13 FEB 2020 The question for Healthcare Delivery is no longer What If, but When Disaster will strike. Gary M. Schindele, FF/EMT, FHFI Recent years have proven that disaster can strike anywhere at any time. The Center for Medicare/Medicaid Services (CMS), the NFPA (Section 12.4 General. Sub Section 12.4.1) and the Joint Commission have all mandated the need for healthcare providers at many levels to be prepared for a Mass Casualty incident and “Surge” population management. A new NFPA Active Shooter Standard (NFPA 3000) has also recently been released. The cause of these spikes in patient population are more variable than we can predict. In the past, pandemic flu seasons e.g. in 2017, the CDC reported that Since the start of the flu season, there were approximately 15 flu-related hospitalizations per 100,000 people in the United States, while the rate at this time last flu season (2016) was approximately two flu-related hospitalizations per 100,000 people” . In 2020 we are dealing with Corona Virus, as we have in the past with Swine or Bird Flu, SARS and MERS. The true global impact of COVID19 (corona virus as named by the World Health Organization) has yet to play out. One lesson already learned from the event, is that healthcare facilities are woefully underprepared to deal with major long term surge populations. Daily occurrences such as Industrial Chemical accidents, brush fires near major metropolitan areas, natural disasters, terrorist attacks or even a bus loaded with people headed on a road trip rolling over. Even any Friday afternoon on a full moon…..surge populations for hospitals are a more frequent event than most realize.. When it is all said and done, the cause does not matter. What really matters is the response. Initial response in the pre-hospital setting is the tip of the spear. More training has taken place with this part of the healthcare team than in any other aspect of the continuum to manage what are routinely call MCI’s, or Mass Casualty Incidents. Unlike the pre-hospital setting where space to manage and treat patients is generally a variable which can be accommodated (move the perimeter, take over a parking lot etc.) fixed healthcare facilities do not have this luxury. The reality is that a hospital must absorb a surge event ON TOP OF existing patient loads, whatever they happen to be, at the time of event. In addition, they must accommodate surge populations in the space which is pre-defined as the facility.
In warmer climates, in Florida for example, many hospitals have the luxury of some outdoor space and decent weather, often allowing the addition of pop-up tents to manage overflow. That is all well and good…...for Florida. Ask any urban facility in New York, Boston, Chicago or Detroit, for example, about setting up a tent in January…….all you hear is laughter. So where do these patients go? At any time when capacity is overburdened, there will be, by nature, a compromise of many basics. The goal of preparing for and training for the “worst case scenario” is not to eliminate compromise but reduce as much risk to patient and care giver alike. The goal should be to proactively MANAGE the compromise rather than reactively deal with it. Life safety should always be given the highest priority, for caregivers first and then patients. If a caregiver is compromised, it will only further reduce the ability to adequately manage patients. The Architectural, Design and Regulatory components of our industry must, at some point, realize that in a crisis situation aesthetics do not matter, codes, regulations and national standards will suddenly come crashing up against the reality of a surging system and will need to bend to reality. I have personally been involved in a number of large-scale MCI events as a responder. Patient care providers (people) and their safety are the first and most important aspect to managing any MCI event. Access to equipment, supplies, personal protective equipment and disposal of hazardous sharps and waste are at the most basic of needs. The ability to “through-put” or “park” patients who are not critical and ADEQUETLY manage them in a non-critical setting making room for more critical patients is a key element of a successful MCI event. This is where the design aspect and equipment planning and staging comes in. Flexibility with space is key in planning the response to a surge event……So What If? What if the hospital main lobby was designed to become the ER overflow space? What if the cafeteria was designed as a “walking wounded” gathering space where patients could re- connect with worried loved ones? All of this is possible with situational understanding and application of the proper mindset and equipment on the front end of the design process….sometimes called Master Planning. Picture gas outlets pre-positioned behind artwork in a lobby, picture the deployment of mobile equipment stations to these areas, where, in a matter of minutes, an entire triage and patient care environment can be created. What if during an epidemic scale flu season you could triage all the worried well in an area separated from the “patient” space…..making sure that those who are not “really” sick stay removed from those who really are sick. What if during a “major terror event” (think Pulse Nightclub) you could move a large number of patients in to non-traditional spaces and still manage them safely and efficiently with the proper care and protection.
What if a facility impacted by a natural disaster could re-locate patients from damaged areas, still accept all walking wounded arriving on their own, even when the physical structure and surrounding infrastructure (roads, power etc.) are compromised. What if every public arena such as baseball stadiums, football stadiums, basketball arena and so on, where “pre-planned” to stage emergency medical supplies. What if all these venues had a medical pre-plan so that patients could be collected, triaged and MANAGED on site. This goes for not only terrorist incidents such as the recent Manchester UK bombing, but in the case of natural disasters (think Hurricane Katrina and the Super Dome in New Orleans). What if all public venue projects or VA facilities using tax money (e.g. Bonds) for construction were mandated that the venue or facility be designed with the deliberate intent to support a public safety role in time of a crisis? USERS MUST DEFEND THEIR CASE. Technology exists to create these spaces and manage these patients. Flexibility, Adaptability and Expandability are the cornerstones of adequate management of surge populations, regardless of the cause, regardless of the location Regulatory agencies, design and architectural firms, as well as local government agencies must at some point address the reality of “non-traditional” areas for patient care in a mass casualty and surge scenario. These events are NOT going away. Gary Schindele is the Board Member and a Fellow of the Health Facility Institute. An International business professional with a strong clinical background. Gary has led international teams in the critical care areas of healthcare for nearly 40 years. Gary has been involved in many hundreds of healthcare projects around the world during his career. His clinical experience comes from 40 years in the Pre-Hospital and Emergency Department arenas. His certifications include: Firefighter Paramedic, Tactical Emergency Casualty Care, Hazardous Materials Technician, and instructor in both Pre-Hospital Trauma Life Support and Pediatric Advanced Life Support. You can reach Gary at gschindele@paladinhc.com
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