Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-17T19:24:12.641Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital Referral Patterns: How Emergency Medical Care Is Accessed in a Disaster

Published online by Cambridge University Press:  08 April 2013

Michael J. Reilly  and
David Markenson
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.

Methods: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.

Results: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.

Conclusions: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

(Disaster Med Public Health Preparedness. 2010;4:226-231)

Keywords

referral patternsemergency departmentshospitalsdisastersemergency medical servicestriage
Type
Original Article
Information
Disaster Medicine and Public Health Preparedness , Volume 4 , Issue 3 , October 2010 , pp. 226 - 231
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Bledsoe, B, Porter, R, Cherry, R.Essentials of Paramedic Care. Upper Saddle River, NJ: Prentice Hall; 2003.Google Scholar
2.Carresi, AL.The 2004 Madrid train bombings: an analysis of pre-hospital management. Disasters. 2008;32 (1):41–65.Google Scholar
3.Centers for Disease Control and Prevention (CDC). Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center—New York City, September 2001. MMWR Morb Mortal Wkly Rep. 2002;51 (1):1–5.Google Scholar
4.Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR.Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34 (2):160–167.Google Scholar
5.Teague, DC.Mass casualties in the Oklahoma City bombing. Clin Orthop Relat Res. 2004 42277–81.Google Scholar
6.Auf der Heide, E.The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47 (1):34–49.Google Scholar
7.Health Resources and Services Administration. A 2002 National Assessment of State Trauma System Development, Emergency Medical Services Resources, and Disaster Readiness for Mass Casualty Events. Washington, DC: HRSA; 2003.Google Scholar
8.Reilly, M, Markenson, DS.Education and training of hospital workers: who are essential personnel during a disaster? Prehosp Disaster Med. 2009;24 (3):239–245.Google Scholar
9.US General Accounting Office. Hospital Preparedness: Most Urban Hospitals Have Emergency Plans but Lack Certain Capacities for Bioterrorism. Washington, DC: GAO; 2003.Google Scholar
10.Institute of Medicine Committee on the Future of Emergency Care in the United States Health System. Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press; 2007.Google Scholar
11.Casey, R, Christy, J, Ellis, D, Wade, J.Elks Lodge building collapse. Emerg Med Serv. 2006;35 (12):185–188, 193.Google Scholar
12.Evans, GW, Isgar, B, Bruins, W, Glover, JR.The Peterborough lorry explosion, 22 March 1989: an analysis of the hospital response. Arch Emerg Med. 1990;7 (4):253–258.Google Scholar
13.Greenwald, PW, Rutherford, AF, Green, RA, Giglio, J.Emergency department visits for home medical device failure during the 2003 North America blackout. Acad Emerg Med. 2004;11 (7):786–789.CrossRefGoogle ScholarPubMed
14.Howells, NR, Dunne, N, Reddy, S.The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems. Emerg Med J. 2006;23 (7):530–533.Google Scholar
15.Karp, E, Sebbag, G, Peiser, J, et alMass casualty incident after the Taba terrorist attack: an organisational and medical challenge. Disasters. 2007;31 (1):104–112.Google Scholar
16.Kossmann, T, Wittling, I, Bühren, V, Sutter, G, Trentz, O.Transferred triage to a level I trauma center in a mass catastrophe of patients; many of them with burns. Acta Chir Plast. 1991;33 (3):145–150.Google Scholar
17.Madzimbamuto, FD.A hospital response to a soccer stadium stampede in Zimbabwe. Emerg Med J. 2003;20 (6):556–559.Google Scholar
18.Mohammed, AB, Mann, HA, Nawabi, DH, Goodier, DW, Ang, SC.Impact of London's terrorist attacks on a major trauma center in London. Prehosp Disaster Med. 2006;21 (5):340–344.Google Scholar
19.Platz, E, Cooper, HP, Silvestri, S, Siebert, CF.The impact of a series of hurricanes on the visits to two central Florida Emergency Departments. J Emerg Med. 2007;33 (1):39–46.Google Scholar
20.Richardson, DB, Kumar, S.Emergency response to the Canberra bushfires. Med J Aust. 2004;181 (1):40–42.Google Scholar
21.van Harten, SM, Welling, L, Perez, RS, Patka, P, Kreis, RW.Management of multiple burn casualties from the Volendam disaster in the emergency departments of general hospitals. Eur J Emerg Med. 2005;12 (6):270–274.Google Scholar
22.Wenck, MA, Van Sickle, D, Drociuk, D, et alRapid assessment of exposure to chlorine released from a train derailment and resulting health impact. Public Health Rep. 2007;122 (6):784–792.Google Scholar
23.Dallas, CE.Detonation of a nuclear device. In: Keys DC, Burstein JL, Schwartz RB, Swienton RE, eds. Medical Response to Terrorism: Preparedness and Clinical Practice. Philadelphia: Lippincott Williams & Wilkins; 2005:180.Google Scholar
24.Lacy, TL, Benedek, DM.Psychological impact of terrorist incidents. In: Roy MJ, ed. Physician's Guide to Terrorist Attack. Totowa, NJ: Humana Press; 2004:379-390.Google Scholar
25.Socher, MM, Leap, EK.Training preparedness for terrorism. In: Keys DC, Burstein JL, Schwartz RB, Swienton RE, eds. Medical Response to Terrorism: Preparedness and Clinical Practice. Philadelphia: Lippincott Williams & Wilkins; 2005:338.Google Scholar
26.Ağalar, F, Cakmakçi, M, Er, M, Akçakanat, A, Sayek, I.Evaluation of trauma care in a developing country highlighted by a major aircraft accident. Eur J Emerg Med. 1997;4 (2):97–102.Google Scholar
27.Allister, C, Hamilton, GM.Cardowan coal mine explosion: experience of a mass burns incident. Br Med J (Clin Res Ed). 1983;287 (6389):403–405.Google Scholar
28.Beyersdorf, SR, Nania, JN, Luna, GK.Community medical response to the Fairchild mass casualty event. Am J Surg. 1996;171 (5):467–470.Google Scholar
29.Katz, E, Ofek, B, Adler, J, Abramowitz, HB, Krausz, MM.Primary blast injury after a bomb explosion in a civilian bus. Ann Surg. 1989;209 (4):484–488.Google Scholar
30.Leiba, A, Halpern, P, Priel, IE, et alA terrorist suicide bombing at a nightclub in Tel Aviv: Analyzing response to a nighttime, weekend, multi-casualty incident. J Emerg Nurs. 2006;32 (4):294–298.Google Scholar
31.Raiter, Y, Farfel, A, Lehavi, O, et alMass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv. Emerg Med J. 2008;25 (4):225–229.Google Scholar
32.Vilke, GM, Smith, AM, Stepanski, BM, Ray, LU, Murrin, PA, Chan, TC.Impact of the San Diego county firestorm on emergency medical services. Prehosp Disaster Med. 2006;21 (5):353–358.Google Scholar