Impact of Hurricane Harvey on Healthcare Utilization and Emergency Department Operations

Introduction: Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017.Methods: This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016.Results: For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers post-flooding to decrease ED boarding times.Conclusion: A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised

Himalayan Trauma: Administrative Thrombosis and Citizens’ Response

In this paper, the author uses excerpts from social media postings and traditional media to highlight how various citizen and volunteer responses to the 2015 earthquake helped fill in the gaps created by institutional dysfunction. Further, he shows how these two types of media played a critical role in facilitating communication between grassroots aid initiatives and earthquake affected people and their families and friends, not only in Kathmandu but also in neglected mountainous areas as well. The author uses a personal, reflexive approach to help situate the distinct experiences of earthquake affected people including trauma patients, people with disabilities, and volunteer aid workers

Mental health services required after disasters: Learning from the lasting effects of disasters

Extent: 13p.Disasters test civil administrations’ and health services’ capacity to act in a flexible but well-coordinated manner because each disaster is unique and poses unusual challenges. The health services required differ markedly according to the nature of the disaster and the geographical spread of those affected. Epidemiology has shown that services need to be equipped to deal with major depressive disorder and grief, not just posttraumatic stress disorder, and not only for victims of the disaster itself but also the emergency service workers. The challenge is for specialist advisers to respect and understand the existing health care and support networks of those affected while also recognizing their limitations. In the initial aftermath of these events, a great deal of effort goes into the development of early support systems but the longer term needs of these populations are often underestimated. These services need to be structured, taking into account the pre-existing psychiatric morbidity within the community. Disasters are an opportunity for improving services for patients with posttraumatic psychopathology in general but can later be utilized for improving services for victims of more common traumas in modern society, such as accidents and interpersonal violence.A. C. McFarlane and Richard William

Becoming Rasuwa Relief: Practices of Multiple Engagement in Post-Earthquake Nepal

In this article, we reflect on the multiple nature of our engagements in the wake of the 7.8m earthquake that struck Nepal on April 25th 2015. Specifically, we trace the events, experiences, decisions, positions, and processes that constituted our work with a post-earthquake volunteer initiative we helped to form, called Rasuwa Relief. Using the concept of multiplicity (cf. Mol 2002), we consider the uncertain process by which Rasuwa Relief began to cohere, as a collective of diverse efforts, interventions, projects, and commitments, and how Rasuwa Relief was continually and multiply enacted through practices of engagement. As a collaborative effort that coordinated and consolidated many of our post-earthquake interventions over a period of two years, Rasuwa Relief was always in a state of becoming. This process of becoming, we suggest, indexed and informed the multiple ways that we participated and intervened in the aftermath of the earthquake—as accidental humanitarians or ‘relief workers’, as early-career scholars, and as people attempting to balance diverse personal, academic, and ethical commitments within and beyond Nepal. Based on a reflexive analysis of these multiple engagements, we also present an embedded critique of ‘humanitarian reason’ (Fassin 2012), inclusive of our own decisions and actions, alongside a selfcritical analysis of the affective factors that shaped our own ‘need to help’ (Malkki 2015)

Equitable Optimization of Patient Re-allocation and Temporary Facility Placement to Maximize Critical Care System Resilience in Disasters

