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COVID-19 Alternate Care Site Resources
Topic Collection
April 6, 2020

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 and ACS.

Please refer to CDC’s Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID19 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.

Must Reads


Office of the Assistant Secretary for Preparedness and Response. (2020). Federal Healthcare Resilience Task Force Alternate Care (ACS) Toolkit: First 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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  • 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

Select Resources


This ASPR TRACIE TA Response includes several plans for key recommendations for Alternate Care Site 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
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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This document includes a comprehensive definition of the term “alternate care site” (ACS) and the guidance it contains can help staff develop ACS planning teams, plan for specific threats (a supply list and pandemic-specific considerations for medication storage are used as an example; job action sheets are included, too), and adequately care for patients on site.
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Centers for Disease Control and Prevention. (2020). Alternate Care Sites: Infection Prevention and Control Considerations for Alternate Care Sites. U.S. Department of Health and Human Services.
This guidance offers infection control considerations for alternate care sites. It provides planning considerations and further details to address the physical infrastructure, provided services, and patient care.
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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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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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Florida Department of Health. (n.d.). Alternate Care Site Local Plan Development Guide. (Accessed 3/31/2020.)
This guide provides information to local communities developing alternate care site plans. It is complementary to other alternate care site resources developed by the state of Florida.
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Florida Department of Health. (n.d.). Alternate Care Site Operations Guide. (Accessed 3/23/2020.)
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, Bureau of Preparedness and Response. (2013). Alternate Care Site Standard Operating Procedure.
Broken into six sections (e.g., concept of operations, authorities and references, and attachments), this state-specific standard operating procedure can be tailored by other states involved in designating and planning for Alternate Care Sites. Specific logistics and staffing recommendations are made with comprehensive supply lists.
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Hassol, A. and Zane, R. (2006). Reopening Shuttered Hospitals to Expand Surge Capacity. Agency for Healthcare Research and Quality.
This guidance document provides tools and recommendations to help planners determine if and how to utilize an abandoned or shuttered hospital for surge capacity needs during a mass casualty or other similar event. It provides staffing requirements, safety checklists, supplies and equipment needs, and regulatory/legal issues to consider.
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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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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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Office of the Assistant Secretary for Preparedness and Response. (2020). Federal Healthcare Resilience Task Force Alternate Care (ACS) Toolkit: First 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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  • 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
U.S. Army Corps of Engineers. (n.d.). Alternate Care Sites. (Accessed 3/23/2020.)
This page includes operational templates to assist state and local governments in assessing and developing alternate care sites.
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