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Patients inflow and outflow to the emergency department (ED) in detail timeline.

Patients inflow and outflow to the emergency department (ED) in detail timeline.

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Article
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Purpose: To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. Material and methods: The critical incident tec...

Contexts in source publication

Context 1
... spreadsheets (Excel) along with patient data. The transcrip- tions were organized for process tracing analysis, performance in critical incidents [14,15]. The process trace highlighted how the patient surge played out over time, how it challenged the ED, and how the ED and other hospital units adapted to avoid deterioration of patient care. Figs. 1-3 chart the process in terms of load on the ED, actual and potential bottlenecks, and ...
Context 2
... following is a detailed timeline of events, starting with first knowledge of the FFCDE disaster and ending with the discharge or transfer of all FFCDE patients from the ED. Fig. 1 displays different types of ED patient flows for this time period. In addition to the patients described previously, 300 cumulative personnel gradually arrived to assist in treatment, but it is unknown how many were treating patients at any one time. The ED's earliest awareness a patient surge was around 20:50 when the NTC Dispatch ...

Citations

... • Staff and students at the nursing school called in [53] • Additional staff recruited, asked to come to work, brought in from other areas or stayed back and worked overtime, shift times were relaxed [53,23,24,34,36,41] • Students from the college of nursing helped manage the observation area for paediatric patients [48] Secondary exposure of staff: ...
... • Supplies ran out quickly [24] • Supplies were borrowed from other departments or ambulances [23,36] Antidotes: ...
... • Due to lack of space flushing of wounds was done at a triage area [23] • The ED was re-organised as per pre planning into acuity areas [29] • The ED space was completely reorganised mid response [23] Decontamination: ...
... The machine helps people adapt how it works to keep the system working As situations escalate from normal to exceptional, machines often get in the way more than they help (Woods & Patterson, 2000). Machines stick to their set of rules, but successfully responding to these exceptional situations often requires changing procedures, sacrificing some goals, or otherwise breaking the normal rules (Chuang et al., 2019). Machines must allow (or even help) people break the machine's rules during exceptional circumstances; otherwise, machines are likely to exacerbate the situation with additional burden (Woods & Patterson, 2000). ...
Article
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As machines increasingly behave more like active cognitive agents than passive tools, additional heuristics for supporting joint human-machine activity are urgently needed to complement existing usability heuristics. Despite the rich and extensive design guidance produced by forty years of cognitive systems engineering (CSE) and related fields, the lack of large-scale impact can be attributed, in part, to insufficient translation of CSE principles and guidelines to language and tools that are ready for designers and other decision-makers responsible for these automation-infused solutions. Towards this need, we synthesized a partial and preliminary list of ten machine requirements intended to capture some of the essentials of joint activity. We believe solidifying these essentials and their implications for machines is a first and necessary step towards deriving joint activity design heuristics that are valuable, practical, and sustainable for operational personnel. Through iterative refinement, we believe the combination of strong ideas and strong practicality in these tools can be the basis for a large-scale shift in the design and evaluation of human-machine teams.
... 12 VR has been deployed in a multitude of domains including healthcare/surgery training, air traffic control, emergency response, industrial process control, and space operations. 1,[13][14][15][16] Applications of VR at NASA JSC date as early as the 1990s, with later applications including crew training for STS-61 deployment of the Hubble Space Telescope, involving complex human-robot choreography including an extravehicular crew member and Shuttle robotic arm. 12 VR is a highly visual experience and applications frequently include a variety of sensory modalities to increase immersion. ...
... We validated the simulation model by comparing the results with the recorded in-hospital responses in an actual disaster. Because the target hospital has not experienced a response to a large disaster, we used the available data of other hospitals in response to a MCI in Taiwan [14,15]. ...
... Because the trend of simulation results and records look similar and RMSE is sufficiently small (around 5% of the total number of patients or the total amount of the gauze), we can conclude that the parameter tuning was by and large successful. Subsequently, we simulated another hospital responding to the incident [14] using the parameters obtained. Figs. 4 and 5 respectively compare the time series behavior of the number of patients treated and amount of gauze in stock between the simulation results with the fine-tuned parameters. ...
... Figs. 4 and 5 respectively compare the time series behavior of the number of patients treated and amount of gauze in stock between the simulation results with the fine-tuned parameters. We found some deviation in the second half, which might be due to the change of response strategy in the emergency department [14]. Such adaptive behavior was not considered in the simulation model; however, the simulation replicated the general trend of the variables' behavior; the RMSE of the number of patients treated was 4.6, and the amount of gauze in stock was 50. ...
Article
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In this study, we developed a simulation model of detailed in-hospital disaster response to a mass casualty incident based on the analysis of related documents and actual in-hospital disaster response training, aiming to assess the hospital’s response capacity under various disaster situations. This simulation model includes detailed models of patients, floor configurations, resources, and response tasks, which consider resource requirements for the treatment of different patients with various injuries and physical conditions. The model covers patients’ arrivals to hospitalization or discharge. We conducted simulations of the target hospital to test two resource allocation strategies under two patient scenarios. By comparing the results under different resource allocation strategies, we found that the X-ray photography examination capacity could become a fundamental bottleneck in responding to mass casualty incidents. Also, we found that the appropriate resource allocations and quick replenishment could alleviate the negative effect of resource shortages and maintain a higher performance. Furthermore, the results show that the length of stay can be heavily affected by the patients’ configuration. As a result, by monitoring and anticipating the situation, a resilient and responsive resource allocation strategy must be prepared to handle such uncertain disaster situations.