End-stage renal disease patients face a complicated sociomedical situation and rely on various forms of infrastructure for life-sustaining treatment. Disruption of these infrastructures during disasters poses a major threat to their lives. To improve patient access to dialysis treatment, there is a need to assess the potential threat to critical care facilities from hazardous events. In this study, we propose optimization models to solve critical care system resilience problems including patient and medical resource allocation. We use human mobility data in the context of Harris County (Texas) to assess patient access to critical care facilities, dialysis centers in this study, under the simulated hazard impacts, and we propose models for patient re-allocation and temporary medical facility placement to improve critical care system resilience in an equitable manner. The results show (1) the capability of the optimization model in efficient patient re-allocation to alleviate disrupted access to dialysis facilities; (2) the importance of large facilities in maintaining the functioning of the system. The critical care system, particularly the network of dialysis centers, is heavily reliant on a few larger facilities, making it susceptible to targeted disruption. (3) The consideration of equity in the optimization model formulation reduces access loss for vulnerable populations in the simulated scenarios. (4) The proposed temporary facilities placement could improve access for the vulnerable population, thereby improving the equity of access to critical care facilities in disaster. The proposed patient re-allocation model and temporary facilities placement can serve as a data-driven and analytic-based decision support tool for public health and emergency management plans to reduce the loss of access and disrupted access to critical care facilities and would reduce the dire social costs.Comment: 21 pages, 9 figure

Hospital as a critical infrastructure in the community disaster response system

The Department of Homeland Security lists 19 groups of sectors as Critical Infrastructure Key Resources (CIKR) such as Water, Emergency Services, and Healthcare and Public Health (HPH). Protection of those interdependent sectors is of vital interest for the country in the event of disaster. Hospital infrastructure systems are basic HPH elements of the CIKR. Local hospitals deliver essential routine healthcare services as well as serving as frontline responders during non-routine disaster events. Currently, hospitals generally extend their routine healthcare activities for external community disaster preparedness and response services. This extension takes the form of coordination with other responders within the community. Under this condition, determining the hospital\u27s role in the community disaster response is critical. This thesis evaluates the current external performance of a hospital in response to a community disaster and the degree of integration of hospitals with the community system during and after a disaster. Case studies of two hospitals in Western New York State, one a rural institution sample and the other an urban institution sample, are conducted with data collected through program review and structured interviews of the hospitals\u27 staff and the Emergency Management Officers of each community and analyzed using context analysis. The analysis shows that rural hospitals are more critical to community recovery than urban centers; communication both internal and external to the hospital is key to effectiveness; and emergency planning is actually only a small part of response

Do Natural Disasters Affect Human Capital? An Assessment Based on Existing Empirical Evidence

The last few years have seen a notable increase in the number of studies investigating the causes and effects of natural disasters in many dimensions. This paper seeks to review and assess available empirical evidence on the ex-post microeconomic effects of natural disasters on the accumulation of human capital, focusing on consumption, nutrition, education and health, including mental health. Three major findings come forward from this work. First, disasters appear to bring substantial damages to human capital, including death and destruction, and produce deleterious consequences on nutrition, education, health and many income-generating processes. Furthermore, some of these detrimental effects are both large and long-lasting. Second, there is a large degree of heterogeneity in the size – but not much in the direction – of the impacts on different socioeconomic groups. Yet, an empirical regularity across natural hazards is that the poorest carry the heaviest burden of the effects of disasters across different determinants and outcomes of human capital. Finally, although the occurrence of natural hazards is mostly out of control of authorities, there still is a significant room for policy action to minimize their impacts on the accumulation of human capital. We highlight the importance of flexible safety nets as well as the double critical role of accurate and reliable information to monitor risks and vulnerabilities, and identify the impacts and responses of households once they are hit by a disaster. The paper also lays out existing knowledge gaps, particularly in regard to the need of improving our understanding of the impacts of disasters on health outcomes, the mechanisms of transmission and the persistence of the effects in the long-run.natural disasters, human capital accumulation

Resilience of healthcare and education networks and their interactions following major earthquakes

