Implementing a Fast-Track Team Triage Approach in Response to Hurricane Maria.

Abstract

Hurricane Maria struck Puerto Rico on September 20, 2017, and caused widespread damage to the island, resulting in decreased access to health care. Sixteen days later, a mobile military hospital (MMH) was deployed to Humacao, Puerto Rico, to provide medical relief. Overcrowding in EDs is a problem in disaster relief responses, as was the case here. Initial triage practices resulted in long wait times and limited access to care, and many people left before being seen by a provider. This study describes the implementation of a combined fast-track and team triage process to quickly and effectively screen patients in the MMH. In addition to maintaining a formal triage, our ED staff combined two systems, fast track and team triage, to accommodate the influx of patients. This newly combined approach consisted of a health care provider (an MD, NP, or physician assistant) and an RN to facilitate the evaluation, treatment, and discharge of lower-acuity patients. During peak operations (days 13 to 26 of the total 31 days of operation), 70% of MMH patients were evaluated, treated, and discharged from the combined fast-track and team triage, while only 28% of patients were sent to formal triage; patients with critical conditions (2% of the total) were sent directly to the ED. The mean number of patients seen daily in the first 10 days of operation (n = 84) increased by an average of 48% (n = 124) in the 14 days of peak operations. The combined fast-track and team triage approach enabled us to quickly and effectively screen patients and greatly improved clinical outcomes and patient flow in a mobile facility.