Hospital Emergency Management Research Articles

73: HOSPITAL EMERGENCY RESPONSE AGAINST DISASTERS: EVIDENCE FROM HOSPITALS IN IRAN

Background and aims:Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Hospital emergency management is a continuing process requiring the monolithic integration...

A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters.

Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters. A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events. To demonstrate the model's potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties. Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities. The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed. Carr BG , Walsh L , Williams JC , Pryor JP , Branas CC . A geographic simulation model for the treatment of trauma patients in disasters. Prehosp Disaster Med. 2016;31(4):413-421.

P002: Ten patients, one ventilator: how to best allocate critical care resources during mass disaster

Introduction: Any large-scale disaster may place a hospital system in a precarious position. Planning is fundamental to facilitate an equitable process for allocating scarce critical care resources, yet there is a paucity of literature guiding protocol development, and few Canadian hospitals have done this planning. We performed a scoping review of the available literature, and used this data to develop a hospital-wide policy to guide critical care resource allocation as part of the hospital emergency management planning process. Methods: A primary search of MEDLINE (1946-2015), EMBASE (1980-2015), Disaster Lit (2002-2010) and Pubmed focusing on a priori criteria was completed. A secondary search of the grey literature served to increase sensitivity and rigor. Two independent reviewers manually reviewed the citations, and selected eligible abstracts for full-text. Qualitative thematic analysis was undertaken of the selected articles. The results then informed the development of a hospital-wide policy and protocol to guide critical care resource allocation. Results: The search identified 832 citations; 134 papers were reviewed and 11 selected for qualitative analysis. All included papers were expert opinion and reviews. All suggested that an ethical framework be used; eight discussed this in detail. Ten recommended allocating a triage team to implement the protocol. Nine papers recommended specific resource allocation protocols with inclusion/exclusion criteria, physiologic scores, and reassessment at varying time intervals (12-120 hours). Conclusion: Effective planning, prior to a disaster, is critical to saving as many lives as possible. Based on our scoping review, we have developed a hospital-wide protocol that incorporates ethical principles and clear inclusion and exclusion criteria, to help avoid inequity and promote transparent decision-making. Next steps include a public consultation process and review, prior to implementation testing and educational roll-out.

Assessing the use of initial oxygen therapy in chronic obstructive pulmonary disease patients: a retrospective audit of pre-hospital and hospital emergency management.

Carbon dioxide retention in chronic obstructive pulmonary disease (COPD) exacerbations can be a complication of oxygen therapy. Current recommendations suggest an inspired oxygen level (FiO2 ) < 0.28, aiming for saturation (SpO2 ) of 88-92% until arterial blood gas analysis is available. This study aims to assess the use of O2 therapy and FiO2 in the emergency management of patients with a known diagnosis of COPD. Retrospective audit of 150 COPD patients admitted over 18 months, data being extracted from the hospital records. Of the records reviewed, 57% were male, mean age 75 years. COPD was recognised in 53%. SpO2 recorded in 124 patients, with SpO2 < 88% seen in 40 patients. Oxygen was administered in 123 patients in ambulances; high flow in 111 patients, and only 12 patients received O2 therapy in line with the recommended FiO2 < 0.28. In the emergency department (ED), 112 patients received O2 supplementation; high flow given in 68 patients. Hypercapnia was seen in 71 patients; FiO2 > 0.28 given in 54 patients in ambulances and in 35 patients in ED. Non-invasive ventilation was required in 53 patients; FiO2 > 0.28 given in 29 patients in the ED. Seven patients were admitted to intensive care unit, and 10 patients died. High-flow oxygen is used for the initial treatment of COPD exacerbations, but only 53% are recognised as having COPD. A FiO2 > 0.28 is often initiated before admission and continued in the ED. A larger study would be required to assess any possible harm of this approach, but education of those involved in the care of COPD patients may reduce the risk of complications of hypercapnia.

