Emergency Response to Disasters

UPDATE: here is a link to a grand rounds presentation by Dr. Doug Hamilton, who was the doc who ran the Dome during every night of the crisis. He has lots of great photos and personal anecdotes to share. Thanks to Fidel, MD for the link.

GruntDoc posted a link to this article which concludes that our already-strained emergency departments and hospitals could not handle a large unexpected bolus of patients after a terrorist attack or natural disaster.

"The bombings in Madrid, on the eve of a national election, killed 177 and injured 2,000. Almost 1,000 of the injured were taken to 15 hospitals. One hospital alone received 270 patients in less than three hours," the article breathlessly states.

It seems intuitive that even our Level I trauma centers would be overwhelmed by such a disaster. No ER would be able to suddenly change gears and accommodate that many patients, would they?

Perhaps they would:

"Largely unreported by the media, on September 11, 2001, NYU Downtown Hospital, a 170-bed facility located four blocks from the World Trade Center, treated 500 patients, yet was never overwhelmed-despite the failure of virtually every logistical support system. This was the largest civilian disaster response in U.S. history. The experience suggests clear that the capacity of hospitals to treat victims of a disaster is many times greater than has been assumed."

But what about an overwhelming event like Hurricane Katrina? We all know that the emergency medical response to that disaster was a failure of epic proportions, right? Not in the least. Houston responded in a matter of hours, transforming an empty facility into a fully functioning field hospital that evaluated and treated thousands of patients:

"Staffed by physicians serving 12-hour shifts 24 hours a day, the clinic seamlessly accommodated the majority of medical needs. Countless nurses, allied health professionals, technologists and others volunteered their service, with more than 200 health care professionals assisting during the peak periods of the first two days of the evacuees' arrival. During those first hours, the clinic saw an average of 150 patients per hour. By Day Three, that number had dropped by two thirds.

By being treated on site, children stayed connected to their families, and emergency centers in the Texas Medical Center remained "decompressed to the greatest possible degree," according to Dr. Ralph Feigin, chair of pediatrics at BCM and physician-in-chief at TCH.

Important lessons:

"The experience of setting up the "Katrina Clinic" at the Astrodome/Reliant Center Complex in Houston provides important lessons to cities planning a medical response to disasters and other large-scale emergencies.

For several reasons, the situation in Houston was "logistically and politically" conducive to receiving and treating large numbers of evacuees. Most importantly, the area was not affected by Hurricane Katrina, leaving its extensive health care system intact and ready to respond. A wide range of academic, governmental, and private organizations came together to make and implement plans for the Katrina Clinic. A key first step was the creation of a unified command and control system to direct and coordinate services — a public health infrastructure equivalent to that of a small town was created almost literally overnight.

The Clinic was built in a 100,000-square-foot space in the Reliant Arena. Within 12 hours — aided by the use of existing exhibit hall materials — workers had created a facility including 65 examination rooms. Over the next 2 weeks, the Katrina Clinic saw more than 11,000 of the estimated 27,000 evacuees seeking shelter in the Complex. Clinic staff wrote nearly 17,000 prescriptions, performed nearly 600 x-rays and other radiologic studies, and gave more than 6,000 vaccinations."

Key points to remember about disasters (this article is a must-read):

• Less than 10% of the challenges faced during a disaster are medical.

• Only 10% of persons who arrive at a hospital or shelter following a disaster are in need of acute medical attention.

• Only 10% of those presenting to a shelter clinic or a hospital following a disaster have a potentially life-threatening condition.

• All disaster response is local (at least for the first 48–96 hours).

• The time, effort, and expense needed to transport out-of-state doctors and nurses into the area is rarely justified or needed, especially during the first 48–96 hours.

• All outside assistance and resources should be locally coordinated and arranged at the local level, because that is where the knowledge base for need is most reliable.

• Integrated, collaborative networks with intrinsic local discipline, support, and assignment of responsibility represent the most effective planning and action model.

Read the details here, Dr. Mattox explains how it's done:

"The local response to any disaster is more a function of management of people, ideas, supplies, and strategies, and less a matter of practiced drills for chemical, biologic, radiologic, and blast conditions."