Article

Analysis of Disaster Response Plans and the Aftermath of Hurricane Katrina: Lessons Learned From a Level I Trauma Center

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The purpose of this study was to compare disaster preparedness of a Level I Trauma Center with performance in an actual disaster. Previous disaster response evaluations have shown that the key to succeeding in responding to a catastrophic event is to anticipate the event, plan the response, and practice the plan. The Emergency Management Team had identified natural disaster as the hospital's highest threat. The hospital also served as the regional hospital for the Louisiana Health Resources and Service Administration Bioterrorism Hospital Preparedness Program. The hospital master disaster plan, including the Code Gray annex, was retrospectively reviewed and compared with the actual events that occurred after Hurricane Katrina. Vital support areas were evaluated for adequacy using a systematic approach. In addition, a survey of 10 key personnel from trauma and emergency medicine present during Hurricane Katrina was conducted. The survey of vital support areas were scored as adequate (3 pts), partially adequate (2 pts), or inadequate (1 pt). Ninety-three percent of the line items on the Code Gray Checklist were accomplished before landfall of the storm. The results of the survey of vital support areas were water-3.0, food-2.4, sanitation-1.5, communication-1.4, and power-1.5. Despite identifying the threat of a major hurricane, preparing a response plan, and exercising the plan, a major medical center can be overwhelmed by a catastrophic disaster like Hurricane Katrina. We offer our lessons-learned as an aid for other medical centers that are developing and exercising their plans.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... D isaster: a sudden accident or a natural catastrophe that causes great damage or loss of life. 1 ''Previous disaster response evaluations have shown that the key to succeeding in responding to a catastrophic event is to anticipate the event, plan the response and practice the plan.'' 2 As ongoing events during the tsunami in Japan (tsunami and nuclear accident), the Hurricane Katrina (hurricane and flooding), and the tristate area of New York (flooding) tragi-cally illustrate, mass casualty disasters (MCDs) can be national, regional, and local in scope, take many forms, challenge the health care system in numerous ways, and encompass all hazards. 3 Both man-made and natural disasters result in traumatic injuries. ...
... In 2005, Hurricane Katrina struck New Orleans and the Gulf Coast in the United States, resulting in more than 1,800 deaths. 2 Despite a 3-day warning and indications that the storm was mounting in strength, resources were not mobilized, leading to an inadequate response by trained individuals, the state, and federal resources. 2 The lack of a definitive response plan resulted in medical centers being inundated with casualties. ...
... In 2005, Hurricane Katrina struck New Orleans and the Gulf Coast in the United States, resulting in more than 1,800 deaths. 2 Despite a 3-day warning and indications that the storm was mounting in strength, resources were not mobilized, leading to an inadequate response by trained individuals, the state, and federal resources. 2 The lack of a definitive response plan resulted in medical centers being inundated with casualties. ...
Article
We think that general surgeons are underprepared to respond to mass casualty disasters. Preparedness education is required in emergency medicine (EM) residencies, yet such requirements are not mandated for general surgery (GS) training programs. We hypothesize that EM residents receive more training, consider themselves better prepared, and are more comfortable responding to disaster events than are GS residents. From February to May 2009, the Eastern Association for the Surgery of Trauma-Committee on Disaster Preparedness conducted a Web-based survey cataloging training and preparedness levels in both GS and EM residents. Approximately 3000 surveys were sent. Chi-squared, logistic regression, and basic statistical analyses were performed with SAS. Eight hindered forty-eight responses were obtained, GS residents represented 60.6% of respondents with 39% EM residents, and four residents did not respond with their specialty (0.4%). We found significant disparities in formal training, perceived preparedness, and comfort levels between resident groups. Experience in real-life disaster response had a significant positive effect on comfort level in all injury categories in both groups (odds ratio, 1.3-4.3, p < 0.005). This survey confirms that EM residents have more disaster-related training than GS residents. The data suggest that for both groups, comfort and confidence in treating victims were not associated with training but seemed related to previous real-life disaster experience. Given wide variations in the relationship between training and comfort levels and the constraints imposed by the 80-hour workweek, it is critical that we identify and implement the most effective means of training for all residents.
... Accounting for staff well being is crucial when planning for multi-day disasters, as performing duties outside of normal routine is common. 21 Overall, work shifts should be centered on safety and staff endurance. 6,15,21 Therefore, staffing decisions should consider providers' need for rest, meaning that more providers than usual will likely be required to be in-house to sustain a safe work rotation. ...
... 21 Overall, work shifts should be centered on safety and staff endurance. 6,15,21 Therefore, staffing decisions should consider providers' need for rest, meaning that more providers than usual will likely be required to be in-house to sustain a safe work rotation. ...
... In the wake of a disaster, estimating food and water provisions is challenging given that supplies will probably be needed for more individuals than those originally accounted for. 14,15,21,22 Individuals should consider ways that they can be selfsufficient in the event that conditions require it. Bringing non-perishable food, bottled water, personal hygiene items, personal medications, and sleeping gear may be helpful. ...
Article
Full-text available
Introduction: Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017. Methods: This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016. Results: For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers post-flooding to decrease ED boarding times. Conclusion: A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised.
... Flooding threatens health infrastructure even in wealthy countries. Patients requiring mechanical ventilation and intensive care are particularly vulnerable due to the challenges posed by evacuation and power outages [54]. Resource poor facilities are likely to be even more vulnerable to extreme weather threats. ...
... Known: [32][33][34][35][36][37]64]; potential: [52][53][54][55][56][57][58][59][60][61] Aero-allergen production Increased allergic sensitization, emergency department visits and hospital admissions for asthma and allergic rhinitis ...
... Loss of power for life-support Increased mold growth and endotoxin [53][54][55][56][57][58][59][60][61] Sea level rise Flooding: increased refugee camp populations ...
Article
Full-text available
Climate change is a key driver of the accelerating environmental change affecting populations around the world. Many of these changes and our response to them can affect respiratory health. This is an expert opinion review of recent peer-reviewed literature, focused on more recent medical journals and climate-health relevant modeling results from non-biomedical journals pertaining to climate interactions with air pollution. Global health impacts in low resource countries and migration precipitated by environmental change are addressed. The major findings are of respiratory health effects related to heat, air pollution, shifts in infectious diseases and allergens, flooding, water, food security and migration. The review concludes with knowledge gaps and research need that will support the evidence-base required to address the challenges ahead.
... Events associated with Hurricane Katrina revealed major gaps in available disaster preparedness for at-risk medical institutions, especially tertiary and/or quaternary care academic centers. 2,15,[36][37][38][39][40][41] This study's findings contribute to future preparedness plans by defining pertinent characteristics of a translocated population post landfall of Hurricane Katrina. By eluding to the generalizability of these characteristics, at-risk metropolitan areas at large in this vulnerable region should include this information in their disaster preparedness plans, as lessons learned and suggestions for improvement are currently reported in the existing body of literature. ...
