Abstract

INTRODUCTION: With limited available hospital beds in most urban areas, there are very few options when trying to relocate patients already within the hospital to make room for incoming patients from a mass-casualty incident (MCI) or epidemic (a patient surge). This study investigates the possibility and process for utilizing shuttered (closed or former) hospitals to accept medically stable, ambulatory patients transferred from a tertiary medical facility. METHODS: Two recently closed, acute care hospitals were evaluated critically to determine if they could ...

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Use of "shuttered" hospitals to expand surge capacity

Abstract

INTRODUCTION: Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters. PROBLEM: In the aftermath of sudden-onset disasters, FFHs have been focused on providing emergency trauma care for the initial 48 hours following the sudden-onset disasters, while they tend to be operational much later. In addition, many have remained operational even later. The aim of this study was to assess the timing, activities, and capacities of the FFHs deployed after ...

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Foreign field hospitals in the recent sudden-onset disasters in Iran, Haiti, Indonesia, and Pakistan

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Mobile hospital raises questions about hospital surge capacity

Abstract

INTRODUCTION: Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities. The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks. NULL HYPOTHESIS: The surge ...

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Mar-Apr

Abstract

In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what ...

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The art and science of surge: Experience from Israel and the US military

Abstract

Objectives: To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. Methods: Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the ...

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Characteristics of medical surge capacity demand for sudden-impact disasters

Abstract

Introduction: The World Health Organization and the International Association for Trauma Surgery and Intensive Care have published the Guidelines for Essential Trauma Care. This provides recommendations for the human and physical resources needed to provide an adequate, essential level of trauma care services in countries at all. economic levels worldwide. We sought to use this set of recommendations as a basis to assess the trauma care capabilities in two locations in Vietnam and thus to identify affordable and sustainable methods to ...

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Assessment of the status of resources for essential trauma care in Hanoi and Khanh Hoa, Vietnam

Abstract

This article discusses Taiwan's experience in managing surge needs based on recent events, including the 1999 earthquake, severe acute respiratory syndrome in 2003, airliner crashes in 1998 and 2001, and yearly typhoons and floods. Management techniques are compared and contrasted with U.S. approaches. The authors discuss Taiwan's practices of sending doctors to the scene of an event and immediately recalling off-duty hospital personnel, managing volunteers, designating specialty hospitals, and use of incident management systems. The key differences in bioevents, including the ...

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Improving surge capacity for biothreats: Experience from Taiwan

Abstract

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, ...

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Mar

Abstract

High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on ...

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2006 Nov (Epub 2006 Aug

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Oct

Abstract

The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer ...

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Oct

Abstract

Background: Plausible disasters may yield hundreds or thousands of critically ill victims. However, most countries, including those with widely available critical care services, lack sufficient specialized staff, medical equipment, and ICU space to provide timely, usual critical care for a large influx of additional patients. Shifting critical care disaster preparedness efforts to augment limited, essential critical care (emergency mass critical care [EMCC]), rather than to marginally increase unrestricted, individual-focused critical care may provide many additional people with access to life-sustaining interventions. ...

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May

Abstract

Background: Mass numbers of critically ill disaster victims will stress the abilities of health-care systems to maintain usual critical care services for all in need. To enhance the number of patients who can receive life-sustaining interventions, the Task Force on Mass Critical Care (hereafter termed the Task Force) has suggested a framework for providing limited, essential critical care, termed emergency mass critical care (EMCC). This article suggests medical equipment, concepts to expand treatment spaces, and staffing models for EMCC. Methods: Consensus ...

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May

Abstract

Disaster planning must anticipate how demands imposed by a disaster reconcile with the capacity of the treating facility. Resources must be organized before an event so that they are optimally used to treat as many victims as possible, as well as to avoid overwhelming available resources. [References: 48] ...

