Steps Toward Hospital-Disaster Management

Better management of hospital resources could greatly improve preparedness for disasters such as the tsunami that hit Southeast Asia in December 2004, according to an article in the January 27, 2005, issue of Critical Care (BioMed Central).

Disaster medical response in the past has predominantly focused on prehospital issues such as triage, evacuation, and transport of casualties, in the assumption that hospital management would occur as planned. Researchers note that the intensive care unit (ICU) is an essential link in the chain of events that follow a disaster. Hospitals across the world have limited bed capacity, and staffs are often not prepared for critical situations, even in countries where hospital facilities are thought to be large, modern, and well equipped. For example, after a terrorist bombing in Bali in 2002, 15 patients requiring ventilation were sent to a hospital in Australia, which could care for only 12. Floods in Houston (TX, USA) in 2001 led to the unavailability of ICU beds. Other attacks and environmental disasters have reinforced this state of unpreparedness, according to author J. Christopher Farmer and colleagues.

The authors of the article argue that resources currently directed for hospital patient safety could be used to improve training, planning, and effectiveness of disaster medical response. They argue that critical care professionals should be offered better, more-targeted disaster medical training that includes exercises in realistic disaster situation simulations, emphasizing hospital response. In addition, they believe web-based information should be available to healthcare workers for last-minute, quick, and easy querying at the time of an event.

Co-operation between hospitals in the vicinity of a disaster must also improve, with better communications, training, planning, and triage algorithms that can help move hospital staff, as opposed to patients. Currently, for a large-scale disaster, patients are segregated to specific facilities according to condition or resource allocation. In all, the most pressing needs are education and training and more planning that acknowledges specific disaster medical needs of hospitals.

Dr. Reynolds is a consultant in critical care medicine and professor of medicine, division of pulmonary and critical care medicine, Mayo Clinic (Rochester, MN, USA).