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State of California—Health and Human Services Agency
California Department of Public Health

AFL 20-18
March 8, 2020


Hospital Surge Survey to Assess Capacity Regarding Coronavirus Disease 2019 (COVID-19) and Reminder to Contact Medical Health Operational Area Coordination Office (MHOAC)


​All Facilities Letter (AFL) Summary 

This AFL requests that all hospitals voluntarily complete a state-wide resources survey on surge capacity. The California Department of Public Health (CDPH) is requesting that all hospitals complete the survey immediately. ​

Additionally, this AFL reminds hospitals to contact their MHOAC with resource requests related to COVID-19.

NOTE: This AFL is no longer in effect and is for historical purposes only​

​Hospital Surge Survey

In anticipation of California potentially experiencing a surge of COVID-19 patients, CDPH is requesting that all hospitals complete an online survey on surge capacity. Hospital responses to these questions will greatly assist CDPH in assessing the California health care system's surge capacity. Additionally, this survey will assist CDPH in understanding hospitals current space, supply, and staffing situations, as well as future needs. This is only a gathering of information so that CDPH can better plan, communicate, and coordinate responses if needed.

CDPH requests that hospital leadership immediately complete the Hospital Surge Survey (

If you have any questions regarding the Hospital Surge Survey, please contact CDPH by email at

For information on program flexibility, including the submission process for requesting a temporary program flexibility, see AFL-18-09 Requesting Increased Patient Accommodations Including Medical Surge Tent Use.

Medical Health Operational Area Coordination Office

In order to ensure adequate resources are available to meet the needs of your county/jurisdiction's operational area (OA) medical and health response system, the MHOAC coordinates all medical and health resources within, into, and out of your county/jurisdiction OA consistent with the California Public Health and Medical Emergency Operations Manual (EOM). The MHOAC uses the EOM as a guide to coordinate response among multiple jurisdictions and to access disaster medical and health service response at all levels of government and the private sector.

The MHOAC is responsible for managing disaster medical resources, including personnel, equipment, and supplies. Resource management includes assessing disaster medical response needs, tracking available resources, and requesting or providing mutual aid. The status of local available resources within the OA is assessed before requesting outside resources or submitting a resource request to the Region Disaster Medical Health Coordination/Specialist Program (RDMHC/S). Following an assessment of local resources, the MHOAC may request or provide mutual aid as conditions warrant. The MHOAC acts as the single-point ordering authority for OA medical health mutual aid requirements. If necessary, the MHOAC may also request the public health and medical Department Operations Center (DOC) or OA Emergency Operations Center (EOC) to be activated to support the public health or medical event.

If the MHOAC cannot fulfill a request using local sources, they may request public health and medical resources from outside of the OA via your RDMHC/S. If regional resources are inadequate or delayed, the RDMHC Program will forward the request to the State. If in-State resources are unable to fill the request in a timely manner, the State will request Federal assistance through the California Office of Emergency Services (Cal OES). Acting through Cal OES, the Governor will request Strategic National Stockpile (SNS) via the Department of Homeland Security. Please be aware that while every effort will be made to obtain resources as quickly as possible, requesting entities should anticipate that time from acceptance of a request to actual receipt of the resource may be 48-96 hours or longer, depending on the type and scope of the incident.

Please see the Medical Health Operational Area Coordination (MHOAC) Manual (PDF) for more information. 

For questions about infection control, please contact the CDPH Healthcare-Associated Infections Program at

If you have any questions regarding the infection prevention and control of COVID-19, please contact the CDPH HAI Program at

Please remember to report to your district office if you have confirmed COVID-19 patients at your facility.


Original signed by Heidi W. Steinecker

Heidi W. Steinecker

Deputy Director



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