A Hospital System's Response To A Hurricane Offers Lessons, Including The Need For Mandatory Interfacility Drills
This case study explores the lessons learned when the North Shore-Long Island Jewish Health System, a large, integrated health network in New York, evacuated three hospitals at high risk of flooding from Hurricane Irene in August 2011. The episode resulted in the evacuation, transport, and placement of 947 patients without any resulting deaths or serious injuries. This case demonstrates the utility of having in place a functional evacuation plan, such as the one North Shore-Long Island Jewish Health System developed through its own full-scale exercises in the years following Hurricane Katrina in 2005. In those drills, the health system discovered that it needed to abandon its 1:1 matching of patients to available beds in the region in favor of the group transport of patients with similar needs to facilities that could accommodate them. Despite its overall success, the system identified the need for internal improvements, including automated patient tracking through the use of bar-coded wristbands and identification and training of additional backup personnel for its emergency operations center. Among other changes, policy makers at the state and federal levels should consider mandating full-scale interfacility evacuation drills to refine mechanisms to send and receive patients.
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ABSTRACT: Disasters with significant numbers of burn-injured patients create incredible challenges for disaster planners. Although not unique to burn care, high-intensity areas of speciality such as burns, pediatrics, and trauma quickly become scarce resources in a disaster.All disasters are local, but regional support is critical in burn disaster planning. On a day-to-day basis, burn bed capacity can be problematic. A review of the literature and our experiences, including mathematical modeling and real events, reaffirm how rapidly we can overwhelm our resources.This review includes the Southern Burn Plan, created by the burn centers of the American Burn Association's Southern Region, should there be a need for additional hospital burn beds (capacity) and burn care (capability) in response to a disaster. This article also explores planning and preparedness developments and describes options to improve our efforts, including training and education.It is incumbent upon everyone in the healthcare profession to become comfortable managing burn-injured patients until the patients can be moved to a burn center. Understanding the regional capacity, capability, and when a surge of patients may require the practice of altered standards of care is essential for those involved in medical disaster preparedness.Southern medical journal 01/2013; 106(1):69-73. DOI:10.1097/SMJ.0b013e31827c4d94 · 0.93 Impact Factor
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ABSTRACT: The Southern Region of the American Burn Association began to craft a regional plan to address a surge of burn-injured patients after a mass casualty event in 2004. Published in 2006, this plan has been tested through modeling, exercise, and actual events. This article focuses on the process of how the plan was created, how it was tested, and how it interfaces with other ongoing efforts on preparedness. One key to success regarding how people respond to a disaster can be traced to preexisting relationships and collaborations. These activities would include training or working together and building trust long before the crisis. Knowing who you can call and rely on when you need help, within the context of your plan, can be pivotal in successfully managing a disaster. This article describes how a coalition of burn center leaders came together. Their ongoing personal association has facilitated the development of planning activities and has kept the process dynamic. This article also includes several of the building blocks for developing a plan from creation to composition, implementation, and testing. The plan discussed here is an example of linking leadership, relationships, process, and documentation together. On the basis of these experiences, the authors believe these elements are present in other regions. The intent of this work is to share an experience and to offer it as a guide to aid others in their regional burn disaster planning efforts.Journal of burn care & research: official publication of the American Burn Association 05/2013; 35(1). DOI:10.1097/BCR.0b013e3182957468 · 1.43 Impact Factor
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ABSTRACT: The 9/11 attacks reframed the narrative regarding disaster medicine. Bypass strategies have been replaced with absorption strategies and are more specifically described as "surge capacity." In the succeeding years, a consensus has coalesced around stratifying the surge capacity into three distinct tiers: conventional, contingency, and crisis surge capacities. For the purpose of this work, these three distinct tiers were adapted specifically to burn surge for disaster planning activities at hospitals where burn centers are not located. A review was conducted involving published plans, other related academic works, and findings from actual disasters as well as modeling. The aim was to create burn-specific definitions for surge capacity for hospitals where a burn center is not located. The three-tier consensus description of surge capacity is delineated in their respective stratifications by what will hereinafter be referred to as the three "S's"; staff, space, and supplies (also referred to as supplies, pharmaceuticals, and equipment). This effort also included the creation of a checklist for nonburn center hospitals to assist in their development of a burn surge plan. Patients with serious burn injuries should always be moved to and managed at burn centers, but during a medical disaster with significant numbers of burn injured patients, there may be impediments to meeting this goal. It may be necessary for burn injured patients to remain for hours in an outlying hospital until being moved to a burn center. This work was aimed at aiding local and regional hospitals in developing an extemporizing measure until their burn injured patients can be moved to and managed at a burn center(s).Journal of burn care & research: official publication of the American Burn Association 06/2013; 35(1). DOI:10.1097/BCR.0b013e318283b7d2 · 1.43 Impact Factor
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