Hospital-Based Emergency Care At the Breaking Point (2007) / Chapter Skim
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7 Disaster Preparedness
7 Disaster Preparedness
Pages 259-290
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If we cannot take care of our emergency patients on a normal day, how will we manage a large-scale disaster? Federal, state, and local government entities have since realized the importance of hospitals, particularly emergency departments (EDs)
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How does a hospital protect itself and its staff from chemical or biological agents when patients are contaminated? This chapter examines these and other questions, and considers the current level of hospital disaster preparedness.
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. This report expands that definition in the context of hospital-based emergency and trauma care to include any event that creates a significant, short-term spike in the demand for emergency care services that requires extraordinary measures to address adequately.
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. Of the 15 National Planning Scenarios introduced by the Department of Homeland Security (DHS)
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. In the most extreme cases -- for example, a full-blown influenza pandemic such as that experienced worldwide in 1918 -- this could mean assigning the most severely ill or injured patients to "expectant care," a strategy that withholds treatment for those who have TABLE 7-1 Recent Disaster Events (United States and Worldwide)
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From page 264... ...
National Center for Injury Prevention and Control, Division of Injury Response, is developing a consensus report describing the detailed actions to be taken by hospital and trauma center departments and personnel in the event of an explosive mass casualty event (CDC National Center for Injury Control and Prevention, 2006)
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From page 265... ...
In many cities, hospitals and trauma centers have problems dealing with a multiple-car highway crash, much less the volume of patients likely to result from a large-scale disaster. During emergencies, hospitals can do a number of things to free up capacity and extend their resources, but there are serious physical limitations on this expansion of their capabilities.
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While other staff, such as emergency physicians, critical care specialists, and nurses, are important, they are less likely to represent a major constraint on the ability to treat additional patients. One way in which hospitals can alleviate staff shortages is to use emergency medical services (EMS)
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It received 82 patients, 25 percent of whom were admitted and 25 percent of whom were transferred to other hospitals. A level I trauma center located 12 miles away from the nightclub received 68 patients; approximately 63 percent were admitted (Gutman et al., 2003)
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All air medical resources available in New England were used that evening (Gutman et al., 2003)
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. The Connecticut Department of Public Health contracted with two level I trauma centers, which were designated as regional centers of excellence for bioterrorism preparedness.
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0 HOSPITAL-BASED EMERGENCY CARE in the event of a disaster. Ideally, all assets required for a community or a state to mount an effective response should be developed within the regional context described in Chapter 3.
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. The committee recognizes the importance of the VHA in emergency planning and response, and recommends that the Department of Homeland Security, the Department of Health and Human Services, the Department of Transportation, and the states collaborate with the Veterans Health Administration (VHA)
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HOSPITAL-BASED EMERGENCY CARE 100 92.1% 82.5% 80 72.9% Percentage 60 53.1% 49.2% 40 20 s s ff Ps s rse ian ern Sta s/N sic Nu Int ory PA hy ts/ rat ff P en bo sid Sta La Re FIGURE 7-2 Percentage of hospitals with staff trained in disaster response. NOTE: NP = nurse practitioner; PA = physician assistant.
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Professional Training Curricula Training currently provided to physicians in medical school and continuing education programs does not uniformly address the threat of disasters, types of WMD agents, and procedures for handling mass casualty incidents and events. WMD-related training is only a small component of emergency medicine residency programs, but, as mentioned earlier, approximately 38 percent of practicing emergency physicians are neither residency trained nor board certified in emergency medicine and are therefore not exposed to that curriculum.
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Therefore, to address the need for competency in disaster medicine across disciplines, the committee recommends that all institutions responsible for the training, continuing education, and credentialing and certification of professionals involved in emergency care (including medicine, nursing, emergency medical services, allied health, public health, and hospital administration) incorporate disaster preparedness training into their curricula and competency criteria (7.2)
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DISASTER PREPAREDNESS Protecting the Hospital and Staff Protecting the Hospital The hospital represents a critical asset in the event of a disaster, but it is also a vulnerable one. Hospitals can fall victim to the disaster event itself, as occurred in the cases of Katrina and other recent hurricanes.
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In addition, it is necessary to learn from SARS and similar experiences and to develop techniques and approaches that add to our understanding of the management of disease outbreaks. One possible containment strategy is to use cohort staffing techniques similar to those employed in neonatal intensive care.
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DISASTER PREPAREDNESS BOX 7-3 The SARS Outbreak and Its Implications The 2003 outbreak of severe acute respiratory syndrome (SARS) speaks volumes about the global health care community's deficiencies in recognizing, controlling, and communicating information about potential infectious diseases.
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Additionally, such equipment is often restrictive and cumbersome, making triage and patient care more difficult (Suner et al., 2004; Horton et al., 2005)
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DISASTER PREPAREDNESS augment its recommendations accordingly (OSHA, 2005)
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. Other regions use passive systems, in which information is automatically collected in the course of patient care, and either automatically reported or "mined" by public health workers to solicit information from hospitals (GAO, 2003c; Schur, 2004)
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. The emergency preparedness challenges EDs face are exacerbated in
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Training of staff in emergency preparedness is often complicated by the fact that training meetings are frequently held in urban areas that may be quite far away from rural hospitals. One day of training may require 2 or 3 days away from the hospital to accommodate travel time (Schur et al., 2004)
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DISASTER PREPAREDNESS FEDERAL FUNDING FOR HOSPITAL PREPAREDNESS Total federal preparedness funding has increased substantially in the 5 years since September 11, 2001. Emergency preparedness funding in DHHS, for example, rose from $237 million in fiscal year 2000 to $9.6 billion in fiscal year 2006 (Broder, 2006)
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Therefore, the committee recommends that Congress significantly increase total preparedness funding in fiscal year 2007 for hospital emergency preparedness in the following areas: strengthening and sustaining trauma care systems; enhancing emergency department, trauma center, and inpatient surge capacity; improving emergency medical services' response to explosives; designing evidence-based training programs; enhancing the availability of decontamination showers, standby intensive care unit capacity, negative pressure rooms, and appropriate personal protective equipment; and conducting international collaborative research on the civilian consequences of conventional weapons terrorism.
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From page 285... ...
7.3: Congress should significantly increase total preparedness fund ing in fiscal year 2007 for hospital emergency preparedness in the following areas: strengthening and sustaining trauma care systems; enhancing emergency department, trauma center, and inpatient surge capacity; improving emergency medical services' response to explosives; designing evidence-based training programs; enhancing the availability of decontamination showers, standby intensive care unit capacity, negative pressure rooms, and appropriate personal protective equipment; and conducting international collaborative research on the civilian consequences of conventional weapons terrorism. REFERENCES Accountability Review Boards on the Embassy Bombings in Nairobi and Dar es Salaam.
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Academic Emergency Medicine 12(5)
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2003a. Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities.
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. A 00 National Assessment of State Trauma System Deelopment, Emergency Medical Serices Resources, and Disaster Readiness for Mass Casualty Eents.
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2001. Executive summary: Developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical incidents.
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0 HOSPITAL-BASED EMERGENCY CARE WHO (World Health Organization)
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