2021 Spring.Includes bibliographical references.Healthcare and education systems have been identified by various national and international organizations as the main pillars of communities' stability. Ensuring the continuation of vital community services such as healthcare and education is critical for minimizing social losses after extreme events. A shortage of healthcare services could have catastrophic short-term and long-term effects on a community including an increase in morbidity and mortality, as well as population outmigration. Moreover, a shortage or lack of facilities for K-12 education, including elementary, middle, and high schools could impact a wide range of the community's population and could lead to impact population outmigration. Despite their importance to communities, there are a lack of comprehensive models that can be used to quantify recovery of functionalities of healthcare systems and schools following natural disasters. In addition to capturing the recovery of functionality, understanding the correlation between these main social services institutions is critical to determining the welfare of communities following natural disasters. Although hospitals and schools are key indicators of the stability of community social services, no studies to date have been conducted to determine the level of interdependence between hospitals and schools and their collective influence on their recoveries following extreme events. In this study, comprehensive frameworks are devised for estimating the losses, functionality, and recovery of healthcare and educational services following earthquakes. Success trees and semi-Markov stochastic models coupled with dynamic optimization are used to develop socio-technical models that describe functionalities and restorations of the facilities providing these services, by integrating the physical infrastructure, the supplies, and the people who operate and use these facilities. New frameworks are proposed to simulate processes such as patient demand on hospitals, hospitals' interaction, student enrollment, and school administration as well as different decisions and mitigation strategies applied by hospitals and schools while considering the disturbance imposed by earthquake events on these processes. The complex interaction between healthcare and education networks is captured using a new agent-based model which has been developed in the context of the communities' physical, social, and economic sectors that affect overall recovery. This model is employed to simulate the functional processes within each facility while optimizing their recovery trajectories after earthquake occurrence. The results highlight significant interdependencies between hospitals and schools, including direct and indirect relationships, suggesting the need for collective coupling of their recovery to achieve full functionality of either of the two systems following natural disasters. Recognizing this high level of interdependence, a social services stability index is then established which can be used by policymakers and community leaders to quantify the impact of healthcare and educational services on community resilience and social services stability

Optimizing emergency preparedness and resource utilization in mass-casualty incidents

This paper presents a response model for the aftermath of a Mass-Casualty Incident (MCI) that can be used to provide operational guidance for regional emergency planning as well as to evaluate strategic preparedness plans. A mixed integer programming (MIP) formulation is proposed for the combined ambulance dispatching, patient-to-hospital assignment, and treatment ordering problem. T he goal is to allocate effectively the limited resources during the response so as to improve patient outcomes, while the objectives are to minimize the overall response time and the total flow time required to treat all patients, in a hierarchical fashion. The model is solved via exact and MIP-based heuristic solution methods. The applicability of the model and the performance of the new methods are challenged on realistic MCI scenarios. We consider the hypothetical case of a terror attack at the New York Stock Exchange in Lower Manhattan with up to 150 trauma patients. We quantify the impact of capacity-based bottlenecks for both ambulances and available hospital beds. We also explore the trade-off between accessing remote hospitals for demand smoothing versus reduced ambulance transportation times

Shake table tests for the seismic fragility evaluation of hospital rooms

© 2014 John Wiley & Sons, Ltd. Health care facilities may undergo severe and widespread damage that impairs the functionality of the system when it is stricken by an earthquake. Such detrimental response is emphasized either for the hospital buildings designed primarily for gravity loads or without employing base isolation/supplemental damping systems. Moreover, these buildings need to warrant operability especially in the aftermath of moderate-to-severe earthquake ground motions. The provisions implemented in the new seismic codes allow obtaining adequate seismic performance for the hospital structural components; nevertheless, they do not provide definite yet reliable rules to design and protect the building contents. To date, very few experimental tests have been carried out on hospital buildings equipped with nonstructural components as well as building contents. The present paper is aimed at establishing the limit states for a typical health care room and deriving empirical fragility curves by considering a systemic approach. Toward this aim, a full scale three-dimensional model of an examination (out patients consultation) room is constructed and tested dynamically by using the shaking table facility of the University of Naples, Italy. The sample room contains a number of typical medical components, which are either directly connected to the panel boards of the perimeter walls or behave as simple freestanding elements. The outcomes of the comprehensive shaking table tests carried out on the examination room have been utilized to derive fragility curves based on a systemic approach