The Agency for Healthcare Research

and Quality (AHRQ) is the lead agency

charged with supporting research

designed to improve the quality of

health care, reduce its cost, address

patient safety and medical errors, and

broaden access to essential services.

AHRQ sponsors and conducts research

that provides evidence-based

information on health care outcomes;

quality; and cost, use, and access. 

The information helps health care

decisionmakers—patients and 

clinicians, health system leaders, and

policymakers—make more informed

decisions and improve the quality of

health care services.

Bioterrorism

and Health System Preparedness

Issue Brief

Addressing Surge Capacity 

in a Mass Casualty Event

No. 9

Introduction

A bioterrorist attack or other large-scale

public health emergency has the potential

to result in great numbers of human

casualties. Substantial work has been

done throughout the country at local,

regional, State, and Federal levels to

improve health system preparedness, and

many health care organizations and

systems have developed surge capacity

and other medical care preparedness

plans. Planning for a mass casualty event

should also address what can be done

outside the traditional health care system

to cope with a surge in patient flow

before, during, and after an event.

In 2004, the Agency for Healthcare

Research and Quality (AHRQ) expanded

its Bioterrorism Preparedness Research

portfolio to include several projects that

focus on surge capacity issues. Consistent

with that focus, AHRQ sponsored three

Web conferences on surge capacity and

health system preparedness. The first

dealt with education and training; the

second with facilities and equipment; and

the third in the series, held on October 26,

2004, examined some of the ways

resources might be deployed in response

to a mass casualty event. This issue brief

summarizes this third Web conference. 

Four panelists made presentations: 

▲ Robert Claypool, M.D., Deputy Chief

Medical Officer, Office of the

Assistant Secretary for Public Health

and Emergency Preparedness, U.S.

Department of Health and Human

Services 

▲ Nathaniel Hupert, M.D., Assistant

Professor of Public Health and

Medicine, Weill Medical College of

Cornell University

Surge capacity is a health

care system’s ability to expand

quickly beyond normal

services to meet an increased

demand for medical care in

the event of bioterrorism or

other large-scale public health

emergencies.

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality
▲ Michael Shannon, M.D., Director

of the Center for Biopreparedness

and Chief of the Hospital’s

Emergency Medicine Division,

Children’s Hospital Boston 

▲ Gregory Bogdan, Ph.D., Research

Director and Medical Toxicology

Coordinator, Rocky Mountain

Poison and Drug Center, Denver

Health

Dr. Robert Claypool discussed the role

of the Department of Health and

Human Services (HHS) in developing

surge capacity as part of the National

Response Plan and described an

initiative to develop Public Health

Service Contingency Stations as

alternative care facilities. Dr. Nathaniel

Hupert presented models of surge

capacity and pre-hospital treatment in

a surge event. Dr. Michael Shannon

described the challenges of treating

large numbers of children, and laid out

the main steps in creating a schoolbased emergency response plan. Dr.

Gregory Bogdan explained the critical

role that risk and crisis communication

play in reducing the number of people

who might seek health care during a

large-scale public health emergency. A

short question and answer period

followed the presentations by the

panelists.

Role of HHS in

Achieving Surge

Capacity Capabilities

Dr. Robert Claypool began his

presentation by saying that the

definition of surge capacity should

include three factors: the volume of

cases, time as a function of the volume

of cases, and the complexity of cases

involved. He explained that hospitals

deal with surge fairly regularly, when

they go on bypass or have to send

patients to other places. In dealing

with weapons of mass destruction,

however, the health system is at risk of

being severely stressed and so inelastic

that at least two things might happen.

First, access to care, or having care

rendered, might become compromised.

Second, the quality or the standards of

care might have to change to meet the

greatest good. 

Expanding upon the three-factor

definition of surge, Dr. Claypool

pointed out that surge doesn’t

necessarily have to do with large

volumes of patients. A case in point is

the severe acute respiratory syndrome

epidemic that recently occurred in

Canada, where a relatively small

number of patients severely challenged

the health care delivery capability in

Toronto. Burns are another example of

ways in which relatively few cases can

severely stress health system capability. 

