Disaster Preparedness, Triage, and Surge Capacity for Hospital Definitive Care Areas: Optimizing Outcomes when Demands Exceed Resources

Abstract

Disaster planning must anticipate how demands imposed by a disaster reconcile with the capacity of the treating facility. Resources must be organized before an event so that they are optimally used to treat as many victims as possible, as well as to avoid overwhelming available resources.

Mass Casualty Disasters: Who Should Run the Show?

“…As overtriage increases in a mass disaster so does critical mortality. As noted by Roccaforte and Cushman, Frykberg illustrated a direct linear correlation and demonstrated that after the attacks on September 11, 2001, overtriage rates reached an all-time high of 95% at New York University Downtown Hospital, resulting in devastating critical mortality approaching 45% for mass disaster casualties who initially survived the event (10). Unless a mechanism is Leading Mass Casualty Disasters in place to limit critical interventions on an individual patient in a disaster scenario, adhering to egalitarian protocols could lead to more harm than good in an MCI.…”

“…Undertriage is clearly dangerous, as severe but survivable injuries are overlooked and may go without treatment. Undertriage is minimized in nondisaster settings by protocols intended to purposely overtriage patients to higher levels of care than they may need (10). The intent is to catch patients with critical injuries who are delayed in presentation and may be missed during primary triage.…”

Crisis Standard of Care: Refocusing Health Care Goals During Catastrophic Disasters and Emergencies

“…However, in a disaster, the closer one is to the incident when evaluating resources relative to needs, the more likely that rationing must take place. 1 Rationing may be the best albeit last course of action to be taken to maximize population-based health outcomes in disasters. There are no simple approaches for two reasons.…”

“…Even in the September 11, 2001 attack in Lower Manhattan, analysis of casualties reported from the three main Lower Manhattan receiving hospitals shows that no hospital was overwhelmed by critically injured patients. 1 Hospitals and other entities with systems in place to mobilize and redeploy critical resources in a rapid and timely fashion will be less affected than those without programs in place at the time of a catastrophe.…”

Impact of Operational Staging to Improve Patient Throughput in an Inner-City Emergency Department During the Novel H1N1 Influenza Surge

“…5 In preparation for a disaster, one must anticipate how demand imposed by a disaster reconciles with the capacity of the facility or service. 6 When demand increases dramatically, a rapid needs assessment must be performed, and appropriate resources must be mobilized to fulfill these requirements. 7 We developed some initiatives and made structured plans to stage our response to this surge.…”