Acetabular Fractures - A Review of their Management

Acetabular fractures present with a bimodal distribution, as is often associated with traumatic injuries presenting to trauma and orthopaedic surgeons. It is an injury that mandates a multi- disciplinary team approach as it is associated with injuries to another organ system and/or the lower extremities. The implementation of Advanced Trauma and Life Support (ATLS) principals has led to significant improvements and standardisation of how this injury is managed outside of the hospital setting and emergency management however controversies exist regarding the definitive treatment of this condition. A literature review of this interesting and common place fracture is presented whilst highlighting the areas of debate regarding its further management.

Personnel Response during an Internal Emergency—Unexpected Release of an Irritant Gas in a Hospital

Internal emergencies can occur at any time and location in a hospital. Planning, training, and exercises can prepare personnel to respond effectively to internal emergency situations. All hospital staff should be trained to recognize an internal incident and activate the hospital emergency management system. Maintaining the health and safety of patients, employees, and visitors is paramount. Training and exercises also encourage staff to act with competence and confidence during an untoward incident to mitigate or avert possible catastrophe. This article describes an incident in which 12 hospital employees presented to the emergency department after exposure to a potent pulmonary irritant gas, chlorine, following an unfortunate accident. These cases are used to illustrate how planning, training, and exercises assisted health care personnel in responding to a potentially catastrophic internal emergency.

Personnel Response During an Internal Emergency—Unexpected Release of an Irritant Gas in a Hospital

Internal emergencies can occur at any time and location in a hospital. Planning, training, and exercises can prepare personnel to respond effectively to internal emergency situations. All hospital staff should be trained to recognize an internal incident and activate the hospital emergency management system. Maintaining the health and safety of patients, employees, and visitors is paramount. Training and exercises also encourage staff to act with competence and confidence during an untoward incident to mitigate or avert possible catastrophe. This article describes an incident in which 12 hospital employees presented to the emergency department after exposure to a potent pulmonary irritant gas, chlorine, following an unfortunate accident. These cases are used to illustrate how planning, training, and exercises assisted health care personnel in responding to a potentially catastrophic internal emergency.

Evaluation of regional hospitals’ use of children in disaster drills

Describe the prevalence of pediatric casualties in disaster drills by community hospitals and determine if there is an association between the use of pediatric casualties in disaster drills and the proximity of a community hospital to a tertiary children's hospital. Survey, descriptive study. Tertiary children's hospital and surrounding community hospitals. Hospital emergency management personnel for 30 general community hospitals in the greater Cincinnati, Ohio region. None The utilization of pediatric casualties in community hospital disaster drills and its relationship to the distance of those hospitals from a tertiary children's hospital. Sixteen hospitals reported a total of 57 disaster drills representing 1,309 casualties. The overwhelming majority (82 percent [1,077/1,309]) of simulated patients from all locations were 16 years of age or older. Those hospitals closest to the children's hospital reported the lowest percentage of pediatric patients (10 percent [35/357]) used in their drills. The hospitals furthest from the children's hospital reported the highest percentage of pediatric patients (32 percent [71/219]) used during disaster drills. The majority of community hospitals do not incorporate children into their disaster drills, and the closer a community hospital is to a tertiary children's hospital, the less likely it is to include children in its drills. Focused effort and additional resources should be directed toward preparing community hospitals to care for children in the event of a disaster.

Hospital-Based Emergency Preparedness

The objective of this study was to report an experience with a full-scale neonatal intensive care unit evacuation exercise. This was a retrospective review of lessons learned from a full-scale evacuation exercise following a simulated catastrophe. Thirty-four realistically simulated neonatal intensive care unit infants (including 12 infants who required respiratory support and 3 with very complex medical issues) were horizontally evacuated emergently to limit immediate danger, followed by a vertical evacuation down several flights of stairs to a temporary holding area. The infants were then set up for transport for ongoing care to other regional hospitals. As with a real emergency, the drill involved the hospital incident management resources plus external partners (e.g., police, public health, and fire departments). We found that effective and constant communication was critical. Essential health care personnel resources included (1) staff to physically transport patients, (2) a central communication/coordinating site, and (3) on-site triage in the holding areas. Because it is impossible to anticipate every eventuality, flexibility and creativity are essential in disaster management. Adult tracking forms, equipment, and emergency procedures were nontransferable and often inappropriate for infants. When a disaster occurs, hospital clinical staff, emergency management, and administrators may help avoid unnecessarily high morbidity and mortality among the smallest and most vulnerable patients by developing and practicing contingency plans. We learned what our rate-limiting steps are and how we would mitigate these.

