Mary Grzybowski

Disaster Modeling: Medication Resources Required for Disaster Team Response

INTRODUCTION Responses to disasters involve many factors beyond personnel, such as medical and non-medical equipment and supplies. When disaster teams respond, they must do so with sufficient amounts of medicine and supplies to manage all of the patients expected for several days before re-supply. In order for this process to be efficient and expedient, accurate and advanced planning for supplies needed by disaster workers is necessary. These supplies must provide for general medical care and for hazard-specific problems. OBJECTIVE To develop a model that provides the framework for determining supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster teams in a civilian environment. METHODS A community hospital was modeled to determine patient characteristics when presenting to an emergency department (ED), including patient demographics and chief complaint, medications administered during the ED visit and prescribed at discharge, and laboratory tests ordered to assess disaster team supply requirements. Data were downloaded from a patient tracking software package and abstracted from various hospital data information systems. Data from the community hospital were compared with data published from two hurricane disasters by members of the National Disaster Medical System. RESULTS To the extent possible, the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients. CONCLUSION This model offers a first step in preparing disaster medical teams for deployment.

Variation in physician deep vein thrombosis prophylaxis attitudes and practices at an academic tertiary care center

Background Deep vein thrombosis (DVT) remains a major cause of in-hospital morbidity and mortality. Effective DVT prophylaxis is available but underutilized. We sought to describe physician understanding of DVT epidemiology and prophylaxis practices. Methods All medical and surgical residents, and hospitalist attendings were invited to participate in an on-line survey. Physicians were queried about DVT epidemiology, risk factors, prophylaxis practices, and complications. Means and standard deviations were calculated for ordinal responses. χ2 was used for dichotomous variables. Results Of 281 doctors emailed, 69/160 (43%) medical residents, 26/72 (36%) surgical residents, and 21/49 (43%) hospitalist attendings participated. All three overestimated DVT incidence and morbidity. Surgical residents listed paralysis as high risk and minor surgery as a low/no risk factor. Medical residents thought heart failure and varicose veins were low/no risk for developing DVT. Regarding prophylaxis, surgical residents did not identify ambulation as a prophylactic measure, and were more likely to use SCDs, compression stockings, and enoxaparin, while medical residents and hospitalist attendings prescribed unfractionated heparin most frequently. Medical residents reported that they would hold anticoagulants for comorbidities most frequently, but all 3 groups agreed that anticoagulant prophylaxis would not significantly increase bleeding risks. Conclusions Perceptions of DVT risk factors and prophylaxis practices vary by both physician specialty and attending/resident status. Prophylaxis practice differences may result from these perceptions.