Surge Capacity and the Hotel Industry
Staffing and Training
Incident Command / Communications
It has long been recognized that providing sufficient excess capacity to handle a sudden and drastic
increase in demand for acute care in an emergency, so called “surge capacity,” is a major
weakness in our emergency response system. In the current regime of stringent control of medical costs
it is neither feasible nor likely that excess capacity in our hospital system would be tolerated. Yet
if there were a large epidemic or pandemic or even a medium-sized mass-casualty event, our current
healthcare system would be quickly overwhelmed and overrun. Acute care beds would fill up quickly and
isolation wards could become full within hours. Indeed, consider what alternative resources would be
required should a disaster render one of our major healthcare facilities inoperable. To anyone who
finds this concept inconceivable, one only needs to look back to the San Francisco earthquake of 1906
to find that it left the Agnew State Hospital in near ruin.
One potential source of available capacity that has been overlooked is the many rooms, beds and
ancillary facilities in the “hospitality industry” (hotels and motels). Hotels and motels
are located in urban, suburban and rural areas, have private rooms with bathrooms, and are supported by
efficient ancillary services like kitchens and laundries. Moreover, unlike dormitories or apartment
buildings, no one lives in the rooms. The transient residents have only enough belongings to fit in
easily portable suitcases and can be relocated quickly. Vacancy rates often run as high as 30%. Many
large and medium-sized hotels are located near hospitals and could potentially serve many public health
needs in the event of a disaster, including serving as alternative healthcare facilities, triage sites,
debriefing units to provide counseling and support for emergency responders, and lodging for emergency
The New England Collaborative for Public Health Preparedness has been working with Richard Sharp,
Director of Security for the Marriott Hotel of Boston, and Skip Brandt, Director of Security of the
Boston Park Plaza Hotel, to explore this concept. A meeting of the Collaborative was held at the Boston
Park Plaza Hotel on July 30th to establish working groups for the surge capacity project. In attendance
were experts from New England and Washington in the areas of public health, hospital architecture,
hotel security, law enforcement, emergency response, healthcare, and governmental agencies. At this
meeting, five working groups were formed. These groups began to identify topical areas that must be
addressed in order to formulate a plan involving the use of hotels in the event of a disaster. Some of
the issues defined by these working groups are discussed below.
Where will provider staff come from if hospitals are
utilizing all available personnel?
Who will train responders?
Should there be a single training model to establish
consistency and replication of actions regardless of disaster locale?
What will be required to reconfigure a hotel to meet
the immediate needs of healthcare surge capacity?
How would portable nursing stations be set up quickly
on a hotel/motel floor?
How and where would supplies be obtained and stored for
these surge capacity needs?
How will providers be protected if they respond outside
of their typical work setting; what are the liability issues?
Does a plan to turn a hotel/motel into a temporary
hospital require hospital licensure or particular
How would hotels/motels be reimbursed?
Incident Command / Communications
Who would be in charge?
How would vital information be disseminated; what would
the communications infrastructure look like?
Which governmental or non-governmental agency
would/should control the surge capacity response?
While there is considerably more work to be done on the
issue of surge capacity, the importance of the hotel industry’s ability to make a significant
contribution toward disaster response has been established. Continued efforts by The New England
Collaborative for Public Health Preparedness and other agencies in this arena have already yielded
novel and innovative solutions to this very significant public health readiness issue.
[Return to Autumn 2002 main page]
OZONOFF, MD, MPH, is Professor of Public Health and
Chair of the Department of Environmental Health at
Boston University School of Public Health. In addition
he directs the Superfund Basic Research Center at Boston
University and is Professor of Sociomedical Sciences and
Community Medicine at Boston University School of
Medicine. He is the author of numerous scientific
articles, is on the editorial boards of Archives of
Environmental Health, American Journal of
Industrial Medicine, and The Journal of Urban
Health, and is the North American Editor-in-Chief of
the online journal, Environmental Health. He is a
Fellow of the Johns Hopkins Society of Scholars and a
Fellow of The Collegium Ramazzini. Dr. Ozonoff
may be reached via e-mail: email@example.com.
ANN MORRIS ZAIA, MHA, RN, CHE, COHN-S is Director of
Network Consulting for Operations for the CareGroup
Occupational Health Network. She is double
board-certified as a Healthcare Executive (CHE) and an
Occupational Health Nurse-Specialist (COHN-S). Her areas
of expertise include practice management, strategic
planning and development, police and firefighter
wellness, and healthcare information systems. She is
currently enrolled in a Masters program at Simmons
College and Harvard University and will begin a Doctoral
Program at Harvard University this fall. She is
presently working on a research initiative with the
Greater Boston Association of Occupational Health Nurses
to assess bioterrorism preparedness. Ms. Zaia may be
reached via e-mail: firstname.lastname@example.org.
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