To meet surge capacity needs, the

Federal Government is currently

developing the National Response

Plan. Within that plan, HHS will lead

the emergency support function that

deals with health and medical issues.

The capacity to provide health care

represents the most resource-intensive

component of the plan, but the need

for resources comes at a time when the

economic realities of the health care

system in the United States are

reflected in the closing of hospitals

and the reduction of bed availability.

Within HHS, the Health Resources

and Services Administration, the

Centers for Disease Control and 

Prevention, and AHRQ are all looking

at different ways, through grant and

cooperative agreement programs, to

increase bed capacity in our country.

In addition, a collaborative effort

between HHS, the Department of

Homeland Security, the Department of

Defense, and the Department of

Veterans Affairs is developeing a

program known as the Public Health

Service Contingency Stations 

(PHS-CS). This program borrows a

concept from the Civil Defense System

of the 1950s and 1960s known as

Packaged Disaster Hospitals. These

were deployable hospitals that could be

constituted to support care in the event

of a nuclear attack. At the peak of that

program, 2,000 Packaged Disaster

Hospitals were stationed across the

country, with each providing 200 to 250

beds. 

Surge

Generated From Both Natural and Man-Made Events

Weapons

of Mass

Destruction

Hurricane 

Major 

Flooding

Aircraft

Accident

Greatest

Least

Local, Regional, & State Federal 

IMPACT

Exhibit 1

2
The PHS-CS will have the capability of

a general medical/surgical ward. They

will not have an operating room, an

Intensive Care Unit, or an Emergency

Room. In the initial stage, they will not

have a triage area. Each will be

packaged in 50-bed increments, and

could be deployed in 50-bed increments

up to 250 beds for each station. Each

unit will also contain medical supplies

and a pharmaceutical package. Four

contingency stations have been

purchased in 2004. They are designed to

be used in a shelter of opportunity; i.e.,

they would go into a facility such as a

high school gymnasium or an armory. 

In the future, the PHS-CS program will

include modules for burn/surgical

treatment, acute treatment, isolation,

triage, and decontamination. The top

priorities are the capability to treat

burns and the development of a

deployable isolation module. The burn

module is especially important for

bioterrorism preparedness because

vesicants that might be used in a

chemical attack produce lesions that

mimic burns. The deployable isolation

module will be a self-contained, freestanding unit; that is, it will not require

retrofitting of an existing facility.

Facilities, of course, will require health

care personnel to staff them. HHS is

exploring ways to train health care

professionals to perform multiple

functions. A cardio-pulmonary thoracic

technician, for example, might be crosstrained to support dialysis care. A current

AHRQ project is to develop, implement,

and test a model to cross-train health care

personnel to provide ventilator support.

The project will then determine the

applicability of the cross-training model

for other required functions. 

Modeling Surge

Capacity

Dr. Nathaniel Hupert explained that the

value of modeling surge capacity is to

help us question our common

assumptions about what it would take

to respond to a large mass casualty

incident. Furthermore, modeling helps

us analyze the variables involved (time,

numbers of patients, and so on) in

quantitative terms so that concrete

numbers can be generated to use in

planning. 

Under a project funded by AHRQ, Dr.

Hupert and his colleagues have

analyzed the determinants of surge

capacity as illustrated in Exhibit 2. The

first is surge arrivals at the hospital,

which is a function of (1) the number of

people who have been exposed or

involved in an event, and (2) the

possible treatment of patients outside

the hospital, or pre-hospital

management. The number of surge

arrivals will be greater or fewer,

depending on how many patients can be

accommodated by pre-hospital

management. In the event of a

biological attack or an outbreak of an

infectious disease, for example, prehospital management would include the

dispensing of antibiotics or vaccines to

as many people as possible without

admitting them to the hospital.

