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Disaster management: better management of hospital resources and staff is the answer

January 24, 2005

Better management of current hospital resources and staff could greatly improve preparedness for disasters such as the tsunami that hit South East Asia a month ago, according to an article by J Christopher Farmer and colleagues, to be published in the journal Critical Care.

To date, disaster medical response has predominantly focused on pre-hospital issues such as triage, evacuation, and transport of casualties, and has largely assumed that hospital management would occur as planned.

The intensive care unit (ICU) is an essential link in the chain of events that follow a disaster, write Farmer and colleagues. Hospitals across the world have limited bed capacity and staffs are often not prepared for critical situations. As recent events have shown, hospitals can quickly be overwhelmed in the event of a disaster. This is also the case in countries where hospital facilities are thought to be large, modern and sufficiently equipped. For example, after the terrorist bombing in Bali in 2002, 15 patients requiring mechanical ventilation were sent to an Australian hospital, which could only care for a maximum of 12 ventilated patients. Floods in Houston Texas in 2001 quickly led to unavailability of ICU beds. Innumerable examples of attacks and environmental disasters have reinforced that hospital capacity is the major rate-limiting factor during a disaster medical response.

In the paper, Farmer and colleagues suggest improved, hospital-focused training, more detailed co-operation between hospitals, and the dual use of hospital infrastructure and resources. For example, resources currently directed for hospital patient safety could be repurposed to improve training, planning, and effectiveness of the 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, web-based knowledge collections should be available to health 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 improve, with improved communications, better training and 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 patient-based resource allocation. Planning and preparedness would allow for a better, more efficient exchange of material and human resources when needed.

In all, the most pressing needs are education and training, and more detailed planning that acknowledges the specific disaster medical needs of hospitals and ICUs worldwide.

BioMed Central Limited

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