A Hospital Emergency Support System for Real Time Surveillance Modeling and Effective Response

Introduction

Before 2001, public health departments, including hospitals, rarely played a role in disaster planning, though they functioned in critical roles for victim treatment and recovery. Their roles in disaster response usually initiated after a disaster event had occurred. But the potential for chemical or biological terrorism has pushed them to become frontline responders, as well as critical and central players in most state and local emergency planning teams. According to U.S. General Accounting Office [GAO] (2003), increasing expectations demand that public health agencies at all levels in the United States develop their capacities to respond to incidents of terrorism and other disasters (Bashir et al., 2003). For healthcare facilities, emergency rooms (ER) represent the frontlines for responding to any emergency situation, though most hospital emergency response plans rely on their emergency departments’ response. That is, the emergency department must determine the magnitude of the event and initiate the appropriate institutional response, including decisions to declare an institutional disaster or institutional lock-down and determinations of whether victim decontamination is needed. From this point of view, the extent of the response depends on the capability of each emergency department. At present, however, even without a terrorism incident, emergency departments are crowded, and patients might wait up to a full day to receive treatment (Brownstein, 2007; U.S. National Center for Injury Prevention and Control [NCIPC], 2007). According to a Harvard Medical School survey, the number of ER visits rose from 93.4 million in 1994 to 110.2 million in 2004. A patient has a one in four chance of waiting for more than 50 minutes because of overcrowding in the emergency department, and wait times appear likely to keep increasing (Reuters, 2008). This widespread problem logically will negatively influence their ability to respond to high-consequence chemical, biological, radiological, or nuclear (CBRN) attacks or natural disasters. Should a huge influx of patients arrive due to an unexpected disaster event, the current crowding situation of most emergency departments implies that real emergencies may be lost in the shuffle without an organized response (Conte, 2005Morse, 2002).

Because a variety of challenges, such as organizational, logistical, and patient-care related issues, arises when dealing with an unexpected disaster event, units other than the emergency department within a healthcare facility or hospital may also need to engage in response processes. One of the most important challenges is determining how to increase facilities’ ability to generate and organize a response rapidly (NCIPC, 2007). Effective preparedness and response demand an established functional leadership structure with clear organizational responsibilities, which knows what actions need to be implemented and how to handle clinical management during a disaster. Should an incident occur, those exposed or injured rapidly seek care and may not do so at the facilities designed by existing response plans. Thus, every healthcare facility must be able to organize a response quickly; speed is critical to save lives. The best means to employ existing health care capacities and generate a “dual-use” response infrastructure therefore becomes an urgent issue, because many of the capabilities required for responding to a large-scale chemical or biological attack are also required for responses to naturally occurring disease outbreaks. Furthermore, in a fast-paced disaster such as an explosion, there is little time for meetings or discussion about the appropriate use of different support functions and personnel.