Breakout of Service Levels Based on Facility Impacts For planning purposes assume Control, Modified, Limited, and Emergency” Service levels correspond to progressively deteriorating or destroyed critical “Under infrastructure, supply chain support services, staff, and facility structural compromise. Service Reprioritization Strategies should be based on assumed patient population surge of 20% above daily census. services Please complete the matrix below by first indicating which are offered at your clinic site in the far left column. You may decide to include Service Strategies Staff Assignments services not typically offered, but necessary during an emergency (ex. Triage). Then, indicate which and your clinic will utilize for each service offered by your facility at each stage of service capacity. Use the suggestions and abbreviations listed on the previous page to fill in the boxes below. CLinics Service Normal Control Modified Services Limited Services Essential Services Operations Service Staff / #s Service Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Strategy Strategy RN / 1 MD / 1 MD / 2 MD / 2 MD / 2 RN / 2 RN / 3 RN / 3 RN / 4 MA / 2 MA / 2 MA / 3 MA / 4 N.O. I.S. I.S., E.H. R.V., E.H. R.V., I.S. SAMPLE (TRIAGE) Service Staff / #s Service Staff / #s Service Strategy / #s Service Strategy Staff / #s Service Strategy Staff / #s Strategy Strategy / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Service Staff / #s Service Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Strategy Strategy / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
Breakout of Service Levels Based on Facility Impacts For planning purposes assume “Under Control, Modified, Limited, and Emergency” Service levels correspond to progressively deteriorating or destroyed critical infrastructure, supply chain support services, staff, and facility structural compromise. Service Reprioritization Strategies should be based on assumed patient population surge of 20% above daily census. Please complete the matrix below by first indicating which services are offered at your clinic site in the far left column. You may decide to include services not typically offered, but necessary during an emergency (ex. Triage). Then, indicate which Service Strategies and Staff Assignments your clinic will utilize for each service offered by your facility at each stage of service capacity. Use the suggestions and abbreviations listed on the previous page to fill in the boxes below. CLinics Service Normal Operations Control Modified Services Limited Services Essential Services Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s SAMPLE (TRIAGE) N.O. RN / 1 I.S. MD / 1 RN / 2 MA / 2 I.S., E.H. MD / 2 RN / 3 MA / 2 R.V., E.H. MD / 2 RN / 3 MA / 3 R.V., I.S. MD / 2 RN / 4 MA / 4 Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy / #s Service Strategy Staff / #s Service Strategy Staff / #s / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s Service Strategy Staff / #s / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
Clinic%20Medical%20Surge%20Planning%20Matrix.docx