... By eluding to the generalizability of these characteristics, at-risk metropolitan areas at large in this vulnerable region should include this information in their disaster preparedness plans, as lessons learned and suggestions for improvement are currently reported in the existing body of literature. 2,11,15,36,42 Published reports indicate lessons have not been learned, as many recommendations have been repeated or modified; 15 thus, issues thwarting recovery efforts must be confronted before the next disaster arises. 43 Lessons learned from Hurricane Katrina for medical providers challenge hospitals and health systems to develop a disaster based contingency plan and to become more involved in a state and local response plan. ...
Article
Full-text available
Introduction: Existing literature is missing a description of a displaced population in the aftermath of Hurricane Katrina, who were seen and discharged from emergency departments of a Houston hospital system 10 years ago. Hypothesis/Problem: Health effects of Hurricane Katrina are an important public health topic that is not sufficiently discussed in the existing literature. Failure to provide this information is largely due to the lack of appropriate, representative data and absence of a systematic data capture process. Methods: A retrospective Electronic Health Record review of 'Katrina evacuees', obtained from Houston Fire Department run call data, was used to identify: visit type, top three ICD-9-coded diagnoses, medical insurance, number of visits and emergency medical service utilization. Results: The majority of patient visits were by Black, female gender and adults between 19 and 44 years. The leading diagnosis was hypertension. Circulatory system related diagnoses were nearly three times higher among Katrina evacuees than national data from 2005 and 2007. Most patients used emergency medical service services [815(60%)], had one emergency department visit [570(70%)], and reported Medicaid [577(40%)] or self-pay [425(30%)] as the insurance source. Conclusion: Disaster planning for the aftermath of natural disasters would benefit from knowledge pertaining to known chronic and non-chronic care needs of populations in pre-specified areas. Variance in primary diagnoses suggests the need for published data reporting annual primary diagnoses in local EDs by region. Access to this information via the internet contributes to estimating the likelihood of ED volume of chronic and non-chronic visit demand, 1 providing foundational information for disaster preparedness plans nationwide.
... Communication failure is common during times of unexpected change [4]. Communication is a vital component of an organization's structure; beyond an exchange of information, it strengthens teams, builds trust, and develops understanding [6,12]. ...
... Early on in the pandemic and during the first phase of the residency's reorganization, we realized that we would need an enhanced system for communication to meet the challenges of providing care at outside hospitals, address the concerns of each residency class, and reduce misinformation [4]. Prior to the pandemic, information was disseminated within the residency in large groups; this was no longer possible given isolation restrictions and the rapid changes wrought by the pandemic. ...
... 1,4 Hospital preparedness is part of the disaster plan and should build on a standardized protocol. [5][6][7][8][9] Checklists and other evaluation tools should be incorporated into the hospital disaster plan in order to recognize possible gaps and weaknesses. 10 Several hospital disaster preparedness evaluation methods have been created. ...
... 1,9,62 All phases of disaster management require protocols and plans, which was another predetermined theme for the evaluation tools, since all aspects of disaster management deal with the processes used to protect populations or property or from the effects of disasters. 7,10 The phases of the disaster management are mitigation, preparedness, delivery of medical support during the disaster, and recovery and support after any disaster. 10,65 In order to develop a comprehensive disaster plan, it is necessary that the responsibility to develop the plan be given to a committee or a subcommittee of the safety committee. ...
Article
Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words “crisis,” “disaster,” “disaster medicine,” “emergency,” “mass casualty,” “hospital preparedness,” “hospital readiness,” “hospital assessment,” “hospital evaluation,” “hospital appraisal,” “planning,” “checklist,” and “medical facility” were used in combination with the Boolean operators “OR” and “AND.” PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. ( Disaster Med Public Health Preparedness . 2016;page 1 of 8)
... Disaster/emergency management covers the actions and utilization of resources specific to the period before, during, and after a disaster [1,2]. Several reports have described the facts and lessons learned in terms of disaster/emergency management following large-scale disasters such as the tsunami in Banda Aceh (2004), Hurricane Katrina (2005), and the Bam, Iran (2003), and Great East Japan (2011) earthquakes [3][4][5][6]. ...
Article
Full-text available
We aimed to examine sleep in shelter-analogue settings to determine the sleep and environmental conditions in evacuation shelters. A summer social/educational event was conducted in an elementary school, wherein children and their parents (n = 109) spent one night in the school gymnasium; a total of 15 children and 7 adults completed the study. Data were recording using wrist actigraphy and questionnaires, from two days before the event to two days after the event. During the night in the gymnasium, sleep initiation in the children was found to be significantly delayed, whereas adults did not show any significant change in actigraphic sleep parameters. Although 57% of adults complained of stiffness of the floor, only 7% of children had the same complaint. The nocturnal noise recorded at four locations in the gymnasium showed that the percentage of 1-min data epochs with a noise level >40 dB ranged from 53% to 74% during lights-out. The number of subjects that woke up during the night showed a similar pattern with the changes in the noise level. The changes in sleep might represent event-specific responses, such as to a noisy environment, and the different complaints between adults and children could be useful in shelter management.
... Furthermore, national-level exercises such as ''Dark Winter'' and the Homeland Security Exercise and Evaluation Program (HSEEP) have repeatedly exposed areas where the need for improvement in response is clear. [3][4][5][6][7] For political leaders, health officials, hospital leaders, and emergency management officials, upholding public confidence in their respective institutions before, during, and after a catastrophic event is crucial. This can be done by increasing preparedness for public health emergencies, largely those that require the ability to treat a large influx of patients (surge capacity). ...
Article
Full-text available
Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors. Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP-SCPA) to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1) increase awareness of capabilities and assets, (2) develop and pilot test advanced planning and exercising of plans in the region, (3) augment written medical mutual aid agreements, (4) develop and strengthen partnership relationships, (5) ensure National Incident Management System compliance, and (6) develop and test a plan for effective utilization of volunteer healthcare professionals. In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents. The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.
... 28 In the light of the above, it is not surprising that the need for improved, cost-effective, immersive and accessible training provision for multidisciplinary, multilevel emergency responders has been consistently identified by high-level incident reports and academic review articles. 4,[29][30][31] To address these shortcomings in a valid, clinically appropriate and cost-effective manner, our group has recently established the feasibility of the development and acceptability of use of low-cost simulated environments for multidisciplinary professionals to prepare for major incident response using state of the art virtual environments. 32 Here we report the potential of this technology to be utilised for formal skills assessment of personnel involved in managing a major incident at both pre-hospital and in-hospital settings. ...