Once patients arrive at the hospital or

network of health care facilities (such

as clinics, rehabilitation facilities, or

long-term care facilities), the second

determinant of surge capacity is the

availability of hospital resources. The

number of patients who can be treated

during a surge event depends on such

factors as the number of staff, medical

supplies, and the circulation of beds.

The circulation of beds, in turn,

depends to some extent on the third

determinant, which is surge discharge.

The concept of surge discharge is based

on Dr. Hupert’s work with Sam Benson,

AEMT-P, of the New York City Office

of Emergency Management. The

concept is that some patients who were

already in the hospital at the time of the

event may be transferred to other

facilities, thus making space available

for surge arrivals. Some percentage of

arriving patients also can be treated and

discharged. Examples of places patients

can go if they are ready for discharge

from the hospital include home,

perhaps with skilled nursing care

available at home; an out-of-region

facility; or a special, skilled nursing

facility. Dr. Hupert cited the 3

Determinants of Surge Capacity

Hospital or network

capacity

Staff

Medical supplies

Treated

Died

SNF

Surge

arrivals

Home

*Note: I am indebted to Sam Benson, EMT-P, New York City Office of Emergency Management 

for the notion of “surge discharge” —N. Hupert, M.D., M.P.H.

Event

Out-of-region 

facility

Pre-hospital

management

Surge Discharge*

Beds

Exhibit 2
example of his own hospital’s

experience on September 11 and 12,

2001, when New York Presbyterian

Hospital was able to discharge

approximately 20 percent of its

patients to be able to treat arriving

casualties.

Dr. Hupert described a second model

he and his colleagues have developed

for pre-hospital management in

response to a biological attack or an

outbreak of an infectious disease. A

simple, conceptual model is presented

in Exhibit 3. The model shows that

degree of protection is a function of

how long it takes the community to

respond to the attack or outbreak (delay

in reaction) and the time required to

administer medication to the affected

population (time needed to protect

community). Another way to think

about this is the time that elapses before

the first pill is dispensed, which is the

delay, and the time that passes until the

last pill is dispensed, which is the time

needed for the entire campaign. The

quicker the community can respond,

and the quicker the community can

administer medication, the lower the

potential patient load on community

hospitals will be. 

Dr. Hupert and his colleagues have

translated this conceptual model into a

spreadsheet version that calculates

outcomes for pre-hospital anthrax

prophylaxis. The formulas in the

spreadsheet start with consensus

estimates of how inhalational anthrax

might act if there were an outdoor

release of anthrax spores, and

incorporate a set of assumptions about

detection, effectiveness of treatment,

and patient compliance with

medication. Planners can enter

numbers into the spreadsheet to

generate the percentage of exposed

individuals who do not get sick

because they receive antibiotics in

time. The percentage is highest if the

community responds quickly and is

able to dispense antibiotics to the

affected population in a matter of a

few days. That percentage declines

over time, of course, and those people

who subsequently get sick create an

increase in the numbers of patients

who must be admitted to the hospital.

Thus, the model illustrates the

importance of pre-hospital treatment

in reducing hospital surge. 

Applied differently, the model can also

predict when surge is most likely to

occur. The modeling shows that

planners can take one exposure

scenario, play it out in a number of

different ways, and wind up with very

different daily and total casualty loads,

depending upon how the community

has been organized and how

successful the community is in

responding to that event. 

The components a community must

have in place to prepare for mass

prophylaxis are explained in detail in

Dr. Hupert’s Community-Based Mass

Prophylaxis: A Planning Guide for

Public Health Preparedness. The

Planning Guide was also developed

under an AHRQ grant and is available

on the Bioterrorism Preparedness

section of the AHRQ Web site

(http://www.ahrq.gov/browse/bioterbr.

htm). A companion piece on the

AHRQ Web site, the Bioterrorism and

Epidemic Outbreak Response Model

(BERM), is an interactive database that

makes it possible for planners to

calculate the actual numbers of

facilities and staff they will need in

their communities to prepare for mass

prophylaxis (http://www.ahrq.gov/

research/biomodel.htm). Dr. Hupert

and his colleagues are developing a

Web-based version of the spreadsheet

that calculates outcomes for prehospital anthrax prophylaxis, the

Regional Hospital Caseload

Calculator, which will also be made

available on the AHRQ Web site. 