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2007 Mar

Abstract

BACKGROUND: In a public health emergency, many more patients could require mechanical ventilators than can be accommodated. METHODS: To plan for such a crisis, the New York State Department of Health and the New York State Task Force on Life and the Law convened a workgroup to develop ethical and clinical guidelines for ventilator triage. RESULTS: The workgroup crafted an ethical framework including the following components: duty to care, duty to steward resources, duty to plan, distributive justice, and transparency. Incorporating ...

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Allocation of ventilators in a public health disaster

Abstract

Following the September 11, 2001, incident in the United States (US) and subsequent natural disasters, the US, like other countries, has focused on improving its overall disaster response capabilities. One mechanism that is under development to improve the country's surge capacity, i.e., its ability to substantially increase the number of volunteer health care professionals available to respond during a disaster, is the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). Registries, like ESAR-VHP, are significant tools for disaster planning ...

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Review

Abstract

INTRODUCTION: Local public health departments may assume responsibility for sheltering and providing care for medically needy populations displaced by disasters. In addition, medical special needs shelters will inevitably house persons not requiring medical assistance. The presence of nonpatients may help or hinder shelter operations. This analysis examines the composition, demographics, and medical requirements of a population in a special needs shelter. METHODS: Frequencies and ratios were used to describe persons residing in a medical special needs shelter. All data were obtained ...

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Caregivers and families in medical special needs shelters: an experience during Hurricane Rita

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Nov

Abstract

OBJECTIVES: This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. METHODS: The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A ...

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Bioterrorism and mass casualty preparedness in hospitals: United States, 2003

Abstract

Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ...

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Nov

Abstract

In 2003, the Utah State Department of Health received funding from the Health Resources and Services Administration to develop a medical surge plan to increase the number of available hospital beds in the state by 1250 beds, including 125 beds for burn or critical trauma patients. A prior article discussed the planning procedures and process. This article describes the major components of the plan, including analysis of threats, direction and control, activation and system response; communications; and critical issues. ...

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Development of a state medical surge plan, Part II: Components of a medical surge plan

Abstract

This article reviews what is known about daily emergency department (ED) surge and ED surge capacity and illustrates its potential relevance during a catastrophic event. Daily ED surge is a sudden increase in the demand for ED services. There is no well-accepted, objective measure of daily ED surge. The authors propose that daily and catastrophic ED surge can be measured by the magnitude of the surge, as well as by the nature and severity of the illnesses and injuries that patients ...

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Nov

Abstract

The problem of surge capacity in the wake of a terror-related emergency has lead to a number of interesting proposals designed to mitigate the effects of crowds as well as deficiencies in patient care capacities. The most controversial of these is a proposal to close hospital doors in the wake of a mass casualty terror event. However, several specific challenges posed by mass casualty events make closing hospitals doors undesirable. These include the need for efficient movement of resources, maintenance of ...

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Access to hospitals in the wake of terrorism: challenges and needs for maintaining public confidence

Abstract

As part of a new medical treatment concept for major disasters, we created a prehospital treatment area with external doctors and medical personal in the vicinity of major trauma centers. All patients enter the hospital only through that prehospital treatment area, Were they get triaged and where treatment starts. After primary care, they get transferred to the hospital. Once the hospital capacity (OR) is exceeded, patients remain under the supervision of the prehospital treatment area, where now full treatment including artificial ...

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Appraisal of hospitals during the 2006 FIFA World Cup: Treatment in prehospital treatment areas

Abstract

Alternative care facilities (ACFs) have been widely proposed in state, local, and national pandemic preparedness plans as a way to address the expected shortage of available medical facilities during an influenza pandemic. These plans describe many types of ACFs, but their function and roles are unclear and need to be carefully considered because of the limited resources available and the reduced treatment options likely to be provided in a pandemic. Federal and state pandemic plans and the medical literature were reviewed, ...

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The prospect of using alternative medical care facilities in an influenza pandemic

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Jul

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Nov

Abstract

BACKGROUND: Federal planners have suggested that one strategy to accommodate disaster surges of 500 inpatients per million population would involve altering standards of care. No data are available indicating the extent of alterations necessary to meet disaster surge targets. OBJECTIVE: Our goal was to, in a Monte Carlo simulation study, determine the probability that specified numbers of children could be accommodated for PICU and non-ICU hospital care in a disaster by a set of strategies involving altered standards of care. METHODS: ...