Article
Objectives: To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment. Methods: Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion. Technical skills assessment forms were developed using training syllabus competencies and national guidelines identified by pre-hospital response experts. Non-technical skills were assessed using a seven-point scale previously developed for use by pre-hospital paramedics. The two in-hospital scenarios, focusing on a trauma team leader and a silver/clinical major incident co-ordinator, utilised the validated Trauma-NOTECHS scale to assess five domains of performance. Technical competencies were assessed using an ATLS-style competency scale for the trauma scenario. For the silver scenario, the assessment document was developed using competencies described from a similar role description in a real-life hospital major incident plan. The technical and non-technical performance of all participants was assessed live by two experts in each of the three scenarios and inter-assessor reliability was computed. Participants also self-assessed their performance using identical proformas immediately after the scenarios were completed. Self and expert assessments were correlated (assessment cross-validation). Results: Twenty-three participants underwent all scenarios and assessments. Performance assessments were feasible for both experts as well as the participants. Non-technical performance was generally scored higher than technical performance. Very good inter-rater reliability was obtained between expert raters across all scenarios and both technical and non-technical aspects of performance (reliability range 0.59-0.90, Ps<0.01). Significant positive correlations were found between self and expert assessment in technical skills across all three scenarios (correlation range 0.52-0.84, Ps<0.05), although no such correlations were observed in non-technical skills. Conclusions: This study establishes feasibility and reliability of virtual environment technical and non-technical skills assessment in major incident scenarios for the first time. The development for further scenarios and validated assessment scales will enable major incident planners to utilise virtual technologies for improved major incident preparation and training.
... Over the past decade, disasters, both manmade and natural, have made disaster medicine and emergency management priorities for hospitals and health care systems [34,35]. With the UAE being a major oil-rich financial and tourism hub, preparedness for incidents such as oil spills, plane crashes, and even terrorist attacks forms an important component of the country's comprehensive emergency medical system. ...
Article
Full-text available
It has been a decade since emergency medicine was recognized as a specialty in the United Arab Emirates (UAE). In this short time, emergency medicine has established itself and developed rapidly in the UAE. Large, well-equipped emergency departments (EDs) are usually located in government hospitals, some of which function as regional trauma centers. Most of the larger EDs are staffed with medically or surgically trained physicians, with board-certified emergency medicine physicians serving as consultants overseeing care. Prehospital care and emergency medical services (EMS) operate under the auspices of the police department. Standardized protocols have been established for paramedic certification, triage, and destination decisions. The majority of ambulances offer basic life support (BLS/Type 2) with a growing minority offering advanced life support (ALS/Type 3). Medicine residency programs were established 5 years ago and form the foundation for training emergency medicine specialists for UAE. This article describes the full spectrum of emergency medicine in the UAE: prehospital care, EMS, hospital-based emergency care, training in emergency medicine, and disaster preparedness. We hope that our experience, our understanding of the challenges faced by the specialty, and the anticipated future directions will be of importance to others advancing emergency medicine in their region and across the globe.
... More precipitation will also lead to more flooding (52), which threatens health infrastructure, even in wealthy countries. Patients requiring mechanical ventilation and intensive care are particularly vulnerable due to the challenges posed by evacuation and power outages (53). Multiple health care facilities were evacuated during the unprecedented 2013 floods in Alberta (www.drieottawa.org/presentations/20141017/20141017_tom_watts.pdf), ...
Article
Full-text available
Climate change is already affecting the cardiorespiratory health of populations around the world, and these impacts are expected to increase. The present overview serves as a primer for respirologists who are concerned about how these profound environmental changes may affect their patients. The authors consider recent peer-reviewed literature with a focus on climate interactions with air pollution. They do not discuss in detail cardiorespiratory health effects for which the potential link to climate change is poorly understood. For example, pneumonia and influenza, which affect >500 million people per year, are not addressed, although clear seasonal variation suggests climate-related effects. Additionally, large global health impacts in low-resource countries, including migration precipitated by environmental change, are omitted. The major cardiorespiratory health impacts addressed are due to heat, air pollution and wildfires, shifts in allergens and infectious diseases along with respiratory impacts from flooding. Personal and societal choices about carbon use and fossil energy infrastructure should be informed by their impacts on health, and respirologists can play an important role in this discussion.
... More precipitation will also lead to more flooding (52), which threatens health infrastructure, even in wealthy countries. Patients requiring mechanical ventilation and intensive care are particularly vulnerable due to the challenges posed by evacuation and power outages (53). Multiple health care facilities were evacuated during the unprecedented 2013 floods in Alberta (www.drieottawa.org/presentations/20141017/20141017_tom_watts.pdf), ...
Article
Full-text available
Climate change is already affecting the cardiorespiratory health of populations around the world, and these impacts are expected to increase. The present overview serves as a primer for respirologists who are concerned about how these profound environmental changes may affect their patients. The authors consider recent peer-reviewed literature with a focus on climate interactions with air pollution. They do not discuss in detail cardiorespiratory health effects for which the potential link to climate change is poorly understood. For example, pneumonia and influenza, which affect >500 million people per year, are not addressed, although clear seasonal variation suggests climate-related effects. Additionally, large global health impacts in low-resource countries, including migration precipitated by environmental change, are omitted. The major cardiorespiratory health impacts addressed are due to heat, air pollution and wildfires, shifts in allergens and infectious diseases along with respiratory impacts from flooding. Personal and societal choices about carbon use and fossil energy infrastructure should be informed by their impacts on health, and respirologists can play an important role in this discussion.
... 35 Gabbe and colleagues 13 reported high rates of triage preparedness for MCIs, with 97% of centres in Australia, Canada, England, and NZ having a mass casualty triage protocol that followed internationally accepted principles and guidelines. In large-scale natural disasters such as hurricanes 19,68 and earthquakes, 69 trauma centres in the area of the disaster can be compromised, necessitating transport of a large number of victims to nearby jurisdictions. 11 These types of MCIs demonstrate the importance of both region-wide and multi-region resource management systems. ...
Article
Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.
... Non-oral intake and male sex were significantly associated with mortality. Various cases of evacuation have been reported during natural and man-made disasters, including hurricanes [8][9][10][11][12][13][14][15][16][17][18], cyclone [19,20], storm [21,22], wildfires [23,24], earthquake [25][26][27], flooding [28][29][30], nuclear meltdown [5,31], internal fire [32], bomb threats [33,34], missiles [35] and chemical exposure [33]. During the disaster, it was known that hospital evac- uation increases mortality and morbidity [2]. ...
