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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]
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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

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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