Hospital Referral Patterns: How Emergency Medical Care is Accessed in a Disaster

BACKGROUND: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. METHODS: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. RESULTS: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. CONCLUSIONS: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major inciden

Should waste management be considered a lifeline in New Zealand?

Called Resilient Organisations Research Report 2010/01 at http://www.resorgs.org.nz/pubs/Resilient%20Organisations%20Lifeline%20report_250110.pdfExecutive Summary Lifelines (also referred to as Critical Infrastructure) provide the essential services that support the life of our community. Maintaining provision of these services in an emergency response situation is critical to the recovery of a community. In New Zealand regional lifeline groups have been established to promote planning, resource sharing and coordination between lifeline service providers. In addition to this, New Zealand emergency law has provision for certain designated Lifeline Utilities to act as necessary to restore services in an emergency situation. However, solid waste management is not included in either the planning process nor is it provided for under the emergency legislation. A qualitative assessment of the importance of waste management to a community recovery effort and semi quantitative assessment on the impact of waste management on other lifeline provisions has been carried out. In a recovery, it is shown that waste management has the potential to pose health and safety hazards such as disease and environmental pollution. Waste management is also shown to be important to the provision of many lifelines. Given this importance and dependence, great benefit would be gained from including waste management activities in lifeline planning and coordination to facilitate more effective resource planning and prioritisation. From a legal perspective, the complexity of the waste management system would make it difficult to legislate as a Lifeline Utility. Not only are there multiple components to a solid waste system (disposal, treatment, recycling and collection), pre-disaster solid waste capacities would need to be significantly augmented to cater for the disaster generated waste and often this would entail the operation of organisations not normally involved in solid waste management. However, there would be benefits in providing legislation to require and give regulatory flexibility to pre-disaster solid waste operators and facilities to restore pre-disaster services following a disaster. This allowance would facilitate the first stage of the clean-up effort before an integrated disaster waste management system could be implemented

DISASTER PREPAREDNESS FOR UNIVERSITY/COMMUNITY TRANSIT SYSTEMS

ABSTRACT Public transportation, with its open access, creates an opportunity for masses of people to be hurt while using transit services during human-made or natural disasters. This dissertation reviews the body of academic and professional literature and recent disaster events to characterize the current state of preparedness for disasters affecting transit systems in the United States, focusing on institutions of higher education, other post-secondary educational institutions, and the university/community transit systems providing services to these institutions. The nature of threats is examined, and institutional issues are explored to discover the level of disaster preparedness of university/community transit systems, and their ability to participate in the planning and organization, purchase of equipment, and training exercises for disaster events. To identify potential gaps in disaster preparedness within university/community transit systems, multiple research objectives were developed: review international and national disaster events with emphasis on preparedness planning for transportation systems; examine federal disaster preparedness requirements to find are any proscribed plans transportation systems should be using; and determine how disaster preparedness planning is used in university/community transit system operations to support post-secondary institutions of higher education during a disaster. The research question for this study is \u27how are universities and communities planning for using or protecting transit systems and assets in disaster events?\u27 hypothesis for this research is that university/community transit systems do have appropriately prepared emergency operating plans. A qualitative document analysis was conducted on university transit systems emergency operations plan documents and a quantitative survey was subsequently conducted with emergency managers working for, or transit system operators providing transit services to, post-secondary institutions of higher to determine if the university/community transit systems did or did not have an emergency operations plan. Analysis of the survey results shows that university/community transit systems do not comply with the National Incident Management System, and do not have appropriately prepared emergency operating plans. It is recommended that all other post-secondary institutions of higher education, and transit organizations should develop comprehensive and holistic emergency operations plans, similar to the one developed for Clemson University as contained in Appendix A

Emergency Medical Services: System Description

This working paper presents a draft of a forthcoming report. The report will contain more detail (including diagrams) and numerous references to existing literature. Both the working paper and the report are intended to serve as the basis for a chapter in the forthcoming monograph, "Analysis, Planning and Management of Urban Emergency Services." The author welcomes comments. Responses to the following two questions would be especially appreciated: (1) How can the description of the emergency medical services system be sharpened and clarified, (i) for analytically oriented readers interested in the analytical structure of the system, and (ii) for managerially oriented readers interested more in how the system works and where a particular EMS system may best be improved? (2) How can the description be made both more general and more precise, so that it will apply as well as possible to actual systems in all IIASA's member countries

CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities

Describes the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities. Background Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.   Objective To describe the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities when their acute healthcare needs exceed the scope of the aged care facility staff and general practitioners to manage independently of the hospital system.   Discussion The project delivers high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skills sharing across the care continuum and an individualised, resident-focused approach

Characteristics of Rural Users of Emergency Medical Services in Georgia: A Population-Based Study

