202714 Hospital emergency department referral patterns in a disaster

Wednesday, November 11, 2009: 8:45 AM

Michael J. Reilly, DrPH, MPH, NREMT-P , Center for Disaster Medicine, New York Medical College, Valhalla, NY
David S. Markenson, MD , Center for Disaster Medicine, New York Medical College, School of Public Health, Valhalla, NY
Introduction: A main presumption in hospital disaster planning is that patient arrival from the scene will be through a directed EMS response and distributive transport system, allowing orderly triage of arrivals and the control of numbers arriving at each hospital serving disaster victims. However, case reports in the literature and major incident after action reports have shown that most patients who present at a health care facility following a disaster or other major emergency do not necessarily arrive via ambulance.

Purpose: If these reports of arrival of patients outside an organized transport system are accurate than hospitals and emergency medical services (EMS) systems should be planning differently for a mass convergence of patients on the health care system.

Methods: We conducted a 25-year retrospective review of published data to identify reports of patient care during disasters or major emergency incidents which included categorization of the patient's method of arrival. Using a structured mechanism the data was aggregated and analyzed.

Results: Almost all reports identified discuss the importance of the prehospital emergency care system. However, many suggest that only a fraction of the patients who are treated arrive via ambulance, particularly in the early post-incident stages of a disaster.

Conclusions: Hospitals should develop emergency plans which consider alternative referral patterns of patients during a disaster. Hospital staff should be proficient in triage, decontamination, and safety and security procedures, should they encounter a patient surge on their facility.

Learning Objectives:
Objective: Describe the distribution and referral patterns of patient to emergency departments following disasters, acts of terrorism or public health emergencies. Objective: Discuss planning strategies for large numbers of self-referred patients to hospitals following disasters or incidence of significance. Objective: Identify critical preparedness measures to prepare for the mass convergence of victims on hospitals and medical centers post-disaster.

Keywords: Emergency Department/Room, Disasters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Professor Michael J. Reilly, MPH NREMT-P is the Director of the Graduate Programs in Emergency Preparedness, Assistant Director of the Center for Disaster Medicine, and Assistant Professor of Public Health Practice at New York Medical College. Prof. Reilly earned his Master of Public Health degree from the Yale University School of Medicine, where his concentration was environmental health science and risk assessment. Additionally, he earned his BS cum laude in Health Science, as well as an AS and certificate in Paramedic Technology from Northeastern University in Boston, MA. Professor Reilly has over a decade of multidisciplinary experience in emergency preparedness, public safety, inter-governmental relations, and public health and emergency management. He has been published in the World's leading disaster medicine and public health preparedness journals, and received international awards and recognition for his work on trauma systems and health systems in the context of disaster and public health preparedness. Prof. Reilly is an internationally recognized expert in the areas of emergency medical services, and health system preparedness and response, with direct experience in responding to mass casualty events and public health emergencies. Prof. Reilly is frequently called upon to provide expert consultation, subject matter expertise and evaluate health care systems preparedness, emergency planning, and drills and exercises. In addition to his work at NYMC, Prof. Reilly also holds faculty appointments as an Adjunct Professor at the Metropolitan College of New York, School of Public Affairs & Administration, in the Department of Emergency and Disaster Management, and as an Associate faculty member at the Columbia University, Mailman School of Public Health in the Department of Environmental Health Science. Additionally, he has previously been a member of the faculty at Northeastern University and in the State of Connecticut Community College System. Prof. Reilly remains active as a paramedic in the Metro New York City area and maintains numerous specialty and technical certifications and instructor credentials in the areas of: Emergency medical services, OSHA compliance and worker safety, environmental health, hazardous materials emergency response, emergency management, counterterrorism, and weapons of mass destruction preparedness and response. Prof. Reilly is responsible for the day-to-day operation and management of the Center for Disaster Medicine at New York Medical College. Additionally, he coordinates the research and educational programs for the Center, and provides expert content in the areas of counterterrorism, weapons of mass destruction (WMD) preparedness and response, and general disaster and emergency management. Prof. Reilly has designed numerous educational curricula and training programs for a variety of preparedness functional roles for public health, emergency management and public safety audiences at the professional and graduate levels. He is a Senior Lecturer for multiple Federal Agencies including (DOJ, DHS and OSHA). Additionally, he is an active member of several State and National committees on homeland security and emergency management programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.