Situational Awareness for Novel Epidemic Response - Local Development build (v0.1.0). See the Directory of published versions

Definitions

Definitions are critical during times of crisis. Knowing and understanding these definitions enables the implementors of this specification to operate from a common understanding of meaning, and those using the data produced from those implementations to respond accordingly.

Bed Categories

There are a number of different counts for tracking hospital beds that are relevant in bed availability:

1. The number of beds a facility is licensed for (licensed).
2. The number of beds that it are occupied (census).
3. The number of beds that a facility can staff (staffed).
4. The physical number of beds that a facility has.
5. The number of temporary beds (overflow or surge).

Under normal circumstances the relationship between this is that occupied <= staffed <= licensed. In crises situations, those relationships need not hold. Governments have the authority to waive licensing and staffing restrictions in order to provide adequate care.

The State of Louisiana describes these different categories in their []Definition of Bed Poll Terms](https://esf8.dhh.la.gov/documentportal/Download/Public/Definitions%20of%20Bed%20Poll%20Terms.pdf) documentation, which is informed by the Standardized Hospital Bed Definitions from the AHRQ HAvBED project.

Licensed Beds

The maximum number of beds for which a hospital holds a license to operate. Many hospitals do not operate all of the beds for which they are licensed. o Physically Available Beds: Beds that are licensed, physically set up, and available for use. These are beds regularly maintained in the hospital for the use of patients, which furnish accommodations with supporting services (such as food, laundry, and housekeeping). These beds may or may not be staffed but are physically available.

Staffed Beds

Beds that are licensed and physically available for which staff is on hand to attend to the patient who occupies the bed. Staffed beds include those that are occupied and those that are vacant.

Unstaffed Beds

Beds that are licensed and physically available and have no current staff on hand to attend to a patient who would occupy the bed.

Occupied Beds

Beds that are licensed, physically available, staffed, and occupied by a patient.

Vacant/Available Beds

Beds that are vacant and to which patients can be transported immediately. These must include supporting space, equipment, medical material, ancillary and support services, and staff to operate under normal circumstances. These beds are licensed, physically available, and have staff on hand to attend to the patient who occupies the bed.

To these definitions this specification adds:

Overflow Beds :Beds that are vacant and and to which patients can be transported immediately, but for which there may NOT be adequate supporting space, equipment, medical material, ancillary or support services to operate under normal circumstances. These beds ARE NOT necessarily licensed, though they ARE physically available, and have staff on hand to attend to the patient under emergency circumstances.

Temporary space is already being planned for in Philadelphia, using an event space at Temple University according to an Action News report. Information about these facilities will likely need to be manually reported until systems can be configured to track and manage them.

Intensive Care Unit vs. Critical Care Unit

Ventilation Support

Similarly, ventilators can be shared, so the important number for ventilators may not be the number of devices, but rather the number of patients that can be accomodated (ventilator outputs). New York-Presbyterian Hospital began ventilator sharing in late March as reported in a March 26 New York Times article.

There are also numerous efforts to increase the supply of ventilator devices, and various organizations are created plans to construct and actually build mechanical ventilators from readily available hardware.

Others have noted that respiratory assistance can be provided by non-invasive ventilation (e.g, a CPAP or BiPAP(r) machine or similar device).

Ventilator

A regulated medical device capable of providing ventilation support. Use of a ventilator requires intubation with an endotraceal tube to provide ventilation support, and is considered to be an “invasive procedure”, usually requiring the kind of monitoring performed in an intensive care unit.

Non-Invasive Ventilation Equipment

Non-invasive ventilation refers to ventilation support that does not require the patient to be intubated with an endotracheal tube to provide ventilation support. Non-invasive equipment includes both CPAP and BiPAP described below.

CPAP

A regulated medical device providing continuous positive airway pressure.

BiPAP

BiPAP is the trade name for Respironics Bilevel Positive Airway Pressure equipement. These are regulated medical devices similar to CPAP, but with adjusted pressure levels during the cycles of breathing in and out.

Ventilator Output

A component of a ventilator that is where the airflow comes out. Presently all regulated ventilators have one output slot (and serve one patient). However, simple alterations enable the one slot to be multiplied by two or four to support multiple patients.

Test Kits

Test kits are consumable medical devices that support the completion of a diagnostic test for a given disease. There are many medical devices that operate on a variety of different principles that can support COVID testing. Viral testing ranges from decoding the RNA of viral samples, to looking for specific antibodies in the blood that react to specialized reagents (manufactured chemicals or biologics that react in a certain way in the present of specific molecules in a specimen) and others.

To be clear, this section is talking about diagnostic quality tests, which can confirm or deny the presence of disease, rather than screening tests which might readily rule out disease, but will cannot adequately confirm it.

Reagents can be packaged in quantity to support more than a single use, thus a definition of a test kit is needed in order to enable counting of test kits, since they may not be individually packaged.

Presently, most COVID-19 testing is performed using specimens collected using a nasal (nasopharyngeal to use the precise language) swab and collection technique. However, there are already existing blood tests and manufacturers are working quickly to deliver point of care blood testing systems.

Test Kit

A quantity of materials sufficient to perform a single test on a single specimen for a given disease.

Viral Test Kit

A quantity of materials sufficient to perform a single test on a single specimen for a given viral disease. A Viral Test Kit is a type of test kit.

COVID Test Kit

A quantity of materials sufficient to perform a single test on a single specimen to diagnosis COVID-19.

COVID Test Kit for Swab

A quantity of materials sufficient to perform a single test on a single specimen collected using a nasal swab in order to diagnosis COVID-19.

COVID Test Kit for Blood

A quantity of materials sufficient to perform a single test on a single specimen collected from blood or blood products in order to diagnosis COVID-19.