Article
Full-text available
Introduction After the accident of the Fukushima Daiichi nuclear power plant due to the Great East Japan Earthquake in March 2011, the Japanese government issued a mandatory evacuation order for people living within a 20 km radius of the nuclear power plant. The aim of the current study was to investigate long-term outcomes of these patients and identify factors related to mortality. Materials and methods Patients who were evacuated from hospitals near the Fukushima Daiichi nuclear power plant to the Aizu Chuo Hospital from 15 to 26 March, 2011 were included in this study. The following data were collected from medical records: age, sex, activities of daily life, hospital they were admitted in at the time of earthquake, distance between the facility and the nuclear power plant, reasons of evacuation and number of transfers. The patient outcomes were collected from medical records and/or investigated on the telephone in January 2012. Results A total of 97 patients (28 men and 69 women) were transferred from 10 hospitals via ambulances or buses. No patients died or experienced exacerbation during transfer. Median age of the patients was 86 years. Of the total, 36 patients were not able to obey commands, 44 were bed-ridden and 61 were unable to sustain themselves via oral intake of food. Among 86 patients who were followed-up, 41 (48%) died at the end of 2011. Multiple-regression analysis showed that non-oral intake [Hazard Ratio (HR): 6.07, 95% Confidence interval (CI): 1.94–19.0] and male sex [HR: 8.35, 95% CI: 2.14–32.5] had significant impact on mortality. Conclusion This study found that 48% of the evacuated patients died 9 months after the earthquake and they had significantly higher mortality rate than the nursing home residents. Non-oral intake and male sex had significant impact on mortality. These patients should be considered as especially vulnerable in case of hospital evacuation.
... This modification in our activation criteria causes an unexpected increase in patient severity of injury and hospital resource use. There have been discussions of evolution of trauma systems over time 5 and response of a trauma system to a disaster, 6,7 but no one has looked at the emergent evolution of a trauma system before and after a large natural disaster. Our experience resembles more the rapid devolution of a trauma system with an almost 50 per cent decrease in prestorm resources. ...
Article
Charity Hospital (CH) was devastated by Hurricane Katrina and remains closed. Design and staffing of a new, temporary dedicated trauma hospital relied on data from prior experience at CH, updated census information, and a changed trauma demographic. The study objective was to analyze the new trauma program and evaluate changes in demographics, injury patterns, and outcomes between pre- (PK) and post-Katrina (POK) trauma populations. A retrospective review of trauma patients' demographics, anatomical variables, and physiological variables 6 months PK and POK was performed under an approved Institutional Review Board protocol. Trauma activation triage criteria between study periods were also analyzed. Continuous data comparisons between the two time periods were made with Student's t test. Dichotomous data were analyzed using chi2 test. The demographic of trauma patients is different in the POK interval, reflecting changes in the New Orleans population. Modification of triage criteria by the exclusion of mechanism as an activation criterion resulted in an increase of patients with higher acuity and Injury Severity Score, lower initial Glasgow Coma Score, and a higher proportion of penetrating mechanism. Outcome measures reflect longer length of stay (4.4 vs. 6.8 days, P < 0.0001) without a significant difference in mortality (6.0 vs 7.5, P = 0.227). Hospital data demonstrates that the POK trauma system was stressed by the increased acuity, penetrating injury, and number of procedures per patient (1.7 vs. 3.4). Resources should be directed toward patients requiring multidisciplinary care by increasing intensive care unit beds and operating room capacity. Future resource planning in the recovery phases of large-scale natural disasters should take into account these observations.
... 15 As learned from the Boston Marathon bombings and Hurricane Katrina, having backup systems of communication in place is crucial. 4,5 While not as directly applicable to a viral pandemic given the anticipated course does not involve loss of phone towers, these lessons nonetheless emphasize the importance of contingency plans. ...
Article
Full-text available
The COVID-19 pandemic has placed unprecedented demands on health systems, where hospitals have become overwhelmed with patients amidst limited resources. Disaster response and resource allocation during such crises present multiple challenges. A breakdown in communication and organization can lead to unnecessary disruptions and adverse events. The Federal Emergency Management Agency (FEMA) promotes the use of an incident command system (ICS) model during large-scale disasters, and we hope that an institutional disaster plan and ICS will help to mitigate these lapses. In this article, we describe the alignment of an Emergency Department (ED) specific Forward Command structure with the hospital ICS and address the challenges specific to the ED. Key components of this ICS include a hospital-wide incident command or Joint Operation Center (JOC) and an ED Forward Command. This type of structure leads to a shared mental model with division of responsibilities that allows institutional adaptations to changing environments and maintenance of specific roles for optimal coordination and communication. We present this as a model that can be applied to other hospital EDs around the country to help structure the response to the COVID-19 pandemic while remaining generalizable to other disaster situations.
... However, most studies have focused on teaching, training, PPE, radiation detectors, and response plans to disasters because these factors are of the main areas of preparedness for disasters and accidents. All crisis management phases require a comprehensive and complete plan, but usually, the measures taken prior to the accident are more important and have the most protective effect in the accidents (26,27). Surge capacity is one of the most important measures to increase preparedness when exposed to radiation accidents. ...
Article
Full-text available
Background: The emergency department is the entrance gate of patients to a hospital. Hospitals are confronted with major challenges in radiation, nuclear accidents, and nuclear terrorism. Iran is also at risk of disasters, accidents, and threats, so, the possibility of nuclear and radiation accidents cannot be neglected. Objectives: The present study aimed to extract the effective factors in emergency department preparedness of hospitals for radiation , nuclear accidents, and nuclear terrorism in Iran. Methods: This qualitative study was conducted using in-depth semi-structured interviews with 32 key informants selected through purposive and snowball sampling. Experts were from seven different specialties. Data were analyzed using the thematic analysis method in order to extract the effective factors in emergency department preparedness of hospitals for radiation, nuclear accidents, and nuclear terrorism in Iran in 2019. The interviews were held in the cities of Bushehr, Tehran, Shiraz, and Isfahan from September 2018 to February 2019. Results: Effective factors in emergency department preparedness of hospitals were categorized into staff preparedness, equipment preparedness, and system preparedness with 20 subcategories. The experts emphasized that training courses and exercises could enhance the preparedness and response to these accidents. Conclusions: This study showed that the emergency departments of hospitals in Iran have many challenges. When the country moves towards having nuclear technology, must also provide the infrastructure of the preparedness. There must be an attempt to reduce these challenges by providing financial and structural support. Identifying effective factors in preparation can be helpful in setting up programs for emergency department preparedness of hospitals against nuclear and radiation accidents.