Addressing Pediatric

and School-Based

Surge Capacity 

Dr. Shannon and the Center for

Biopreparedness at Children’s Hospital

Boston have developed several

pediatric-focused tools under AHRQ

contracts and are developing several

protocols for mass casualty events

involving children. Before discussing

those protocols he described some of

the key issues in planning for surge

capacity involving children. 4

Modeling Pre-Hospital Capacity

Long (Days)

None (Hours)

More

Less

Shorter (1-2 Days) Longer (4+ Days)

DELAY 

IN

REACTION

SAFE

PROTECTION

Time needed to protect community

Exhibit 3
Dr. Shannon said, in creating surge

capacity plans for children, it is

important to keep in mind and consider

every potential type of disaster, terrorist

or otherwise; this means that planning

should be based on the all-hazards

approach. In addition, surge capacity

planning should include schools, with

two contingencies in mind: one is the

school as a specific target of a terrorist

event or as the scene of a disaster of

some type. The second is a community

disaster that occurs while school is in

session. 

Key Challenges in

Consequence Management

Every aspect of consequence

management will be challenged in an

incident that involves large numbers of

children: 

▲ All of the first responders—

emergency medical services staff,

firefighters, and police officers—

are going to have a difficult time

when they are taking care of many

injured or traumatized children.

▲ If an event involves an infectious

agent or patients who are

contaminated with a chemical

agent, triage and decontamination

must take place outside the hospital

to protect the hospital campus from

infection or contamination. This

will require establishing control of

all points of ingress and egress. 

▲ Decontamination teams will be

challenged by having to take care of

frightened children or children who

are very small, particularly while

the teams are wearing cumbersome

personal protective equipment. 

▲ The challenge of decontaminating

children will be compounded by

inclement weather, and especially

cold weather. 

▲ If the event requires mass

distribution of antibiotics, antidotes,

or vaccines, health care workers

should expect the triage and

screening of a child to take twice as

long as it would for an adult,

because children will not be able to

provide details of their medical

history. 

▲ General Emergency Departments—

those that take care of mixed

populations, children as well as

adults—are going to be challenged

by having to treat very large

numbers of children with limited

amounts of pediatric supplies.

Hospitals in general will be

similarly challenged. 

▲ There will be enormous needs in

terms of mental health response and

recovery, not only for children but

also for parents and health care

workers. 

Special Needs of Children

Because children are different from

adults, they need to be treated

differently in a mass casualty event. In

terms of a biological event, children

have an immature immune system,

which means that they are less able to

resist some types of infections, thus

leading to greater morbidity and

mortality in children. In a chemical

event, children are a challenge for

anyone to assess, manage, and guide

through decontamination. If there were

a radiological event, children are much

more susceptible to the consequences,

particularly the development of cancer.

If there were a blast injury of some

type or any blunt trauma, treating large

numbers of children in what

Emergency Medicine calls the “golden

hour of trauma” would be difficult. In

an event involving burns, children have

a greater likelihood of life-threatening

fluid loss and susceptibility to infection. 

The School Crisis Response

Manual: Guiding Principles

Dr. Shannon and his colleagues are

currently developing a protocol for

collaboration between hospitals and

schools to prepare and train for

emergency response. Visits to school

districts around the country have

convinced him that guidelines are

desperately needed to prepare for a

school’s being the target of a terrorist

event. 

The main steps in creating a schoolbased emergency response plan are: 

▲ Get a sense of the Principal’s level

of understanding and his or her

communication with local public

health authorities.

