Alternate Care Facilities Symposium-Breakout Session 6: Site Selection

The use of alternate care facilities (ACFs) is an often-considered mechanism to increase care capacity during a patient surge event; however, robust guidance on appropriate site selection is limited. During the Alternate Care Facilities Symposium, we conducted a facilitated breakout session with participants to explore their experience in selecting ACF sites during prior emergencies. This was done to determine best practices regarding the site selection process, as well as successes, challenges, and lessons learned. Participants reported that site feasibility was primarily driven by pre-existing infrastructure, regulatory constraints, and operational factors rather than physical size or political mandate. Large congregate spaces and decommissioned hospitals frequently proved unsuitable, while successful sites were typically non-congregate, located near partner hospitals, and able to support patient dignity, safety, and privacy. Political pressures often resulted in facilities that were underutilized or operationally constrained, while infrastructure deficiencies created major barriers. Given that site selection is a critical determinant of ACF success, early multidisciplinary assessments, realistic capacity planning, and pre-activation walkthroughs and training exercises may improve future emergency response preparedness.