Article
Despite increased disaster preparedness training and funding, healthcare organizations remain ill-prepared. Nontraditional approaches should be a focus of disaster training. We conducted a novel pediatric disaster exercise at a children's hospital. We designed 6 specific exercises comprising Disaster Olympix and piloted a Web-based evaluation survey of the exercise. The mean score of the participants' perception of their Disaster Olympix performance was 3.8/5. The mean score of the perception of the utility of Disaster Olympix was 4.3/5. Novel training approaches can be valuable to staff. Nonpediatric hospitals can readily adapt this approach to prepare for pediatric victims.
Article
The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU. Copyright 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.
Article
Objectives: To determine the feasibility of evidence-based design and use of low-cost virtual world environments for preparation and training in multi-agency, multi-site, major incident response. Methods: A prospective cohort feasibility study was carried out. One pre-hospital, and two in-hospital major incident scenarios, were created in an accessible virtual world environment. 23 pre-hospital and hospital-based clinicians each took part in one of three linked major incident scenarios: a pre-hospital bomb blast site, focusing on the roles of the team leader and triage person; a blast casualty in a resuscitation room, focusing on the role of the trauma team leader; a hospital command and control scenario focusing on the role of the clinical major incident co-ordinator/silver commander. Participants supplied both quantitative and qualitative feedback. Results: Using a systematic, evidence-based approach, three scenarios were successfully developed and tested using low-cost virtual worlds (Second Life and OpenSimulator). All scenarios were run to completion. 95% of participants expressed a desire to use virtual environments for future training and preparation. Pre-hospital responders felt that the immersive virtual environment enabled training in surroundings that would be inaccessible in real-life. Conclusions: The feasibility and face/content validity of using low-cost virtual worlds for multi-agency major incident simulation has been established. Major incident planners and trainers should explore utilising this technology as an adjunct to existing methodologies. Future work will involve development of robust assessment metrics.
Article
We examined the response of 11 Los Angeles County (LAC) hospitals designated as Disaster Resource Centers (DRCs) to a statewide, earthquake preparedness drill, LAC's most comprehensive earthquake disaster drill to date. Semistructured interviews were conducted with the coordinators of 11 of the 14 LAC DRCs within 3 weeks of the drill. Interviews were transcribed and thematic analysis was supported by analytical software (Atlas.ti). Except for one pediatric specialty DRC, most DRCs did little to fully test their institutions' capacity to manage pediatric patients. Few DRCs included children as mock victims. Little or no attention was focused on pediatric triage and other pediatric clinical, psychosocial, and resource issues. Respondents maintained that community readiness is hampered by compartmentalizing the preparedness planning, training, and drilling. Without a mandate to coordinate with other agencies, few DRCs reported coordination with other community entities. Those that did were in smaller submunicipalities within LAC. Community coordination is critical to effective response to disasters, yet disaster preparedness planning and drills are most often uncoordinated and compartmentalized. Drills and training need to be transdisciplinary and coordinated with other community entities likely to play a role in pediatric disaster management. ( Disaster Med Public Health Preparedness . 2012;6:182–186)
Article
The need for healthcare systems and academic medical centers to be optimally prepared in the event of a disaster is well documented. Events such as Hurricane Katrina demonstrate a major gap in disaster preparedness for at-risk medical institutions. To address this gap, we outline the components of complete self-sufficiency planning in designing and building hospitals that will function at full operational capacity in the event of a disaster. We review the processes used and outcomes achieved in building a new critical access, freestanding children's hospital in Florida. Given that hurricanes are the most frequently occurring natural disaster in Florida, the executive leadership of our hospital determined that we should be prepared for worst-case scenarios in the design and construction of a new hospital. A comprehensive vulnerability assessment was performed. A building planning process that engaged all of the stakeholders was used during the planning and design phases. Subsequent executive-level review and discussions determined that a disaster would require the services of a fully functional hospital. Lessons learned from our own institution's previous experiences and those of medical centers involved in the Hurricane Katrina disaster were informative and incorporated into an innovative set of hospital design elements used for construction of a new hospital with full operational capacity in a disaster. A freestanding children's hospital was constructed using a new framework for disaster planning and preparedness that we have termed complete self-sufficiency planning. We propose the use of complete self-sufficiency planning as a best practice for disaster preparedness in the design and construction of new hospital facilities.
Article
The creation of hospitals safe from disaster is an area of increasing public policy. The vulnerability of hospitals to damage and destruction during an event has profound implications for the health of a community. Although hospital evacuations do occur in Australia, their prevalence is unknown and what leads to a successful evacuation is poorly understood. This article reviewed the worldwide hospital evacuation literature to determine the prevalence of hospital evacuations and common precipitants for evacuation. Factors leading to safe evacuation and areas of ongoing challenge were identified. The findings highlight the need for more structured and detailed reporting of hospital responses to disaster. A number of lessons can be learned from hospitals that have experienced evacuation. Most critically, all hospitals must have a practised, detailed hospital evacuation plan existing before an impending threat. There are also areas for improvement in the areas of assessing the risk to the facility, communications, leadership, logistics, staffing and planning. These lessons should be included into comprehensive, detailed evacuation plans for all Australian hospitals, supported by a national framework that standardises planning and response.
Chapter
Trauma is the most common cause of mortality in the United States in those <46 years old [1]. Although only a small minority of all survivable and non-survivable trauma are the result of a mass casualty event (MCE), highly publicized disasters such as the Boston Marathon bombings, Asiana Airlines crash, and Hurricane Katrina are reminders that at any moment, in any location, multiple mechanisms are capable of producing large numbers of seriously injured patients. Because of the rarity of such large-scale incidents, one of the major obstacles to successful management of MCE’s is a lack of real world experience by the average provider. Rarity, coupled with the very complex nature of a MCE is why preparation and planning play large roles in the navigation of these events. At the most basic level, a mass casualty event is one in which the number of casualties creates imbalance between the medical needs of the patients and the resources available to treat them. Imbalance makes it impossible to provide optimal care for each patient. Thus, the treatment facility is forced to shift from the fundamental principle of providing the greatest good for the individual, to providing the greatest good for the greatest number [2, 3]. The number of casualties needed for an incident to be considered a mass casualty event will vary by institution capabilities and size. Two or three critically injured patients arriving at the same time could easily overwhelm a small rural hospital, whereas a large urban trauma center may be capable of handling several critically injured patients simultaneously before the available resources are exhausted [4]. Regardless of location, it is the duty of the triage officer to determine toward which patients limited resources are directed.
