Disaster Medicine Experts Highlight Strategies for Managing Hospital Patient Surges Following a Terrorism Event

WASHINGTON, D.C. -- With terrorism threats looming over the upcoming national

political conventions, Annals of Emergency Medicine is releasing online this

week an article highlighting regional strategies, including Massachusetts'

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

event."

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