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Jan

Abstract

OBJECTIVE: To estimate the potential for disaster mortality reduction with two surge response strategies: 1) control distribution of disaster victims to avoid hospital overcrowding near the scene, and 2) expand capacity by altering standards of care to only "essential" interventions. DESIGN: Quantitative model of hospital mortality. SETTING: New York City pediatric intensive care unit and non-intensive care unit pediatric hospital capacity and population. MEASUREMENTS AND MAIN RESULTS: Mortality was calculated for a hypothetical sudden disaster, of unspecified mechanism, assuming 500 children ...

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Dec

Abstract

This report reflects the proceedings of a breakout session, "Surge Capacity: Defining Concepts," at the 2006 Academic Emergency Medicine Consensus Conference, "Science of Surge Capacity." Although there are several general descriptions of surge capacity in the literature, there is no universally accepted standard definition specifying the various components. Thus, the objectives of this breakout session were to better delineate the components of surge capacity and to outline the key considerations when planning for surge capacity. Participants were from diverse backgrounds and ...

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Surge capacity for healthcare systems: A conceptual framework

Abstract

This breakout session at the Academic Emergency Medicine 2006 Consensus Conference examined how baseline overcrowding impedes the ability of emergency departments to respond to sudden, unexpected surges in demand for patient care. Differences between daily and catastrophic surge were discussed, and the need to invoke a hospital-wide response to surge was explored. ...

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Nov

Abstract

INTRODUCTION: Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral). OBJECTIVE: The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to ...

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Management of evacuee surge from a disaster area: solutions to avoid non-emergent, emergency department visits

Abstract

Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible ...

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2007

Abstract

Recent terrorist and epidemic events have underscored the potential for disasters to generate large numbers of casualties. Few surplus resources to accommodate these casualties exist in our current health care system. Plans for "surge capacity" must thus be made to accommodate a large number of patients. Surge planning should allow activation of multiple levels of capacity from the health care facility level to the federal level. Plans should be scalable and flexible to cope with the many types and varied timelines ...

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Health care facility and community strategies for patient care surge capacity

Abstract

Excessive demand on hospital services from large-scale emergencies is something that every emergency department health care provider and hospital administrator knows could happen at any time. Nowhere in this country have we recently faced a disaster of the magnitude of concern we now face involving agents of mass destruction or social disruption, especially those in the area of infectious diseases and radiological materials. The war on terrorism is not a conventional war, and terrorists may use any means of convenience to ...

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Surge capacity for health care systems: Early detection, methodologies, and process

Abstract

BACKGROUND: Hospital surge capacity has been advocated to accommodate large increases in demand for healthcare; however, existing urban trauma centers and emergency departments (TC/EDs) face barriers to providing timely care even at baseline patient volumes. The purpose of this study is to describe how alternate-site medical surge capacity absorbed large patient volumes while minimizing impact on routine TC/ED operations immediately after Hurricane Katrina. METHODS: From September 1 to 16, 2005, an alternate site for medical care was established. Using an off-site ...

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Aug

Abstract

Background: Anticipated circumstances during the next severe influenza pandemic highlight the insufficiency of staff and equipment to meet the needs of all critically ill victims. It is plausible that an entire country could face simultaneous limitations, resulting in severe shortages of critical care resources to the point where patients could no longer receive all of the care that would usually be required and expected. There may even be such resource shortfalls that some patients would not be able to access even ...

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May

Abstract

The threat of mass-casualty disasters raises concern about the adequacy of hospitals' surge capacity. This paper measures surge capacity as the number of empty staffed beds per capita at the county level and compares it to a disaster-planning benchmark released by the federal government. The percentage of the U.S. population living in counties falling below the benchmark increased from 19 percent in 2000 to 30 percent in 2005. Limitations in surge capacity are associated with rapid population growth but not with ...