Disaster Preparedness: Emergency Planning in the NICU

Hospital emergency management has evolved beyond satisfying regulatory requirements. Although tools and resources have been developed to support hospitals in emergency planning, there appears to be a scarcity of resources to guide hospital departments. To ensure that standards of care are maintained and to minimize the impact on the hospital and/ or a nursing unit, Good Samaritan Hospital has developed a mobile emergency system and an Emergency Operations Plan (EOP) template to assist other nursing units in their planning efforts. This article focuses on the development of emergency bedside backpacks, mobile disaster boxes, disaster documentation and forms go-kits, and guidelines for creating such a plan. The ongoing equipment testing, inventory rotation, staff training, and exercising response protocols are all crucial to test the effectiveness of the program in place. All these activities require a multidisciplinary approach to ensure integration with hospital-wide emergency planning efforts.

Book Review: GIS in Hospital and Healthcare Emergency Management

Book Review: GIS in Hospital and Healthcare Emergency Management

The Pediatric Hospital Incident Command System: An Innovative Approach to Hospital Emergency Management

The Pediatric Hospital Incident Command System: An Innovative Approach to Hospital Emergency Management

Assessment of Hospital Emergency Management in the Beijing Area

In recent years, the number of public health emergencies has increased. Improving hospital emergency management is an important challenge. This is a pilot study intended to assess hospital emergency management in the Beijing area, make recommendations to government health authorities and hospital managers, and offer references for similar studies. This was an observational, cross-sectional survey. Forty-five hospitals in the Beijing area were selected randomly. A self-administered questionnaire was used as a data collection tool. It comprised of three sections: (1) Section A was the introduction; (2) Section B asked for the respondent's personal information; and (3) Section C comprised the major part of the questionnaire and was intended to gather information regarding the hospital's general emergency management situation. The survey response rate was 44%, accounting for 29% of total hospitals that the study targeted. No hospital had an established emergency management department or full-time staff for emergency management. A total of 15-45% of the hospitals had established a hospital emergency management committee, performed a vulnerability analysis, or evaluated emergency management regularly. Twenty-five percent of respondents thought that the local government health authority had established an integrated hospital incident command system. A total of 40%-55% of hospitals contracted with outside institutions for supplements, backup of key functional systems and professional support. After the occurrence of the 2003 severe acute respiratory syndrome (SARS) epidemic, Chinese hospital managers took many measures to improve hospital resilience. However, most of these efforts lacked the guidance of theories, concepts, principles, and methods. An integrated, standardized, operational hospital emergency management model has not been established. Although the survey response rate was relatively low, some clues for further study were discovered, and suggestions to the health authority for hospital emergency management improvement were revealed.

(A288) World Health Organization Regional Office for Europe All-Hazard Hospital Emergency Preparedness Checklist

ObjectivesHospitals play a critical role in communities to provide essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the health care system at large. The World Health Organization (WHO) Regional Office for Europe All-Hazard Hospital Emergency Preparedness Checklist aims to assist hospital administrators and disaster managers in preparing health facilities to respond effectively to the most likely disaster scenarios.MethodsA checklist tool was developed that comprises current hospital-based emergency management principles and techniques, and integrates applications specific to hospital preparedness needs in the WHO European Region.ResultsA list of recommended actions within critical service categories is provided in a step-wise, all-hazard form for rapid implementation by hospital administrators and disaster managers in response to the most likely types of disaster.ConclusionsThe principles and recommendations provided in this tool may be used by hospitals at any level of emergency preparedness. The checklist is not intended to replace standards and protocols already defined in hospital emergency management plans. Rather, it provides recommendations to enhance existing plans in concert with national guidelines.