Background: Emergency medical services (EMS) are an essential part of health care. Appropriate information about EMS usage in rural areas will allow effective utilization of EMS resources for their intended purpose, and at the state level, drive the adoption of better EMS policies to ensure and maintain equitable access to these health services in rural areas. Methods: The present study, performed by analyzing data from the Georgia Emergency Medical Services Information System (GEMSIS), describes the population using EMS in rural Georgia. Distributions of rural EMS transports are reported, along with usage for selected population groups based on race, gender, age groups, and primary impressions recorded by emergency medical personnel (EMP). Results: The groups with the highest rates of EMS use were African Americans, females, and the elderly. In 2014, about twice as many African Americans used EMS as compared to Whites. Rural use of EMS increased with age, with the elderly having the highest percentage of users. About 31% of all transports were for emergency conditions; the remaining 69% were for non-emergencies. The most frequent health complaints were those for altered physical conditions and traumatic injuries. Conclusions: The findings of this study can guide decision in planning future services and ensuring appropriate access to EMS in rural Georgia

Spatial accessibility and social inclusion: The impact of Portugal's last health reform

Health policies seek to promote access to health care and should provide appropriate geographical accessibility to each demographical functional group. The dispersal demand of health‐careservices and the provision for such services atfixed locations contribute to the growth of inequality intheir access. Therefore, the optimal distribution of health facilities over the space/area can lead toaccessibility improvements and to the mitigation of the social exclusion of the groups considered mostvulnerable. Requiring for such, the use of planning practices joined with accessibility measures. However,the capacities of Geographic Information Systems in determining and evaluating spatial accessibility inhealth system planning have not yet been fully exploited. This paper focuses on health‐care services planningbased on accessibility measures grounded on the network analysis. The case study hinges on mainlandPortugal. Different scenarios were developed to measure and compare impact on the population'saccessibility. It distinguishes itself from other studies of accessibility measures by integrating network data ina spatial accessibility measure: the enhanced two‐stepfloating catchment area. The convenient location forhealth‐care facilities can increase the accessibility standards of the population and consequently reducethe economic and social costs incurred. Recently, the Portuguese government implemented a reform thataimed to improve, namely, the access and equity in meeting with the most urgent patients. It envisaged,in terms of equity, the allocation of 89 emergency network points that ensured more than 90% of thepopulation be within 30 min from any one point in the network. Consequently, several emergency serviceswere closed, namely, in rural areas. This reform highlighted the need to improve the quality of the emergencycare, accessibility to each care facility, and equity in their access. Hence, accessibility measures becomean efficient decision‐making tool, despite its absence in effective practice planning. According to anapplication of this type of measure, it was possible to verify which levels of accessibility were decreased,including the most disadvantaged people, with a larger time of dislocation of 12 min between 2001 and 2011

Federal Emergency Management Information System (FEMIS), Installation Guide for FEMIS 1.4.6

The Federal Emergency Management Information System (FEMIS) is an emergency management planning and response tool that was developed by the Pacific Northwest National Laboratory (PNNL) under the direction of the U.S. Army Chemical Biological Defense Command. The FEMIS System Administration Guide provides information necessary for the system administrator to maintain the FEMIS system. The FEMIS system is designed for a single Chemical Stockpile Emergency Preparedness Program (CSEPP) site that has multiple Emergency Operations Centers (EOCs). Each EOC has personal computers (PCs) that emergency planners and operations personnel use to do their jobs. These PCs are corrected via a local area network (LAN) to servers that provide EOC-wide services. Each EOC is interconnected to other EOCs via a Wide Area Network (WAN). Thus, FEMIS is an integrated software product that resides on client/server computer architecture. The main body of FEMIS software, referred to as the FEMIS Application Software, resides on the PC client(s) and is directly accessible to emergency management personnel. The remainder of the FEMIS software, referred to as the FEMIS Support Software, resides on the UNIX server. The Support Software provides the communication data distribution and notification functionality necessary to operate FEMIS in a networked, client/server environment

UAV-Enabled SWIPT in IoT Networks for Emergency Communications

Energy-limited devices and connectivity in complicated environments are two main challenges for Internet of Things (IoT)-enabled mobile networks, especially when IoT devices are distributed in a disaster area. Unmanned aerial vehicle (UAV)-enabled simultaneous wireless information and power transfer (SWIPT) is emerging as a promising technique to tackle the above problems. In this article, we establish an emergency communications framework of UAV-enabled SWIPT for IoT networks, where the disaster scenarios are classified into three cases, namely, dense areas, wide areas and emergency areas. First, to realize wireless power transfer for IoT devices in dense areas, a UAV-enabled wireless power transfer system is considered where a UAV acts as a wireless charger and delivers energy to a set of energy receivers. Then, a joint trajectory planning and resource scheduling scheme for a multi-UAVs system is discussed to provide wireless services for IoT devices in wide areas. Furthermore, an intelligent prediction mechanism is designed to predict service requirements (i.e., data transmission and battery charging) of the devices in emergency areas, and accordingly, a dynamic path planning scheme is established to improve the energy efficiency (EE) of the system. Simulation results demonstrate the effectiveness of the above schemes. Finally, potential research directions and challenges are also discussed