outpatient providers, telemedicine plays an integral role in Alternate Care Sites (ACS). ACS are one of many alternate care strategies intended to provide additional hospital surge capacity and capability. HHS ASPR and ASPR TRACIE hosted this webinar where speakers discussed operations, management, and lessons learned from using telemedicine in these settings.
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Cybersecurity and Infrastructure Security Agency. (2020). Emergency Communications Best Practices For Establishing Alternate Care Sites. (Added 12/10/2020.) U.S. Department of Homeland Security.
This document identifies best practices for establishing communications capabilities in Alternate Care Sites during a disaster.
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Federal Emergency Management Agency. (2020). Healthcare Capacity Building: Alternative Care Sites and Federal Medical Stations.
This fact sheet explains the differences between alternate care sites (ACS) and Federal Medical Stations (FMS), identifies planning resources and federal support for establishing an ACS, and includes a quick reference chart comparing an ACS to and FMS.
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International Association for Healthcare Security and Safety. (2020). IAHSS Security Design Guidance for Alternate Care Sites - Medical Surge Capacity.
This guidance can help healthcare security practitioners, design teams, clinicians and building owner representatives ensure physical security of alternate care sites.
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Knickerbocker, D.. (2014). Federal Medical Station (FMS). (Please request document from ASPR TRACIE: askasprtracie@hhs.gov.) U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response.
This document provides an overview of the Federal Medical Station (FMS), including what is included in the FMS cache and examples of how they have been deployed during events. Also included are a fact sheet and staffing model for the 50-bed FMS, a FMS Wrap Around Checklist, and FMS Site Survey Checklist. Please note that the descriptions provided in this resource are specific to federal FMS operations only.
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National Health Care for the Homeless Council. (2020). Medical Respite Care and Alternate Care Sites. (Added 5/15/2020.)
This issue brief outlines considerations for communities providing respite care to people experiencing homelessness to promote infection prevention or offer a safe place while waiting for COVID-19 test results or recovering from illness. The document includes links to guides, protocols, and handbooks used in some communities.
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Nelsen, G., Pigott, H., Hopkinson, C., and Formea, C. (2020). Considerations for Development of Pharmacy Support Models for COVID-19 Alternate Care Sites. American Journal of Health-System Pharmacy.
This article describes the planning considerations of one health system’s pharmacy department to support pharmacy operations at an alternate care site (ACS). Building upon the Federal Healthcare Resilience Task Force ACS Toolkit, U.S. Army Corps of Engineers ACS guidance web page, and crisis standards of care concepts, the pharmacy team developed resource lists to meet the needs of their expected patient population. Included in appendices and tables are: key assumptions and issues in medication list planning for an ACS, key medication-related and staffing questions to consider in alternate site care planning, and considerations and options for IV infusion pump use, staffing, and transitions of care at an ACS.
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