Anthony G. Macintyre

Challenge of hospital emergency preparedness: analysis and recommendations.

In the United States, recent large-scale emergencies and disasters display some element of organized medical emergency response, and hospitals have played prominent roles in many of these incidents. These and other well-publicized incidents have captured the attention of government authorities, regulators, and the public. Health care has assumed a more prominent role as an integral component of any community emergency response. This has resulted in increased funding for hospital preparedness, along with a plethora of new preparedness guidance.Methods to objectively measure the results of these initiatives are only now being developed. It is clear that hospital readiness remains uneven across the United States. Without significant disaster experience, many hospitals remain unprepared for natural disasters. They may be even less ready to accept and care for patient surge from chemical or biological attacks, conventional or nuclear explosive detonations, unusual natural disasters, or novel infectious disease outbreaks.This article explores potential reasons for inconsistent emergency preparedness across the hospital industry. It identifies and discusses potential motivational factors that encourage effective emergency management and the obstacles that may impede it. Strategies are proposed to promote consistent, reproducible, and objectively measured preparedness across the US health care industry. The article also identifies issues requiring research.

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.

Urban search and rescue

Structural-collapse rescue is one of the most challenging and dangerous disaster response activities. Sophisticated, multidisciplinary search-and-rescue capabilities have evolved to address the difficulties in finding, reaching, and extricating deeply entombed survivors. An equally advanced medical team is required to provide health and medical support to rescuers and to optimize extrication and survival of the often critically injured victims. Adaptations in the usual approach to emergency medical services and emergency medical care are needed to evaluate and treat confined-space victims adequately.

Health care emergency management: establishing the science of managing mass casualty and mass effect incidents.

Particularly since 2001, the health care industry has witnessed many independent and often competing efforts to address mitigation and preparedness for emergencies. Clinicians, health care administrators, engineers, safety and security personnel, and others have each developed relatively independent efforts to improve emergency response. A broader conceptual approach through the development of a health care emergency management profession should be considered to integrate these various critical initiatives. When based on long-standing emergency management principles and practices, health care emergency management provides standardized, widely accepted management principles, application concepts, and terminology. This approach could also promote health care integration into the larger community emergency response system. The case for a formally defined health care emergency management profession is presented with discussion points outlining the advantages of this approach.

Emergency health and risk management in sub-saharan Africa: a lesson from the embassy bombings in Tanzania and Kenya.

In 1998, terrorists simultaneously bombed United States Embassies in Dar es Salaam, Tanzania and Nairobi, Kenya. The local response to these bombings was unorganized and ad hoc, indicating the need for basic disaster preparedness and improvement of emergency management capabilities in both countries. In this context, risk and risk management are defined and are related to the health hazards affecting Tanzanians and Kenyans. In addition, the growing number of injuries in Tanzania is addressed and the relationship between risk management and injury is explored. Also, an emergency medicine-based strategy for injury control and prevention is proposed. Implications of implementing such a protocol in developing nations also are discussed.

Consensus and tools needed to measure health care emergency management capabilities.

There is no widely accepted, validated framework of health care emergency management capabilities (HEMCs) that can be used by facilities to guide their disaster preparedness and response efforts. We reviewed the HEMCs and the evaluation methods used by the Veterans Health Administration, The Joint Commission, the Institute of Medicine Metropolitan Medical Response System committee, the Department of Homeland Security, and the Department of Health and Human Services to determine whether a core set of HEMCs and evaluative methods could be identified.Despite differences in the conceptualization of health care emergency management, there is considerable overlap among the agencies regarding major capabilities and capability-specific elements. Of the 5 agencies, 4 identified occupant safety and continuity of operations as major capabilities. An additional 5 capabilities were identified as major by 3 agencies. Most often the differences were related to whether a capability should be a major one versus a capability-specific element (eg, decontamination, management of resources). All of the agencies rely on multiple indicators and data sources to evaluate HEMCs. Few performance-based tools have been developed and none have been fully tested for their reliability and validity. Consensus on a framework and tools to measure HEMCs is needed.

The 2015 Hyogo Framework for Action: Cautious Optimism

Worried concentration mingled with cautious optimism on the faces and in the work of delegates who attended the International Symposium on Disaster Medical and Public Health Management, held May 21-22, 2014, in Washington, DC. This conference was one of several international thematic workshops to prepare for the second Hyogo Framework for Action (HFA-2), entitled “Building the Resilience of Nations and Communities to Disasters,” which will take place in Sendai, Japan, in 2015. Specifically, this conference was designed to produce and shape themes to introduce medical and health into an anticipated rewrite of the original 2005 Hyogo Framework for Action (HFA-1).

Extreme measures: field amputation on the living and dismemberment of the deceased to extricate individuals entrapped in collapsed structures

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted. This and other factors may necessitate field amputation of an extremity on a living person or dismemberment of the deceased to achieve a rescue. Although case reports have described industrial, mining, and transportation accidents, few discuss this potential in collapsed structures. Also, few specifically outline the indications or the decision process and associated administrative procedures that should be addressed before conducting these procedures. This report presents a review of the literature along with a limited case series. A discussion regarding relevant decision making is provided to encourage the development of protocols. An international consensus statement on these procedures is provided.

International Symposium on Disaster Medicine and Public Health Management: review of the Hyogo framework for action.

The World Conference on Disaster Risk Reduction was held on January 18-22, 2005 in Kobe, Hyogo, Japan. This conference was sponsored by the International Strategy for Disaster Reduction (ISDR) division of the United Nations. At the conclusion of this meeting, 168 countries signed a document titled “Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters.” The most recent Typhoon in the Philippines and the Great East Japan Earthquake and Tsunami of 2011 have served to highlight the need for improved medical and health management in response to large-scale disasters around an “all-hazards approach.” This need is consistent with the concepts of disaster preparedness and resilient communities called for in the Hyogo Framework for Action (HFA). At the Third World Conference on Disaster Risk Reduction to be held in Sendai, Miyagi, Japan in March of 2015, modifications and suggestions will be introduced to improve the existing framework as the world has learned many lessons over the past ten years.

Confined space medicine and the medical management of complex rescues: A case series

OBJECTIVE A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours. METHODS The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents. RESULTS Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications. CONCLUSION Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents.