political conventions, Annals of Emergency Medicine is releasing online this
week an article highlighting regional strategies, including
plan, for handling the surge of patients who would seek care at hospital
emergency departments following a terrorism event.
In the face of frequent emergency department overcrowding, a loss of 38,000
hospital beds and a 20 percent decrease in intensive care unit capacity, a
mass casualty event will force emergency physicians and nurses to turn to a
more primitive battlefield type of medicine as hospital capacity becomes
depleted and jails, detention centers, mental health facilities, and sports
arenas are opened to handle the influx of the walking wounded.
Dr. John L. Hick with Hennepin County Medical Center in Minneapolis and
several other disaster medicine experts, including Dr. Jonathan L. Burstein,
medical director for the Emergency Preparedness and Response Program at the
Massachusetts Department of Public Health, review options for handling a
sudden surge in hospital patients from a variety of disaster events.
"With a healthcare system that is often operating at or over capacity on a
daily basis, we will never have the resources to be 'prepared' for every
disaster," said Hick. "But with appropriate partnerships, incident
management systems, and a tiered response framework, we can be prepared to
'respond' to any challenge."
Researchers point out that a large-scale airborne anthrax attack will
rapidly overwhelm intensive care resources, such as ventilators. A smallpox
outbreak may develop more slowly and place long-term demands on hospitals,
isolation facilities, and the workforce. Most victims from chemical and
explosive events will come to emergency departments within the first six
hours following an event.
"Given the wide range of disasters that can occur, effective planning thus
requires comprehensive resource coordination and control to allow for a
flexible response," said Hick. "Our paper highlights several key
stakeholders who should be involved in the planning process, six tiers of
health care disaster response, potential alternative care sites, and factors
to consider when selecting alternative care sites. We also provide examples
of how four community systems (Minneapolis/St. Paul, Massachusetts,
Colorado, and Northern Virginia) are planning to respond to a terrorism
In Massachusetts, 74 hospitals with emergency departments serve a population
of 6.5 million people. To prepare for a disaster, the state has developed
regional hospital planning groups to implement facility and community
planning. These groups incorporate representation from skilled nursing
facilities, health clinics, and home health agencies. Local public health
departments will be assigned the responsibility of performing mass
vaccinations and providing preventative treatments, thus allowing hospitals
to reserve their capacity for the ill.
In Massachusetts, four large state-owned hospital facilities (currently
assigned for mental health care) will provide hospital-level care if
off-site facilities are required. Volunteers willing to be pre-identified
will be incorporated into specific "reserve" teams assigned to a particular
hospital or public health agency, and issued formal identification. They
will periodically train and drill with the facility or agency. These groups
will include practicing health personnel ("redeployment"), and
"nontraditional" disaster providers such as dentists ("adaptation").
The state expects to issue identifying decals for driver's licenses to
licensed medical providers to allow quick on-scene "credential
verification." Medical or nursing students and retirees from the health care
profession will be able to apply for such designation as well.
"While our research outlines the various options that should be considered
in a community's effort to plan for a surge of patients from various types
of disasters, more research and more mock exercises are required to better
identify strengths and weaknesses of particular strategies," said Hick.
Source: American College of Emergency Physicians