Performance-based Fire Safety Design for Existing Small-scale Hospitals

The new era of National Health Insurance in 2000 has had a significant impacted on the management and operation of smallscale hospitals. In response to social needs, and in order to survive under the new insurance system, some small-scale hospitals have transformed or established new Respiratory Care Wards by using existing hospital space. According to the 2009 statistics released by Department of Health, Executive Yuan, there are a total of 307 small-scale medical institutes which provide servicesunder 99 beds. Compared with other large-scale medical centers and general hospitals, small-scale hospitals cannot properly deal with safety management and response to emergency evacuation due to lack of facilities, equipment and human resources. Therefore, small-scale hospitals face a major challenge in emergency response once a fire has occurred. As a result of such a situation, this study has focused mainly on Respiratory Care Wards (RCW) where patients are unable to evacuate. It hopes to analyse the safety management, and emergency response in small-scale hospitals by means of understanding the space characteristics and fire risk. Through on-site surveys, we can understand the fire risk, space features, patient characteristics, facilities and equipment. With reference to the related regulations of hospital emergency management and response, we will propose some fire safety engineering approaches, such as refuge areas in horizontal evacuation and so-called “besieged zones” for “defense-in-place”, etc., to provide some alternative measures to improve fire safety for those small-scale hospitals.

Assessing hospital emergency management plans: A guide for infection preventionists

BackgroundHospital emergency management plans are essential and must include input from an infection preventionist (IP). Multiple hospital planning documents exist, but many do not address infection prevention issues, combine them with noninfection prevention issues, or are disease/event specific. An all-encompassing emergency management planning guide for IPs is needed.MethodsA literature review and Internet search were conducted in December 2008. Data from relevant sources were extracted. A spreadsheet was created that delineated hospital emergency management plan components of interest to IPs.ResultsOf the sources screened, 49 were deemed relevant. Eleven domains were identified: (1) having a plan; (2) assessing hospital readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) having laboratory support; (8) addressing surge capacity issues; (9) having anti-infective therapy and/or vaccines; (10) providing infection prevention education; and (11) managing physical plant issues.ConclusionInfection preventionists should use this article as an assessment tool for evaluating their hospital emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

Major Influences on Hospital Emergency Management and Disaster Preparedness

The role of hospitals in the community response to disasters has received increased attention, particularly since the terrorist attacks of September 11, 2001. Hospitals must be prepared to respond to and recover from all-hazards emergencies and disasters. There have been several initiatives to guide hospitals' role in these events and to assist hospitals in their effort to prepare for them. This article focuses on the efforts of 4 distinct groups: The Joint Commission (TJC), the executive branch of the US government, the US Congress, and the Department of Health and Human Services (DHHS). Despite the different approach each group uses to assist hospitals to improve their emergency management capabilities, the initiatives reinforce one another and have resulted in increased efforts by hospitals to improve their disaster preparedness and response capabilities and community integration. The continued progress of our medical response system in all-hazard emergencies and disasters depends in large part on the future guidance and support of these 4 key institutions.

Are We Ready and How Do We Know? The Urgent Need for Performance Metrics in Hospital Emergency Management

An extraordinary number of health care quality and patient safety indicators have been developed for hospitals and other health care institutions; however, few meaningful indicators exist for comprehensive assessment of hospital emergency management. Although health care institutions have invested considerable resources in emergency management preparedness, the need for universally accepted, evidence-based performance metrics to measure these efforts remains largely unfulfilled. We suggest that this can be remediated through the application of traditional health care quality paradigms, coupled with novel analytic approaches to develop meaningful performance data in hospital emergency management.

Community Resilience Roundtable on the Implementation of Homeland Security Presidential Directive 21 (HSPD-21)

