Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-18T16:21:51.542Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital Bed Surge Capacity in the Event of a Mass-Casualty Incident

Published online by Cambridge University Press:  28 June 2012

Daniel P. Davis ,
Jennifer C. Poste ,
Toni Hicks ,
Deanna Polk ,
Thérèse E. Rymer  and
Irving Jacoby
Daniel P. Davis*
Affiliation:
University of California-San Diego (UCSD)Department of Emergency Medicine, La Jolla, California UCSD School of Medicine, La Jolla, California
Jennifer C. Poste
Affiliation:
John Muir College, University of California-San Diego, La Jolla, California
Toni Hicks
Affiliation:
Sharp Healthcare, San Diego, California DMAT San Diego California-4
Deanna Polk
Affiliation:
Scripps Memorial Hospital, La Jolla, California DMAT San Diego California-4
Thérèse E. Rymer
Affiliation:
DMAT San Diego California-4 UCSD Medical Center, Office of Emergency Preparedness and Response, San Diego, California
Irving Jacoby
Affiliation:
University of California-San Diego (UCSD)Department of Emergency Medicine, La Jolla, California UCSD School of Medicine, La Jolla, California DMAT San Diego California-4
*
UCSD Emergency Medicine200 West Arbor Drive #8676San Diego, CA 92103USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualtyincident.

Objective:

To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities.

Methods:

Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient.

Results:

A total of 1,741 assessments of 788 patients by 82 nurse managers aabnd 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than werenurse managers to send patients to such a facility or discharge them, but less likely to transfer patients outof the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses.

Conclusions:

A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.

Keywords

admissionsdischarge (hospital)hospitalnurse managerson-site nursing facilitypatient dispositionphysicianssurge capacity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 3 , June 2005 , pp. 169 - 176
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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

1.Levi, L, Michaelson, M, Admi, H, et al. : National strategy for mass casualty situations and its effects on the hospital. Prehosp Disast Med 2002;17(1):12–16.CrossRefGoogle ScholarPubMed
2.Burkle, FM Jr, : Mass-casualty management of a large-scale bioterrorist event: An epidemiological approach that shapes triage decisions. Emerg Med Clin North Am 2002;20(2):409–436.CrossRefGoogle ScholarPubMed
3.Kvetan, V: The World Trade Center attack. Is critical care prepared for terrorism? Crit Care 2001;5(6):321–322.CrossRefGoogle ScholarPubMed
4.Hirshberg, A, Holcomb, JB, Mattox, KL: Hospital trauma care in multiplecasualty incidents: Critical view. Ann Emerg Med 2001;37(6):647–652.CrossRefGoogle ScholarPubMed
5.Levi, L, Bregman, D, Geva, H, Revah, M: Does number of beds reflectthe surgical capability of hospitals in wartime and disaster? The use of a simulation technique at a national level. Prehosp Disast Med 1997;12(4):300–304.CrossRefGoogle Scholar
6.Bloem, K:Treating the sick: Capacity of the US health care system to respond to an epidemic. Public Health Rep 2001;116(Supplement 2):34–35.CrossRefGoogle Scholar
7.Halpern, P, Tsai, MC, Arnold, JL, et al. : Mass-casualty, terrorist bombings: Implications for emergency department and hospital emergency response (Part II). Prehosp Disast Med 2003;18(3):235–241.CrossRefGoogle ScholarPubMed
8.Libow, LS: The acts of terrorism. N Engl J Med 2002;346(7):539.Google ScholarPubMed
9.Rhodes, H: Disaster plans: Lessons learned. J AHIMA 1996;67(4):36–38.Google ScholarPubMed
10.Borowski, R: How prepared are you? Reviewing your disaster plan may save your life. NAHAM Manage J 1995;22(1):3–31.Google ScholarPubMed
11.Roccaforte, JD, Cushman, JG: Disaster preparation and management for the intensivecare unit. Curr Opinion Crit Care 2002;8:607–615.CrossRefGoogle Scholar
12.Milsten, A: Hospital responses to acute-onset disaster: A review. Prehosp Disast Med 2000;15:(1):32–45.CrossRefGoogle ScholarPubMed