▲ Work with school nurses to ensure

there is a plan for taking the

children’s medications with them

during evacuation and relocation. 

▲ Include a sheltering and/or a lockdown plan. 

▲ Determine the best sites for

sheltering or lock-down, based on

an understanding of the unique

architecture of the school, the

location of the heating systems,

routes of ingress and egress, and so

on. 

▲ Include after-school programs in the

planning and identify the person

who would be in charge.

▲ Integrate with existing plans; for

example, with the evacuation and

relocation plan for a fire drill.

▲ Take inclement or stormy weather

into account.

▲ Conduct drills, including tabletop

exercises with the key leadership of

the school. 

5
6

Protocols for Disaster Medical

Assistance Teams and

Emergency Departments

Dr. Shannon and his colleagues are also

developing protocols for Disaster

Medical Assistance Teams (DMAT)

and Emergency Departments in

response to a mass casualty incident

involving children. DMATs are part of

the National Disaster Medical System

and have been in existence for some

time. They are designed to respond to a

disaster of any type. Of approximately

30 existing DMATs, however, only two

are dedicated pediatric teams. More are

needed; at the very least, the system

should consider having these teams

regionalized so that the site of the

emergency can be reached more

quickly if needed. In addition, existing

DMAT teams should receive additional

training in taking care of children.

The challenges Emergency

Departments will face include:

▲ Having adequate number of

pediatric supplies

▲ Having in place pediatric

decontamination equipment and

protocols

▲ Having developed an effective

response plan to manage large

numbers of children 

▲ Having staff skilled at assessing

young, non-verbal children

▲ Taking care of children while

wearing personal protective

equipment

▲ Creating systems for identifying,

tracking, and reuniting children

with their families

▲ Having identified the rational use

of alternate sites for taking care of

children, such as schools or

neighborhood health centers

▲ Allocating resources to treat the

“second wave” of patients

Dr. Shannon said schools and

neighborhood health centers can be

used to accommodate the “worried

well” and to treat the “walking

wounded” so that the Emergency

Department can be reserved for those

who really need immediate help. As

was learned from the Sarin incident in

Tokyo in 1995, the first wave of

patients arriving at the hospital are able

to get there on their own and are

relatively healthy. The more seriously

injured and ill have to be treated at the

scene and transported to the hospital;

they are the “second wave.”

The AHRQ products being developed

by Children’s Hospital Boston are in

various stages of completion. Their

availability will be announced on the

AHRQ Web site.

Addressing Surge

Capacity Through

Information Exchange

Dr. Bogdan explained that one of the

key components of surge response is

risk and crisis communication: getting

out the appropriate messages to the

public so they know what is going on

and what is available to help them. This

would reduce the number of people

presenting to health care facilities who

may not need to be seen—the “worried

well”—which would allow hospital

resources to be used most effectively to

treat people who need these resources

the most.

The challenges for communicating

with the public during an emergency are

illustrated by the findings of the

Redefining Readiness Project from the

Center for Advancement of

Collaborative Strategies and Health

(http://www.cacsh.org). According to

this study, 60 percent of the public said

they would not heed official

instructions to get vaccinated during a

smallpox outbreak, and 40 percent of

the public would not heed official

instructions to shelter in place during a

dirty bomb incident. The conclusion to

be drawn is that people won’t

necessarily accept and follow

instructions, but want to decide for

themselves what is best for their

families. Call centers provide a

mechanism for the public to ask their

questions and express their concerns to

enable them to make their own

decisions. 

The public needs to know general event

information—who, what, where, when,

and why—and they need to trust the

source of the information. They want to

find out how they can protect

themselves and their families. They

want to know what State and local

health departments recommend and, if

they have further needs, they want to be

able to refer to the most appropriate

agencies to take care of those needs.

They also want help with making

decisions. They want to know, based on

their own circumstances, their own

problems, and their own underlying

medical conditions, what they should

do next to take care of themselves and

their families. 