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and ScienceVol. 6, No. 3 Meeting ReportCommunity Resilience Roundtable on the Implementation of Homeland Security Presidential Directive 21 (HSPD-21)Monica Schoch-Spana, Brooke Courtney, Crystal Franco, Ann Norwood, and Jennifer B. NuzzoMonica Schoch-SpanaSearch for more papers by this author, Brooke CourtneySearch for more papers by this author, Crystal FrancoSearch for more papers by this author, Ann NorwoodSearch for more papers by this author, and Jennifer B. NuzzoSearch for more papers by this authorPublished Online:16 Sep 2008https://doi.org/10.1089/bsp.2008.0809AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byAn Approach to the Unified Conceptualization, Definition, and Characterization of Social Resilience9 May 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 9Health-Care Services as a Platform for Building Community Resilience among Minority Communities: An Israeli Pilot Study during the COVID-19 Outbreak16 October 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 20The Los Angeles County Community Disaster Resilience Project: A Community-Level, Public Health Initiative to Build Community Disaster Resilience31 March 2016An agent-based model of a multimodal near-field tsunami evacuation: Decision-making and life safetyTransportation Research Part C: Emerging Technologies, Vol. 64Use of the Structured Interview Matrix to Enhance Community Resilience Through Collaboration and Inclusive Engagement15 January 2014 | Systems Research and Behavioral Science, Vol. 32, No. 6International Journal of Environmental Research and Public Health, Vol. 11, No. 8The Promise and Pitfalls of Community Resilience18 December 2013 | Disaster Medicine and Public Health Preparedness, Vol. 7, No. 6Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public HealthAmerican Journal of Public Health, Vol. 103, No. 7Disaster Resilience and People with Functional NeedsNew England Journal of Medicine, Vol. 367, No. 24Citizen Preparedness for Disasters: Are Current Assumptions Valid?8 April 2013 | Disaster Medicine and Public Health Preparedness, Vol. 6, No. 2Resilience thinking in health protection6 April 2011 | Journal of Public Health, Vol. 33, No. 3Major Influences on Hospital Emergency Management and Disaster Preparedness8 April 2013 | Disaster Medicine and Public Health Preparedness, Vol. 3, No. S1 Volume 6Issue 3Sep 2008 InformationMary Ann Liebert, Inc.To cite this article:Monica Schoch-Spana, Brooke Courtney, Crystal Franco, Ann Norwood, and Jennifer B. Nuzzo.Community Resilience Roundtable on the Implementation of Homeland Security Presidential Directive 21 (HSPD-21).Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science.Sep 2008.269-278.http://doi.org/10.1089/bsp.2008.0809Published in Volume: 6 Issue 3: September 16, 2008PDF download

Recommended Modifications and Applications of the Hospital Emergency Incident Command System for Hospital Emergency Management

The Hospital Emergency Incident Command System (HEICS), now in its third edition, has emerged as a popular incident command system model for hospital emergency response in the United States and other countries. Since the inception of the HEICS in 1991, several events have transformed the requirements of hospital emergency management, including the 1995 Tokyo Subway sarin attack, the 2001 US anthrax letter attacks, and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreaks in eastern Asia and Toronto, Canada. Several modifications of the HEICS are suggested to match the needs of hospital emergency management today, including: (1) an Incident Consultant in the Administrative Section of the HEICS to provide expert advice directly to the Incident Commander in chemical, biological, radiological, nuclear (CBRN) emergencies as needed, as well as consultation on mental health needs; (2) new unit leaders in the Operations Section to coordinate the management of contaminated or infectious patients in CBRN emergencies; (3) new unit leaders in the Operations Section to coordinate mental health support for patients, guests, healthcare workers, volunteers, and dependents in terrorism-related emergencies or events that produce significant mental health needs; (4) a new Decedent/Expectant Unit Leader in the Operations Section to coordinate the management of both types of patients together; and (5) a new Information Technology Unit Leader in the Logistics Section to coordinate the management of information technology and systems. New uses of the HEICS in hospital emergency management also are recommended, including: (1) the adoption of the HEICS as the conceptual framework for organizing all phases of hospital emergency management, including mitigation, preparedness, response, and recovery; and (2) the application of the HEICS not only to healthcare facilities, but also to healthcare systems. Finally, three levels of healthcare worker competencies in the HEICS are suggested: (1) basic understanding of the HEICS for all hospital healthcare workers; (2) advanced understanding and proficiency in the HEICS for hospital healthcare workers likely to assume leadership roles in hospital emergency response; and (3) special proficiency in constituting the HEICS ad hoc from existing healthcare workers in resource-deficient settings. The HEICS should be viewed as a work in progress that will mature as additional challenges arise and as hospitals gain further experience with its use.