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TRENDS The Dwindling Supply Of Empty Beds: Implications For Hospital Surge Capacity

Abstract

INTRODUCTION: Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event ofbioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements ...

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Mar-Apr

Abstract

Patients who have been contaminated by chemical compounds present a number of difficulties to emergency departments, in particular, the risk of secondary contamination of healthcare staff and facilities. The Department of Health in the United Kingdom has provided equipment to decontaminate chemically contaminated casualties who present at emergency departments. The capacity of this equipment is limited, and although both the ambulance and fire services have equipment to cope with mass casualties at the scene of a chemical incident, there is still ...

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Decontamination of multiple casualties who are chemically contaminated: a challenge for acute hospitals.

Abstract

There is a need for emergency planners to accurately plan for and accommodate a potentially significant increase in patient volume in response to a disaster. In addition, an equally large political demand exists for leaders in government and the healthcare sector to develop these capabilities in a financially feasible and evidence-based manner. However, it is important to begin with a clear understanding of this concept on a theoretical level to create this capacity. Intuitively, it is easy to understand that surge ...

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Mar

Abstract

The term surge capacity in disaster medicine describes the ability of a health care system to suddenly expand its ability beyond normal services to meet the increased demand for qualified medical staff and services during a large scale event. Currently, there is no accepted standard definition for the term surge capacity. The three main components of surge capacity consist of stuff, staff and structure. The goal is to save as many lives as possible in a situation when the needs exceed ...

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The concept of surge capacity for disasters

Abstract

As economic forces have reduced immediately available resources, the need to surge to meet patient care needs that exceed expectations has become an increasing challenge to the health care community. The potential patient care needs projected by pandemic influenza and bioterrorism catapulted medical surge to a critical capability in the list of national priorities, making it front-page news. Proposals to improve surge capacity are abundant; however, surge capacity is poorly defined and there is little evidence-based comprehensive planning. There are no ...

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Nov

Abstract

Objectives: To quantify resource requirements (additional beds and ventilator capacity), for critical care services in the event of pandemic influenza. Materials and Methods: Cross-sectional survey about existing and potential critical care resources. Participants comprised 156 of the 176 Australasian (Australia and New Zealand) critical care units on the database of the Australian and New Zealand Intensive Care Society (ANZICS) Research Centre for Critical Care Resources. The Meltzer, Cox and Fukuda model was adapted to map a range of influenza attack rate ...

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Pandemic influenza-implications for critical care resources in Australia and New Zealand

Abstract

Natural and complex disasters can cause a dramatic increase in the demand for emergency medical care. Local health services can be overwhelmed, and damage to clinics and hospitals can render them useless. Many countries maintain mobile field hospitals for defense or humanitarian purposes. Dispatching these facilities to disaster-affected countries would seem an ideal response to emergency medical needs. Unfortunately, experience has shown that in the case of natural disasters, field hospitals often have not met the expectations of recipients and donor ...

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Guidelines for the use of foreign field hospitals in the aftermath of sudden-impact disaster

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Aug

Abstract

Objective: To explore the utilization of emergency materials for mass disaster. Methods: We retrospectively analyzed the 2 338 casualties from Wenchuan earthquake who visited our emergency department from 2:28 PM, May 12 to 2:28 PM, June 2. The injury condition and demand on emergency materials at different phase were also analyzed. Results: Among the 2 338 casualties, the most common injuries were fracture, skin or soft tissue injury, and brain injury. Primary drugs are tetanus immune globulin, normal sodium and antibiotics. ...

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Utilization analysis of emergency materials of 2338 wounded patients in emergency after Wenchuan earthquake. [Chinese]

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Mar

Abstract

Disaster medicine must master the simultaneous treatment of many patients under less favourable conditions, with usually less physicians and rescue forces available than necessary, with not sufficient or insufficient means and under substantial time pressure. In emergencies, large damage events and disasters mass accumulation of hurt gotten sick victims has to be handled. Not all clinically relevant medicines have to be available at place. However, in large damage events and disasters sufficient medical material must be available, both for mastering the ...

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Jun