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Coping With a Mass Casualty: Insights into a Hospital’s Emergency Response and Adaptations After the Formosa Fun Coast Dust Explosion

Published online by Cambridge University Press:  23 August 2019

Sheuwen Chuang Open the ORCID record for Sheuwen Chuang [Opens in a new window] ,
David D. Woods ,
Hsien-Wei Ting ,
Richard I. Cook  and
Jiin-Chyr Hsu
Sheuwen Chuang*
Affiliation:
Graduate Institute of Data Science, Health Policy and Care Research Center, Taipei Medical University, Taipei, Taiwan
David D. Woods
Affiliation:
Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
Hsien-Wei Ting
Affiliation:
Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
Richard I. Cook
Affiliation:
Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
Jiin-Chyr Hsu
Affiliation:
Department of Chest Medicine,Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
*
Correspondence and reprint requests to Sheuwen Chuang, 12F, No. 172-1, Sec 2 Keelung Rd., Taipei, 10675, Taiwan (e-mail: [email protected]).
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Abstract

Objective:

The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE).

Methods:

Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge.

Results:

The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital’s ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands.

Conclusion:

Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

Keywords

disaster planningemergency responseFormosa Fun Coast Dust Explosionmass casualty incident
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 14 , Issue 4 , August 2020 , pp. 467 - 476
Copyright
© 2019 Society for Disaster Medicine and Public Health, Inc.

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References

REFERENCES

Atiyeh, B, Dibo, S. Measures of intervention in burn disasters: preparedness and crisis management. J Def Manag. 2013;S3:001.CrossRefGoogle Scholar
Potin, M, Sénéchaud, C, Carsin, H. Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan. Burns. 2010;36:741-750.CrossRefGoogle ScholarPubMed
Yang, CC, Shih, CL. A coordinated emergency response: a color dust explosion at a 2015 concert in Taiwan. Am J Public Health. 2016;106:1582-1585.CrossRefGoogle Scholar
Wang, TH, Jhao, WS, Yeh, YH, et al. Experience of distributing 499 burn casualties of the June 28, 2015 Formosa Color Dust Explosion in Taiwan. Burns. 2017;43:852-857.CrossRefGoogle ScholarPubMed
American Burn Association, National Burn Repository. 2016 National Burn Repository: report of data from 2006–2015. 2016, Verson 12.0. http://ameriburn.org/education/publications/. Accessed November 16, 2017.Google Scholar
Eaton, L. Loss of 79,000 jobs adds to city’s economic woes. The New York Times. November 16, 2001: A1.Google Scholar
Inglesby, TV. Progress in disaster planning and preparedness since 2001. JAMA. 2011;306:1372-1373.Google Scholar
Dai, NT, Tzeng, YS, Wang, CH, et al. Five critical clinical periods for managing mass burn casualties in Formosa Fun Coast Dust Explosion disaster – experience of tri-service general hospital. J Taiwan Soc Plast Surg. 2017;26:1-13.Google Scholar
Chuang, SY, Huang, HF, Liu, TJ, et al. Mass burn injury triage experience in Formosa Fun Coast Dust Explosion disaster of National Taiwan University hospital. J Taiwan Soc Plast Surg. 2017;26:14-21.Google Scholar
Hu, HC, Chang, CH, Hsu, HH, et al. Inhalation injury caused by cornstarch dust explosion in intubated patients – a single center experience. Burns. 2018;44:134-139.CrossRefGoogle ScholarPubMed
Chiang, IH, Chen, SG, Huang, KL, et al. Adjunctive hyperbaric oxygen therapy in severe burns: experience in Taiwan Formosa Water Park dust explosion disaster. Burns. 2017;43:852-857.CrossRefGoogle ScholarPubMed
Flanagan, JC. The critical incident technique. Psychol Bull. 1954;51:327-358.CrossRefGoogle ScholarPubMed
FitzGerald, K, Seale, NS, Kerins, CA, et al. The critical incident technique: a useful tool for conducting qualitative research, J Dent Educ. 2008;72:299-304.CrossRefGoogle ScholarPubMed
Klein, GA, Calderwood, R, MacGregor, D. Critical decision method for eliciting knowledge. IEEE Trans Syst Man Cybern Syst. 1989;19:462-472.CrossRefGoogle Scholar
Woods, DD. Process tracing methods for the study of cognition outside of the experimental psychology laboratory. In: Klein, GA, Orasanu, J, Calderwood, R, eds. Decision Making in Action: Models and Methods. Ablex, NJ: Praeger;1993:228-251.Google Scholar
Woods, DD. Discovering how distributed cognitive systems work. In: Hollnagel, E, ed. Handbook of Cognitive Task Design. Mahwah, NJ, UK: Lawrence Erlbaum Associates; 2003:37-54.CrossRefGoogle Scholar
Back, J, Ross, AJ, Duncan, MD, et al. Emergency department escalation in theory and practice: a mixed-methods study using a model of organizational resilience. Ann Emerg Med. 2017;70:659-671.CrossRefGoogle Scholar
Barbisch, DF, Koenig, KL Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13(11):1098-1102.10.1197/j.aem.2006.06.041CrossRefGoogle ScholarPubMed
Klein, GA, Feltovich, PJ, Bradshaw, JM, et al. Common ground and coordination in joint activity. In: Rouse, WB, Boff, KR, eds. Organizational Simulation. Hoboken, NJ: Wiley-Interscience; 2005:139-184.CrossRefGoogle Scholar
Burstein, JL. The myths of disaster education. Ann Emerg Med. 2006;47:50-52.CrossRefGoogle ScholarPubMed
Altevogt, BM, Stroud, C, Hanson, SL, et al., eds. Guidance for Establishing Standards of Care for Use in Disaster Situations. Washington, DC: National Academies Press; 2009.Google Scholar
Hoejenbos, MJJ, McManus, J, Hodgetts, T. Is there one optimal medical treatment and evacuation chain for all situations: “Scoop and Run” or “Stay-and-Play.” Prehosp Disaster Med. 2008;23:s74-s78.CrossRefGoogle ScholarPubMed
Atiyeh, BS, Hayek, SN. Management of war-related burn injuries: lessons learned from recent ongoing conflicts providing exceptional care in unusual places. J Craniofac Surg. 2010;21:1529-1966.CrossRefGoogle ScholarPubMed
Hick, JL, Hanfling, D, Cantrill, SV. Allocating scarce resources in disasters: emergency department principles. Ann Emerg Med. 2011;59:177-187.CrossRefGoogle ScholarPubMed
Wears, RL, Cook, RI. Getting better at being worse. Ann Emerg Med. 2010;56:465-467.CrossRefGoogle ScholarPubMed
Cheng, MH, Mathews, AL, Chuang, SS, et al. Management of the Formosa color dust explosion: lessons learned from the treatment of 49 mass burn casualty patients at Chang Gung Memorial Hospital. Plast Reconstr Surg. 2016;137:1582-1585.CrossRefGoogle ScholarPubMed
King, RV, North, CS, Larkin, GL, et al. Attributes of effective disaster responders: focus group discussions with key emergency response leaders. Disaster Med Public Health Prep. 2010;4:332-338.CrossRefGoogle ScholarPubMed
Woods, DD. Chapter 9: resilience and the ability to anticipate. In: Hollnagel, E, Pariès, J, Woods, DD, et al., eds. Resilience Engineering in Practice. Farnham, UK: Ashgate; 2011.Google Scholar
Auf der Heide, E. Disaster planning, part 2: disaster problems, issues, and challenges identified in the research literature. Emerg Med Clin North Am. 1996;14:453-480.CrossRefGoogle ScholarPubMed