Disaster Preparedness Daily News

Posts Tagged ‘emergency’

Factors that lead to emergency department overcrowdings, ambulance diversions and other incidents that endanger patient safety have been revealed. A study published in BioMed Central’s open access Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine has shown that reductions in the number of hospital beds and downsizing or closure of emergency departments may create a dangerous loss of ’surge capacity’.

Amir Khorram-Manesh, from the Prehospital and Disaster Medicine Centre, Gothenburg, Sweden, worked with Annika Hedelin and Per Ortenwall to study all data concerning ‘hospital-related incidents’ in Sweden’s Region Västra Götaland between January 2006 and December 2008. He said, “Disasters seldom occur, but if they strike, a fast and effective response from healthcare services is expected. The incidents we document, where emergency hospitals, for different reasons, could not operate at their normal capacity are a matter of concern for patient safety as well as disaster response preparedness”.

The researchers found increasing numbers of ‘incidents’ over the three years studied. Bed shortages in intensive care and ordinary wards were the most common, followed by technical dysfunctions in the radiology department. They blame cost-cutting reductions in the size and staffing of emergency departments and increased pressure to treat people on an out-patient basis for the rise. Khorram-Manesh said, “Although these measures seem to be logical steps taken to improve healthcare effectiveness and reduce costs, they also, in a negative way, affect the surge capacity of a hospital”.

Source: Medical News Today

Two new studies published in the American Medical Association’s (AMA) Disaster Medicine and Public Health Preparedness journal suggest that sufficient hospital capacity during a disaster can be achieved through evaluating resources and discharging non-critical patients.

“Making hospital beds available for victims of a mass emergency may be easier than once thought,” said study lead author Gabor D. Kelen M.D., professor of emergency medicine at Johns Hopkins University School of Medicine. “Reverse triage, which is a system to create more inpatient hospital beds by discharging non-critical patients, can significantly increase surge capacity without a corresponding increase in resources.”

A related study suggests that refining and standardizing definitions of surge capacity relating to space, staffing, and supply concerns help implement surge capacity strategies for hospitals and health facilities during a mass casualty incidence.

“There is currently no accepted protocol for a detailed, phased way to increase hospital space during a disaster,” said John L. Hick, M.D., associate professor of emergency medicine at the University of Minnesota and physician at Hennepin County Medical Center. “Surge capacity is affected by many variables, so systems and processes are critical to support surge-capacity decision making.” Read the rest of this entry »

In the face of terrorism and catastrophic natural disasters, modern regional trauma systems that improve survival for critically injured patients are more vital than ever. Yet many fundamental assumptions underlying these systems — such as the notion that it is imperative to send the sickest patients to the hospital first — have rarely been subjected to rigorous scientific scrutiny.

Now, for the first time, researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have created a computer simulation model of trauma system response to mass casualty incidents involving dozens or hundreds of injured victims. The study shows that the best response depends more on the capability of regional hospitals to treat critically injured victims than on the ability to accurately identify those victims in the field.

“There’s been the notion gleaned from prior studies that ‘overtriage’ — letting some people into emergency care who might not actually need it — usually ends up costing lives, with deaths rising as overtriage rates increase. But our new model demonstrates that overtriage alone is unlikely to be the culprit,” says lead researcher Dr. Nathaniel Hupert, assistant professor of public health and medicine at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Instead, levels of overtriage can be beneficial, harmless or detrimental, depending on complex factors included in the researchers’ model, he says. Those factors include the capacity of medical facilities to deal with the wounded and the time it takes to process and care for patients.

“No triage system is 100-percent accurate, so the key issue to define from an outcomes perspective is, ‘How good is good-enough?’” Dr. Hupert says. “Our study suggests that pre-disaster planning can begin to address this question systematically, using modeling that takes into account local resources and response times, as well as specific types of mass casualty events.” Read the rest of this entry »