Overcrowding impact in the response to mass casualty incidents in hospital emergency departments in Puerto Rico

Background/Purpose: Hospital emergency departments (EDs) play an exclusive role in an emergency and disaster preparedness and response system. In addition to attending the usual load of incoming patients, EDs must be able to attend an unexpected number of victims of a mass casualty incident (MCI). However, factors such as overcrowding may affect an EDs capability to attend to a large volume of patients. Objective: To assess Puerto Rico hospital emergency departments level of disaster and emergency preparedness and response capability to a mass casualty incident(MCI). Methods: A survey was conducted to characterize ED level of preparedness and response to a MCI. Thirty-nine hospitals of a sample of 44 participated in the study. The questionnaire administered to hospital executives explored: general hospital characteristics; emergency plans; ED capacity and volume; equipment and infrastructure; collaborative agreements; personnel trainings; emergency communications; laboratory facilities; treatment protocols; security; and, epidemiologic surveillance. Results: Hospital EDs in Puerto Rico are filled to capacity more than 60% of the time. The factor most commonly associated with overcrowding is their inability to transfer patients to inpatient beds in a timely fashion. Conclusion: Overcrowding in EDs is very common in Puerto Rico hospitals and is most commonly associated with their inability to transfer ED patients to inpatient beds. This situation endangers the EDs ability to respond in an effective way to a MCI. The management of ED overcrowding must be considered as part of a comprehensive hospital emergency and disaster preparedness plan.