... • Clinicians adapting to avoid or mitigate workload bottlenecks that can interfere with patient care Wears 2015, Perry andWears 2012). • EDs adapting to cope with high patient numbers and "beyond surge capacity" events (Chuang et al. 2019, Wears et al. 2008). • Maladaptive processes when different parts of a hospital or hospital system fail to coordinate, such as when EDs and ICUs are heavily crowded (Stephens, Woods, and Patterson 2015). ...
... Space mission control is the definitive exemplar for this capability, especially how space shuttle mission control developed its skill at handling anomalies, even as they expected that the next anomaly to be handled would not match any of the ones they had planned and practised for (Watts-Perotti and Woods 2009). However, one of the most productive natural laboratories for learning the basic patterns and laws of adaptation are customers of the healthcare implementation system: emergency and critical care medicine (e.g., Chuang et al. 2019, Patterson and Wears 2015, Stephens, Woods, and Patterson 2015, Wears et al. 2008, Woods and Branlat 2011. ...
... Some initial receiving hospitals experienced severe difficulties due to insufficient surge capacity. According to the previous findings of the FFCDE studies (Chuang et al., 2019a(Chuang et al., , 2019b, the hospitals' emergency response plans did not fully support emergency medicine in the events. The hospitals relied on adaptive responses to deal with the patient surge to generate adequate emergency care resources accordingly. ...
... Data analysis of the two hospitals' responses involved chronological process-tracing analysis, synthesis, and compare and contrast analysis in developing responsive adaptation patterns. The contents of these analysis are described in more detail in individual publications about each hospital (Chuang et al., 2019a(Chuang et al., , 2019b. ...
Conference Paper
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Understanding and learning from hospitals’ resilient behavior or adequate responses to beyond-surge capacity incidents to be better prepare staff for offering patients the appropriate, timely care is imperative. The study adopted the previous findings from the Formosa-Fun-Coast-Dust-Explosion studies as the base of data analysis. We synthesized the past discoveries and identified nine adaptation patterns. The results systematically organized how two initial receiving hospitals’ responsive adaptations changed over time to cope with the difficulties in the emergency departments in the aftermath of the mass burn casualty incidents. The benefit of the pattern approach can in-crease the efficiency and effectiveness of the learning process.
... Some hospitals experienced severe difficulties due to insufficient surge capacity in the aftermath of the FFCDE. According to the findings of the FFCDE studies [5][6][7][8], the hospitals' emergency response plans did not fully support emergency medicine in the events. The hospitals relied on adaptive responses to deal with the patient surge to generate adequate emergency care resources accordingly. ...
... Next, the researchers conducted extensive, in-depth, semi-structured interviews with 34 participants across multiple levels of each of the four hospitals. The content of the interviews is described in more detail in individual publications regarding two of the hospitals [6,7]. Finally, the data were corroborated with detailed patient information from hospital records. ...
... They can use Fig. 1 (overload patterns) and Tables 3, 4 and 5 for the planning to capture an overall understanding of what challenges could occur over time and how hospitals responded to these difficulties to extend emergency care in each category. Also, emergency planners can consult the responses described in more detail in individual publications regarding two hospitals at an extreme and high level [6,7]. ...
Article
Full-text available
Background Large-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. Methods The 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. Results A 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. Conclusions The 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.
... Another study examined how hospital staff adapted to the overwhelming surge in patients and workload and the concomitant shortage of clinicians, beds, and medical materials. 16 However, their findings were practical responses for mobilization, rather than emotional responses to the experience. ...
Article
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Background Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse–patient relationships. Aim This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. Research design A qualitative descriptive study using a phenomenological approach. Participants and research context Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi’s method. Ethical considerations This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Findings Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. Conclusions Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient–nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.
... A previous study reported that more than 700 tanker truck explosions occurred in China from 2004 to 2011, resulting in numerous burn-related casualties [5]. The accidental explosions that happen casually worldwide also cause a mass of burn-related injury and death [6,7]. ...
Article
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Background Mass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties. Material/Methods The New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy. Results A total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044). Conclusions The Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.
... Unfortunately, valuable information is sometimes covered by the successful medical outcomes of animated controversies, such as the case discussed in this article. [18][19][20][21][22] The detailed EMS transportation plan was examined by the appropriateness and reasonable means to learn the lessons for facing an unpredictable MCI similar to the Formosa Fun Color Dust Party explosion. ...
Article
Full-text available
The purpose of this research is to analyze and introduce a new emergency medical service (EMS) transportation scenario, Emergency Medical Regulation Center (EMRC), which is a temporary premise for treating moderate and minor casualties, in the 2015 Formosa Fun Color Dust Party explosion in Taiwan. In this mass casualty incident (MCI), although all emergency medical responses and care can be considered as a golden model in such an MCI, some EMS plans and strategies should be estimated impartially to understand the truth of the successful outcome. Factors like on-scene triage, apparent prehospital time (appPHT), inhospital time (IHT), and diversion rate were evaluated for the appropriateness of the EMS transportation plan in such cases. The patient diversion risk of inadequate EMS transportation to the first-arrival hospital is detected by the odds ratios (ORs). In this case, the effectiveness of the EMRC scenario is estimated by a decrease in appPHT. The average appPHTs (in minutes) of mild, moderate, and severe patients are 223.65, 198.37, and 274.55, while the IHT (in minutes) is 18384.25, 63021.14, and 83345.68, respectively. The ORs are: 0.4016 (95% Cl = 0.1032–1.5631), 0.1608 (95% Cl = 0.0743–0.3483), and 4.1343 (95% Cl = 2.3265–7.3468; P < .001), respectively. The appPHT has a 47.61% reduction by employing an EMRC model. Due to the relatively high appPHT, diversion rate, and OR value in severe patients, the EMS transportation plan is distinct from a prevalent response and develops adaptive weaknesses of MCIs in current disaster management. Application of the EMRC scenario reduces the appPHT and alleviates the surge pressure upon emergency departments in an MCI.