The “natural fits” to provide needed

information are the Poison Control

Centers that exist across the country;

nurse advice lines, which many HMO

agencies utilize; drug information

centers; and public health agencies.

Exhibit 4 illustrates how a medical call

center works. The general public and

health care providers can contact these

centers in a variety of ways, but the

most common mode of communication

is the telephone. Some callers will

describe symptoms that require a visit to

a health care facility for further

evaluation, but many questions or

concerns can be answered effectively

over the telephone. In a surge event, the

medical call center fulfills its purpose by

reducing the number of patients who
seek care at a hospital or other health

care facility, allowing those agencies to

focus on helping those with the greatest

need.

The Colorado Health Emergency Line

for the Public, or CO-HELP, is a

medical call center that has been in

operation since January 2003. This

service was created to provide a

standardized, prepared response to

health events in Colorado and to

provide consistent and accurate

information to callers. It was also

designed to collect and maintain

structured data that could help

characterize events for future responses.

The service was funded by the State

Health Department to provide the

capacity and the capability to adapt to

emerging health threats. 

CO-HELP refers users to the right

agencies for further assistance. These

include the State’s poison control

center, nurse advice lines, health care

providers, and guidelines and protocols

available from local and State health

departments. CO-HELP’s users include

the general public, health care

providers, hospitals, clinics, health

agencies, and schools. It was accessed,

for example, by tourists who were

planning to visit Colorado in 2003,

when West Nile virus and influenza

were concerns. 

“The greatest benefit of using

a medical call center is to be

able to provide the public with

a mechanism for one-on-one

information exchange.” 

Dr. Bogdan and his colleagues

developed the Health Emergency

Assistance Line and Triage Hub

(HEALTH) Model under a contract with

AHRQ. The report describes how the

Denver Health Medical Information

Centers determined the requirements,

specifications, and resources needed to

develop a public health emergency

contact center that is highly integrated

with public health agencies. The report

is available on the Bioterrorism

Preparedness section of the AHRQ Web

site (http://www.ahrq.gov/research/health/

health.pdf), as is the HEALTH Contact

Center Assessment Tool

(http://www.ahrq.gov/research/health/

health.asp). The Assessment Tool was

developed to assist other agencies in

developing the capabilities and

functions of the HEALTH Model.

Discussion

The question and answer period

included discussion of the PHS-CS,

including time needed to deploy them

and how they will be staffed. Staffing

of Medical Call Centers was also

discussed.

Public Health Service

Contingency Stations

Dr. Claypool explained that the time

required to deploy the PHS-CS is

expected to evolve as the Stations

themselves are developed in stages and

as they are procured in greater

numbers. The initial set of four Stations

that were purchased in 2004 were tested

in late 2004 and early 2005. The

component parts of these Stations are

palletized and are designed to be set up

in a facility such as a high school

gymnasium. Dr. Claypool estimated

that, initially, response to a medical

event might take 24 to 48 hours. 

The goal of the PHS-CS program over

the next few years is to place the

Stations in ready positions all around

the country, in each of the Federal

Emergency Management Agency’s

Health Emergency Service Regions.

The corresponding goal is to be able to

deploy one or more of the Stations in a

matter of hours. Dr. Claypool gave the

example of having to quarantine the

passengers on a 747 jet at an airport:

Rather than hold the passengers on the

airplane, parked on the tarmac for 24 or

48 or 72 hours, the target would be to

set up a 250-bed Contingency Station

with its quarantine capability in a

hangar at the affected airport in as few

as 4 hours. 

7

Exhibit 4

How a Medical Call Center Works

General

Public

Health

Professionals

M

C

C

Voice 

Fax

Video

E-mail

Web

Voice 

Fax

Video

E-mail

Web

Hospitals and Health 

Care Facilities

Local and State Public

Health Agencies

patient surges reduced

by providing 

information and triage

through multiple paths
8

The staffing of a Contingency Station is

separate from its physical components.

