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Tracker Autumn 2002

Ann M. Zaia MHA, RN, CHE, COHN-S David Ozonoff, MD, MPH
Surge Capacity and the Hotel Industry

Surge Capacity
Staffing and Training
Legal Issues
Incident Command / Communications
Agency Involvement

Surge Capacity
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 staff.

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.


Staffing and Training

  • 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?

Legal Issues

  • 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?

Agency Involvement

  • 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]

About the authors:
DAVID 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:

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:

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