Management of evacuee surge from a disaster area: solutions to avoid non-emergent, emergency department visits.

INTRODUCTION: Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral). OBJECTIVE: The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs. METHODS: Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact. RESULTS: During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs. CONCLUSION: An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.

The use of trained observers as an evaluation tool for a multi-hospital bioterrorism exercise.

INTRODUCTION: Evidence suggests that regular disaster exercises have beneficial effects on subsequent mock and actual disaster responses. The purpose of this report is to describe a multiple hospital, bioterrorism exercise, evaluated by independent observers who used an evaluation template. METHODS: The overall tabletop exercise design included participation from 23 Joint Commission Accreditation of Healthcare Organizations hospitals, four health departments, and a representative from one federal agency. The exercise was evaluated by trained exercise observers utilizing an independently prepared, evaluation protocol. RESULTS: All exercise sites successfully identified the bio-agent involved and answered after-exercise debriefing questions without much difficulty. Evaluations, in the form of an after-action report by the independent observers, commented upon the many limitations to the construct of the exercise. CONCLUSION: Having an independent observer group at the exercise appeared to provide a value-added benefit for capturing subjective information and data. However, these data were not in a form conducive to statistical analysis. Further work is needed to create an evaluation tool that would allow for statistical analysis so that exercises can be compared and improvements can be objective.

Testing emergency medical personnel response to patients with suspected infectious disease.

OBJECTIVES: In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan. METHODS: Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital "lock-down"; and (3) breach of drill protocol. RESULTS: None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's biological agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their "infected" patients, only two (29%) followed their notification protocol and contacted the local health department. CONCLUSION: This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.