Dr. Claypool said that the basic unit,

that is, a 50-bed module that has

medical service ward capability, would

require two doctors who would be

supported by physician’s assistants,

registered nurses, medical technicians,

and some administrative staff. The total

would be 20 or more qualified staff

members. 

In response to a question about the

relationship between DMATs and the

PHS-CS, Dr. Claypool said it is likely

that both would be activated in response

to a major event, and they would be

expected to work in concert and to

coordinate with each other.

Regarding both time to deploy and the

number of staff needed, Dr. Shannon

cited his experience as a member of one

of the Pediatric DMATs. He said that

the actual transport time to get the

Children’s Hospital Boston team to the

site of an emergency is “as quick as any

type of plane ride you can imagine.”

More time is involved, however, in

mobilizing the team, including

contacting team members, and

mobilizing their equipment. That

mobilization can add many, many hours

to the time for deployment, which is

another argument for regionalization of

Pediatric DMATs. The size of the

Pediatric DMAT varies from 10 to 20

members, depending on the size of the

emergency and whether or not that

Pediatric DMAT team is incorporated

into another DMAT team.

Dr. Claypool pointed out that the

Contingency Stations will have pediatric

capability, including pediatric

formulations of drugs and pediatric beds. 

Medical Call Centers

A question submitted by e-mail asked,

“In the event that call centers are

utilized as a tool for mass casualty

events and/or infectious disease

outbreaks, what personnel will be used

to support these call center

infrastructures already in place?”

Assuming the surge of incoming calls

would be more than regular staff could

handle, “Where will the additional

personnel come from? Volunteers?

Public health people already in the

organizations?” 

Dr. Bogdan responded that the medical

call centers have the technology

infrastructure to handle large volumes

of calls, “But we always come up short

with personnel.” He explained that

additional personnel can be trained to

perform limited functions, especially

those such as setting up prepared

answers to questions and helping the

caller to understand the answers. His

experience in Colorado has included

considering pools of volunteers and

establishing relationships with the

Public Health Departments so they can

supply personnel to help staff the

phones. Another successful approach

has been to use recorded messages that

callers hear when they first connect

with the call center. Those messages

can be changed to reflect the

information that is most commonly

required at different points in time. 

Dr. Bogdan cited his experience with the

influenza outbreak in Colorado in 2003.

Initially, the most common question was

“Where can I get my shot?” Callers who

asked that question could select from a

menu of options that provided Web

addresses containing information on

locations in their neighborhoods where

they could get their shot. The question

most frequently asked then quickly

became “What are the signs and

symptoms of influenza?” The call

center’s message was changed to provide

that information with the result that

callers could learn what they wanted to

know without necessarily having to be

connected to a live human being.

For More Information

The Web conference on which this

issue brief is based, “Addressing Surge

Capacity in a Mass Casualty Event,” is

available as a streaming presentation

and as a text transcript on the

Bioterrorism Preparedness section of

AHRQ’s Web site

(http://www.ahrq.gov/news/ulp/btsurge

mass/). 

Several resources on health system

preparedness for bioterrorism have been

developed with funding from AHRQ

and are available on the AHRQ Web

site. The Rocky Mountain Regional

Care Model for Bioterrorist Events

(http:www.ahrq.gov/research/altsites.

htm) presents information on alternative

care facilities in response to a surge

event and the personnel resources

needed to staff those facilities.

To keep abreast of AHRQ-sponsored

research, the availability of new tools,

and other information relevant to surge

capacity and bioterrorism preparedness,

readers are encouraged to subscribe to

AHRQ’s Bioterrorism Preparedness

LISTSERV. Instructions for subscribing

can be found at

http://www.ahrq.gov/research/btpreplist.

htm

_______________________ 

This issue brief was prepared for

AHRQ by the National Academy for

State Health Policy under contract

number 290-98-0009.

AHRQ Pub. No. 06-0027

January 2006