Article
Background: Makkah (Mecca) is a holy city located in the western region of the Kingdom of Saudi Arabia. Each year, millions of pilgrims visit Makkah. These numbers impact both routine health care delivery and disaster response. This study aimed to evaluate hospitals' disaster plans in the city of Makkah. Methods: Study investigators administered a questionnaire survey to 17 hospitals in the city of Makkah. Data on hospital characteristics and three key domains of disaster plans (general evaluation of disaster planning, structural feasibility of the hospitals, and health care worker knowledge and training) were collated and analyzed. Results: A response rate of 82% (n=14) was attained. Ten (71%) of the hospitals were government hospitals, whereas four were private hospitals. Eleven (79%) hospitals had a capacity of less than 300 beds. Only nine (64%) hospitals reviewed their disaster plan within the preceding two years. Nine (64%) respondents were drilling for disasters at least twice per year. The majority of hospitals did not rely on a hazard vulnerability analysis (HVA) to develop their Emergency Operations Plan. Eleven (79%) hospitals had the Hospital Incident Command Systems (HICS) present in their plans. All hospitals described availability of some supplies required for the first 24 hours of a disaster response, such as: N95 masks, antidotes for nerve agents, and antiviral medications. Only five (36%) hospitals had a designated decontamination area. Nine (64%) hospitals reported ability to re-designate inpatient wards into an intensive care unit (ICU) format. Only seven (50%) respondents had a protocol for increasing availability of isolation rooms to prevent the spread of airborne infection. Ten (71%) hospitals had a designated disaster-training program for health care workers. Conclusions: Makkah has experienced multiple disaster incidents over the last decade. The present research suggests that Makkah hospitals are insufficiently prepared for potential future disasters. This may represent a considerable threat to the health of both residents and visitors to Makkah. This study demonstrated that there is significant room for improvement in most aspects of hospital Emergency Operations Plans, in particular: reviewing the plan and increasing the frequency of multi-agency and multi-hospital drills. Preparedness for terrorism utilizing chemical, biologic, radiation, nuclear, explosion (CBRNE) and infectious diseases was found to be sub-optimal and should be assessed further. Al-Shareef AS , Alsulimani LK , Bojan HM , Masri TM , Grimes JO , Molloy MS , Ciottone GR . Evaluation of hospitals' disaster preparedness plans in the holy city of Makkah (Mecca): a cross-sectional observation study. Prehosp Disaster Med. 2017;32 (1):1-13.
Article
Background: Mass casualty incidents are unfortunately becoming more common. The coordination of mass casualty incident response is highly complex. Currently available options for training, however, are limited by either lack of realism or prohibitive expense and by a lack of assessment tools. Virtual worlds represent a potentially cost-effective, immersive, and easily accessible platform for training and assessment. The aim of this study was to assess feasibility of a novel virtual-worlds-based system for assessment and training in major incident response. Methods: Clinical areas were modeled within a virtual, online hospital. A major incident, incorporating virtual casualties, allowed multiple clinicians to simultaneously respond with appropriate in-world management and transfer plans within limits of the hospital's available resources. Errors, delays, and completed actions were recorded, as well as Trauma-NOnTECHnical Skills (T-NOTECHS) score. Performance was compared between novice and expert clinician groups. Results: Twenty-one subjects participated in three simulations: pilot (n = 7), novice (n = 8), and expert groups (n = 6). The novices committed more critical events than the experts, 11 versus 3, p = 0.006; took longer to treat patients, 560 (299) seconds versus 339 (321) seconds, p = 0.026; and achieved poorer T-NOTECHS scores, 14 (2) versus 21.5 (3.7), p = 0.003, and technical skill, 2.29 (0.34) versus 3.96 (0.69), p = 0.001. One hundred percent of the subjects thought that the simulation was realistic and superior to existing training options. Conclusion: A virtual-worlds-based model for the training and assessment of major incident response has been designed and validated. The advantages of customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods and may be applicable to further areas of surgery as well.
Article
Full-text available
Effect of an educational strategy in the development of knowledge of emergency medicine residents on protocols disaster del Distrito Federal. La elaboración y validación del instrumento se realizó por expertos en desastres e investigación educativa ajenos al estudio; su confiabilidad a través de la prueba de Kuder Richarson fue de 0.91. Se empleó estadística no paramétrica. La estrategia educativa se realizó a través de un curso taller, el cual se constituyó con una parte teórica de ocho sesiones de una hora realizadas con discusión dirigida y trabajo en pequeños grupos; y una parte de 8 h prácticas en donde a través de ejercicios los participan-tes reafirmaran sus conocimientos, los cuales aterrizaban con un simula-cro final sobre un desastre interno. Resultados. Participaron 13 residentes de los tres grados académicos, con una edad media de 28.23 ± 2.12. Todos se ubicaron de forma inicial en rangos inferiores de conocimiento. Posterior a la estrategia 23.77% de los residentes alcanzaron niveles medios. El 69.33% de los partici-pantes subieron de grado de conocimiento. El incremento en evaluacio-nes fue más significativo en los participantes de 2o. y 3er. año. ABSTRACT Objective. To determine the effect of an educational strategy in learning emergency medicine residents regarding protocols disaster. Methods. Quasi-experimental study examined the effect of an educatio-nal strategy for the development of knowledge about disaster protocols residents specialty of emergency the Federal District. The development and validation of the instrument was performed by disaster experts and others to study educational research; reliability through the Kuder Ri-chardson was 0.91. Nonparametric statistics were used. The educatio-nal strategy was conducted through an ongoing workshop, which was established with a theoretical eight hour sessions conducted with gui-ded discussion and small group work; and part of 8 hours practice through exercises where participants reaffirm their knowledge, which landed with a final drill on an internal disaster. Results. 13 residents attended the three degrees, with a mean age of 28.23 ± 2.12. All were located in a initial in lower ranks of knowledge. Following the strategy 23.77% of residents reached average levels. The 69.33% of participants rose to level of knowledge. The increase in assessments was more significant in participants 2o. and 3rd. year. Conclusions. The educational strategy seems appropriate type work-shop course for training medical residents in the specialty of emer-gency medicine. Artículo Original
Article
Full-text available
Objective This literature review aimed to identify the range of methods used in after action reviews (AARs) of public health emergencies and to develop appraisal tools to compare methodological reporting and validity standards. Methods A review of biomedical and gray literature identified key approaches from AAR methodological research, real-world AARs, and AAR reporting templates. We developed a 50-item tool to systematically document AAR methodological reporting and a linked 11-item summary tool to document validity. Both tools were used sequentially to appraise the literature included in this study. Results This review included 24 highly diverse papers, reflecting the lack of a standardized approach. We observed significant divergence between the standards described in AAR and qualitative research literature, and real-world AAR practice. The lack of reporting of basic methods to ensure validity increases doubt about the methodological basis of an individual AAR and the validity of its conclusions. Conclusions The main limitations in current AAR methodology and reporting standards may be addressed through our 11 validity-enhancing recommendations. A minimum reporting standard for AARs could help ensure that findings are valid and clear for others to learn from. A registry of AARs, based on a common reporting structure, may further facilitate shared learning. (Disaster Med Public Health Preparedness. 2018;page 1 of 8)
Article
Introduction Risk assessment is a vital step in the disaster-preparedness continuum as it is the foundation of subsequent phases, including mitigation, response, and recovery. Hypothesis/Problem To develop a risk assessment tool geared specifically towards the Union of European Football Associations (UEFA) Euro 2012. In partnership with the Donetsk National Medical University, Donetsk Research and Development Institute of Traumatology and Orthopedics, Donetsk Regional Public Health Administration, and the Ministry of Emergency of Ukraine, a table-based tool was created, which, based on historical evidence, identifies relevant potential threats, evaluates their impacts and likelihoods on graded scales based on previous available data, identifies potential mitigating shortcomings, and recommends further mitigation measures. This risk assessment tool has been applied in the vulnerability-assessment-phase of the UEFA Euro 2012. Twenty-three sub-types of potential hazards were identified and analyzed. Ten specific hazards were recognized as likely to very likely to occur, including natural disasters, bombing and blast events, road traffic collisions, and disorderly conduct. Preventative measures, such as increased stadium security and zero tolerance for impaired driving, were recommended. Mitigating factors were suggested, including clear, incident-specific preparedness plans and enhanced inter-agency communication. This hazard risk assessment tool is a simple aid in vulnerability assessment, essential for disaster preparedness and response, and may be applied broadly to future international events. Wong EG , Razek T , Luhovy A , Mogilevkina I , Prudnikov Y , Klimovitskiy F , Yutovets Y , Khwaja KA , Deckelbaum DL . Preparing for Euro 2012: developing a hazard risk assessment. Prehosp Disaster Med. 2015;30(2):1-6 .
