Hospital emergency department referral patterns in a disaster

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.