Abstract
BackgroundLarge-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.MethodsThe Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework.ResultsA four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans.ConclusionsThe study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.
Highlights
Hospitals provide essential emergency care during patient surge following large-scale burn disasters
The study focused on analyzing the hospitals’ responses to the situations they were challenged in the emergency department (ED) period, starting when the hospital was first informed of the Formosa Fun Coast Dust Explosion (FFCDE) and ending with the discharge or transfer of all FFCDE patients from EDs
Large-scale mass casualty incidents that overwhelm health care systems have become normal in recent decades
Summary
Hospitals provide essential emergency care during patient surge following large-scale burn disasters. Within 6 h, 499 burn victims had been transported to 36 hospitals including 10 large medical centers, 23 regional hospitals, and 3 district hospitals across regions [1, 2]. These hospitals differed in their response capacity in terms of critical care bed numbers, burn care capability, accreditation level, and distance to the disaster scene. Despite the extreme patient surge and limited resources, the overall mortality rate was 3% (15 out of 499) This result was remarkable compared with international incidents [3, 4], which was acknowledged by the international emergency medicine community. This study pro‐ poses a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surgecapacity events
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