Article
Full-text available
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
Article
On August 23rd, 2012 at 7:54 am a hot air balloon crashed in Ljubljana Marshes, leaving 32 injured on site. This case report analyses the biggest multiple casualty incident attended by University Medical Centre Ljubljana in recent history. Analysis of all segments regarding the incident was conducted: mobilisation, arrivals, triage, work-up, identification, public relations and outcome. Issues such as mobilisation, diagnostics, communication, documentation and intensive care unit space are discussed. Twenty-one patients arrived over 63 minutes, 8 of those were immediate resuscitation cases and 10 of those suffered burns. The average Injury Severity Score was 15.7 (ranging 3 to 50), 28.1 for admitted patients. 90% of patients had x-ray, 23% CT and 38% ultrasound diagnostic procedures. 33% of patients required urgent surgery and 60% of admitted cases required intensive care units. A relatives and media territory was established. CT location, loss of communication, inadequate documentation and intensive care bed space were most problematic. At 7-year follow up, we had a roughly 5% hospital fatality rate, 74% of patients gained full recovery and 21% good recovery. Even though the event occurred on a weekday during regular hours, it still exposed many weaknesses. A new radio frequency system for intra-hospital communication has been implemented, the multiple casualty incident protocol has been revised, and regular drills are now performed. Our emergency department is currently undergoing renovation to include CT diagnostics on the same floor. Plans have been made to ease documentation with dictation modules, whereas bed space remains unchanged.
Chapter
This chapter outlines an all-hazards approach to protecting and expanding definitive-care areas such as operating room and critical care resources during rapidly evolving disasters such as explosions or earthquakes resulting in a large number of casualties. Understanding the recurring patterns of disasters and the typical pitfalls in response allows early anticipation of casualty numbers, injury patterns, required resources, and the time course. Further, an appreciation of dead:injured ratios, triage principles, surge capacity, and the consequences of overtriage to critical mortality enables care providers to optimize outcomes.
Chapter
The provision of care under adverse conditions is a subject that is becoming more and more relevant in the last decade with the spread of terrorism and the advent of regional wars, as well as natural disasters and the increasing focus on surgical volunteerism. The provision of surgical care under these circumstances comes with unique challenges, which requires that the surgeon clearly identify what resources are available to him at the outset. Triage becomes more important than in the usual setting, and the surgeon should realize that a degree of improvisation will be necessary, as will realistic goals for outcomes with the limited resources available. Surgeons should familiarize themselves with the older operations and equipment they are likely to encounter. The provision of critical care will be extremely difficult, and simple resources such as blood or oxygen may also be lacking. Cultural sensitivity is often important under these circumstances, as well as knowing your own limitations to ensure that the best medical care is provided.
Article
Ventricular assist devices (VADs) are an Advanced Life Support for patients with heart failure. These patients are particularly vulnerable in the event of a disaster. A hazard vulnerability analysis (HVA) was conducted to determine areas of susceptibility for these patients. Lack of electrical power, limited access to medications and anticoagulation, dehydration, extreme temperature and weather environments, conditions which predispose to infection, and evacuation transport are all identified circumstances that place these patients at an increased risk for harm and death. Future preparations in disaster planning are needed to address and mitigate these risks. DavisKJ, O’SheaG, BeachM. Assessment of Risks Posed to VAD Patients During Disasters. Prehosp Disaster Med. 2017;32(4):1–5.
Chapter
There are many reasons why you, as a surgeon, could find yourself practicing under adverse or austere conditions. This is clearly to be expected in the case of a military deployment or a volunteer mission to a developing nation. Austere conditions are also seen in the setting of natural disasters where urgent surgical care is hindered by widespread damage to infrastructure and other resources. Recent examples include the 2010 Haiti earthquake the 2011 Tohoku Earthquake and Tsunami off the northwest coast of Japan. Both natural events such as those mentioned above and man-made stressors such as wars, political unrest, and terrorism can all generate large numbers of injured patients that exceed the capabilities of existing medical resources.
Article
Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners. ObaidJM , BaileyG , WheelerH , MeyersL , MedcalfSJ , HansenKF , SangerKK , LoweJJ . Utilization of functional exercises to build regional emergency preparedness among rural health organizations in the US . Prehosp Disaster Med . 2017 ; 32 ( 2 ): 1 – 7 .
Article
Hazard vulnerability analysis (HVA) is used to risk-stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital-specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.
Article
Hurricane Katrina devastated the city of New Orleans as well as a large section of the Gulf Coastal region of the United States. Herein, we present a first-hand view of physicians who were actually running the hospital of a major medical center during this natural disaster. This event demonstrates the vulnerability of basic human services, including health care even in industrialized, wealthy countries.
Article
Loss of essential utilities and danger of explosion forced a rapid nighttime winter evacuation of 229 patients from an acute-care Veterans Administration hospital. Although distribution of patients to recipient hospitals was not optimal, and the location of several patients could not be documented for more than 24 hours, the evacuation in subfreezing weather went smoothly. Continuity of care and careful planning permitted an orderly return to the hospital five days later. Although financial costs were high, no excess mortality or morbidity was associated with the evacuation. No changes in pharyngeal gram-negative bacterial flora of the patients were noted. Further, a critique is presented to aid in planning for similar emergencies elsewhere.
