When disasters strike the emergency department: a case series and narrative review

Abstract

Introduction Emergency departments (EDs) are reasonably well prepared for external disasters, such as natural disasters, mass casualty incidents, and terrorist attacks. However, crises and disasters that emerge and unfold within hospitals appear to be more common than external events. EDs are often affected. Internal hospital crises and disasters (IHCDs) have the potential to endanger patients, staff, and visitors, and to undermine the integrity of the facility as a steward of public health and safety. Furthermore, ED patient safety and logistics may be seriously hampered. Methods Case series of 3 disasters within EDs. Narrative overview of the current IHCD-related literature retrieved from searches of PubMed databases, hand searches, and authoritative texts. Discussion The causes of IHCDs are multifaceted and an internal disaster is often the result of a cascade of events. They may or may not be associated with a community-wide event. Examples include fires, floods, power outages, structural damage, information and communication technology (ICT) failures, and cyberattacks. EDs are particularly at-risk. While acute-onset disasters have immediate consequences for acute care services, epidemics and pandemics are threats that can have long-term sequelae. Conclusions Hospitals and their EDs are at-risk for crises and their potential escalation to hospital disasters. Emerging risks due to climate-related emergencies, infectious disease outbreaks, terrorism, and cyberattacks pose particular threats. If a hospital is not prepared for IHCDs, it undermines the capacity of administration and staff to safeguard the safety of patients. Therefore, hospitals and their EDs must check and where necessary enhance their preparedness for these contingencies.

Changing Admission Patterns in Pediatric Emergency Departments during the COVID-19 Pandemic in Italy Were Due to Reductions in Inappropriate Accesses

“…Parents may also have avoided attending hospital due to the expectation of overcrowding and long wait times, as reported for adult EDs in the Lombardy and Piedmont areas heavily affected by COVID-19 during this period [9][10][11][12].…”

Three decades of hospital evacuations in the Netherlands: a scoping review

“…In the Netherlands, this particularly concerns riverine and flash floods. 1 15 In 2015, a flood risk analysis determined that 75% of the 185 Dutch hospital locations faced a flooding risk. 6 Despite these risks, most of the vulnerable hospitals have their ED and emergency generators situated on the ground floor or even in the basement.…”

“…A hospital evacuation for an internal fire carries other challenges than an evacuation procedure for natural disasters, when the external infrastructure and surrounding hospitals may be incapacitated. 1 18 Furthermore, it is crucial to differentiate between hospital evacuations due to foreseeable threats (i.e. most riverine floods) and those prompted by acute-onset disasters (i.e.…”

“…However, these very situations may also disrupt hospital functions and subsequently create a threat to patient safety and the continuity of emergency and non-emergency care. 1 2 Sudden onset events that severely disrupt the everyday, routine services of a hospital facility are referred to as ‘internal hospital crises and disasters’ (IHCDs). 1 3 IHCD frequency is increasing over time, which is in part explained by the growing impact of information and communication technology (ICT) failures as well as the increasing complexity of hospital infrastructures.…”

“…1 2 Sudden onset events that severely disrupt the everyday, routine services of a hospital facility are referred to as ‘internal hospital crises and disasters’ (IHCDs). 1 3 IHCD frequency is increasing over time, which is in part explained by the growing impact of information and communication technology (ICT) failures as well as the increasing complexity of hospital infrastructures. 3 4 A previous study from the Netherlands revealed that the annual risk for a hospital to experience an IHCD was 16% between 2010 and 2020.…”