Award Date


Degree Type


Degree Name

Doctor of Nursing (ND)



First Committee Member

Lori Candela

Second Committee Member

Carolyn Sabo

Third Committee Member

Richard Tandy

Number of Pages



An approach to fulfill a need for additional hospital beds during emergency and disaster situations has been establishment of alternate care sites (ACS). Kern County, California, with a population of about 856,000 and approximately 1,500 hospital beds, is at significant risk for inability to care for the medical needs of its residents in the face of a disaster or an emergency. Even the most conservative estimates of additional hospital beds requirements in a disaster or emergency would indicate the need for nine to ten ACSs accommodating up to 50 patients each in Kern County.

Recognizing the need for alternatives to manage hospital surge, the local public health department along with state and federal officials are collaborating with community partners to establish alternative sites where emergency medical facilities can be established to help deliver medical care in a catastrophe. Preparing community partners with tools to assist in establishment of ACSs is one goal in a long-term plan to assist in disaster and emergency response. While healthcare personnel will be needed in the activation and operation of an ACS, little work has been done to define what other personnel will be needed and what training would enhance staff performance of these roles. Development of an ACS staff training matrix tool was the aim of this project.

Guidance exists for organization of healthcare staff during an emergency or disaster in the form of the Hospital Incident Command System (HICS). There also are numerous training modules available providing instruction in emergency and disaster response. However, no previous reference has matched the job positions defined by HICS with the training required to fulfill the requirements of the job descriptions for each of the job positions.

The ACS Staff Training Matrix was designed to support emergency planners mustering appropriate staff for an ACS during a disaster or emergency. The ACS Staff Training Matrix was based on selection of job positions from HICS and coupling of those job positions with existing emergency and disaster training modules selected for availability, affordability, and relationship to the job descriptions for each position. Training capabilities selected for the ACS Staff Training Matrix were reviewed by subject matter experts to ensure the level of requirement (mandatory versus recommended).

The ACS Staff Training Matrix is intended to provide guidance to emergency planners and ACS partners in training of staff who might be called upon to respond to ACS activation during a disaster or emergency. The ACS Staff Training Matrix also provides capacity to list persons qualified to fill those positions based on training completed, along with contact information for each individual. Job descriptions provided through links to HICS simplify pre-event and event planning and identification of training needs. When insufficient staff is identified as a need, the ACS Staff Training Matrix can be used to define and communicate specific requirements for completion of resource requests transmitted outside the operational area using terminology and nomenclature easily recognized by other jurisdictions. Training obtained through use of the ACS Staff Training Matrix also is applicable to a wide variety of Incident Command System (ICS) and HICS job positions, leading to flexibility of staff relative to needed job assignments in the “all-hazards” approach that is encouraged in emergency planning and training efforts.


Alternate Care Site; Emergency Preparedness; Preparedness


Nursing | Public Health

File Format


Degree Grantor

University of Nevada, Las Vegas




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