Article
The evacuation of a 102-bed geriatrics hospital in the middle of the night and from the centre of a riot in Toxteth, Liverpool, is described, together with its effect on the patients involved. No increase in the mortality rate occurred during the six weeks following the evacuation, but a significant increase in morbidity was found. Specific recommendations are made for action to be taken should other city centre geriatrics hospitals need to be evacuated in similar circumstances.
Article
Many hospital emergency plans focus on the hospital as a disaster responder, with a fully operational medical facility, able to receive and treat mass casualties from a clearly defined accident scene. However, hospitals need to prepare a response for extreme casualty events such as earthquakes, tornadoes, or hurricanes. This article describes the planning, mitigation, response, and recovery of a major medical--surgical center thrust into a victim responder role following the devastating Northridge earthquake. The subsequent evacuation and care of patients, treatment of casualties, incident command, prior education and training, and recovery issues are addressed.
Article
Valuable lessons can be learned from the emergent evacuation of a large urban teaching hospital because of flooding. Case report. Four hundred fifty-bed adult and 150-bed children's tertiary referral teaching hospital. Massive rainfall from tropical storm Allison caused extensive flooding. Emergency power came on at 1:40 AM. Complete power loss occurred at 3:30 AM. The decision to begin evacuation of patients was made at approximately 10:30 AM. All 575 patients were either discharged from the hospital (169 patients) or evacuated (406 patients) to 29 other facilities by both ambulance and helicopter by 3 PM the next day. Six deaths occurred, none of which could be attributed to the conditions created by the flooding. The lessons learned from this experience included the following: (1) flooding will occur in a flood plain; (2) electrical power outages are not necessarily temporary-begin evacuation; (3) appoint a triage officer from those available; (4) have a reliable in-house communication system not dependent on telephone lines or electricity; (5) have a reliable telephone system for contacting outside facilities; (6) have flashlights available on all units; (7) have battery-operated exit signs and stairway lights; (8) maximize use of volunteers when they are available and fresh; (9) maintain a paper record of all patient transfers; (10) coordinate loading of ambulances and helicopters for patient transfer; and (11) reassign staff as necessary to care for transferred patients. Emergent evacuation of a large, tertiary hospital requires extensive effort from both the hospital staff and the community.
Article
To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning. Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available. There were 275 reported evacuation incidents from 1971-1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%). More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.
Article
We knew there was a storm coming. Its name was Katrina, and it was headed straight for Florida, which was unfortunate for those having just endured a recent hurricane. Katrina lulled the city of New Orleans, Louisiana, to sleep, and that night she swerved. In an unusual and ultimately devastating turn of events, the hurricane literally cut west and traversed the state of Florida to find itself brewing with room to grow in the Gulf of Mexico. Despite this, no one panicked. There still existed a wide area of uncertainty for its landfall, and New Orleans had been spared from a direct hit numerous times before. We had just been lucky, I suppose. It became apparent that New Orleans would see some part of this growing monster, and as a precaution (one to which we have become accustomed), an evacuation of the city was ordered. In the children’s hospital setting, this translated to another “code gray.” Given that patients are not in a position to leave the hospital during a storm, it falls on chance that a group of doctors must weather it with them. Therefore, on this day, 12 resident physicians received a call telling us that we should prepare our bags to stay at Children’s Hospital of New Orleans. Neither I nor any of my resident peers had had disaster training as part of our curriculum. When I found I was chosen to be on-call, I did not envision it lasting more than 2 days. I packed only a bare minimum, invested in water and microwaveable meals, and, by sheer luck, decided to pack some important documents just in case. The day was sunny and beautiful. As I drove to the hospital that morning, I was determined to remain in a chipper mood. I greeted everyone in an … Address correspondence to Sandhya D. Mani, MD, Department of Internal Medicine/Pediatrics, Children’s Hospital New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118. E-mail: smani{at}lsuhsc.edu
Article
The preparation and rebuilding in the wake of a devastating hurricane can be a challenge at all levels. The summer of 2004 proved how frequently these preparations might need to happen, and the hurricanes of 2005 demonstrated how extensive these preparations should be and the cost of inadequate preparation. Medical care is a very large component of the disaster plan for hurricanes and must include not only supplies but also personnel. Personal and professional limitations can impede the response of valuable personnel to distant sites, but one must remember that the local response falls in the hands of those first on site (ie, those who reside in the area). Proper planning and effective drills can mitigate the extent of damage to structures and human life, and when deemed necessary, effective evacuation of at-risk areas is crucial. In the end, nature is much too powerful a force for us to fight-we can only be prepared to respond to and bend with the potentially devastating forces directed our way.
Article
This article describes and analyzes key aspects of the medical response to Hurricane Katrina in New Orleans. It is based on interviews with individuals involved in the response and on analysis of published reports and news articles. Findings include: (1) federal, state, and local disaster plans did not include provisions for keeping hospitals functioning during a large-scale emergency; (2) the National Disaster Medical System (NDMS) was ill-prepared for providing medical care to patients who needed it; (3) there was no coordinated system for recruiting, deploying, and managing volunteers; and (4) many Gulf Coast residents were separated from their medical records. The article makes recommendations for improvement.
Article
Hurricane Katrina devastated the city of New Orleans as well as a large section of the Gulf Coastal region of the United States. Herein, we present a first-hand view of physicians who were actually running the hospital of a major medical center during this natural disaster. This event demonstrates the vulnerability of basic human services, including health care even in industrialized, wealthy countries.
Article
On August 29, 2005, a hurricane named Katrina struck the Gulf Coast. Many feared the consequences of such a storm, but very few believed that it could ever happen. This article is a narrative written shortly after the evacuation of patients and personnel from the flooded Charity Hospital. The days at Charity hospital were hot and humid following Katrina, and as time passed the air was permeated by a stench that was inescapable. Rendering care to patients without electricity, and thus light and air conditioning, with a temperature in the 90°s and no running water was a challenge. Trying to cool patients with central fever and providing adequate ventilation for unconscious patients was extremely difficult. Without elevators, climbs up to and down from the 14th floor—where the author and his colleagues had their sleeping rooms—and the 12th (surgical intensive care unit [ICU]), seventh (neuro ICU and step-down units), and sixth (medical ICU) floors were tedious. The descent to check the emergency department and obtain a closer look at flooding in the streets around the hospital, which maintained a 4- to 5-foot water level, became prohibitive because of the contemplation of the necessary return ascent. There were 21 patients, mostly neurosurgical, in the neuro ICU and step-down units and wards. This is their story.