The Need for a New Approach to MCI Readiness in the Era of Emergency Department and Hospital Crowding.

Emergency department (ED) visit volumes have increased since 2007, with crowding in the United States reaching its highest levels in 2022. During this same period, mass casualty incidents (MCIs) have increased dramatically, both in frequency and severity, across the United States. Resuscitation of trauma patients is a time-sensitive process that requires immediate patient assessment by coordinated clinical teams in order to successfully diagnose and manage life-threatening injuries.

Formal and informal hospital emergency management practices: managing for safety and performance amid crisis.

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics.

Assessing health care leadership and management for resilience and performance during crisis: The HERO-36.

Background: Whereas organizational literature has provided much insight into the conceptual and theoretical underpinnings of organizational leadership and management during emergencies, measures to operationalize related effective practices during crises remain sparse.

Purpose: To address this need, we developed the Healthcare Emergency Response Optimization survey, which set out to examine the leadership and management practices in health care organizations that support resilience and performance during crisis.

Methodology: We administered an online survey in April to May 2022 to health care administrators and frontline staff intimately involved in their hospital's emergency response during the COVID-19 pandemic, which included a sample of 379 respondents across nine rural and urban hospitals (response rate: 44.

Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation.

Background: Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment.

Study Design: Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA.

The 2023 Model Core Content of Disaster Medicine.

Introduction: Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States.

Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study.

Background: The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response.

Objective: To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response.

Methods: We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states.

Sustainable and Resilient Health Care in the Face of a Changing Climate.

Climate change is a threat multiplier, exacerbating underlying vulnerabilities, worsening human health, and disrupting health systems' abilities to deliver high-quality continuous care. This review synthesizes the evidence of what the health care sector can do to adapt to a changing climate while reducing its own climate impact, identifies barriers to change, and makes recommendations to achieve sustainable, resilient health care systems.

Emergency preparedness: What is the future?

Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities' emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history.

Feasibility and Acceptability of a Model Disaster Teleconsultation System for Regional Disaster Health Response.

The federally funded Region 1 Regional Disaster Health Response System (RDHRS) and the American Burn Association partnered to develop a model regional disaster teleconsultation system within a Medical Emergency Operations Center (MEOC) to support triage and specialty consultation during a no-notice mass casualty incident. Our objective was to test the acceptability and feasibility of a prototype model system in simulated disasters as proof of concept. We conducted a mixed-methods simulation study using the Technology Acceptance Model framework.

Making Space to Save Lives: A Critical Role for the Hospitalist During Mass Casualty Incidents.

Objective: An effective hospital response to mass casualty incidents (MCIs) requires rapid mobilization of personnel capable of caring for critically ill trauma patients and availability of resuscitation resources.

Methods: Hospitals facing an MCI wrestle with the challenge of immediately adjusting their overextended clinical operations to resuscitate a large number of rapidly arriving patients without compromising the care of existing patients.

Results: Hospitalists are well positioned to add significant value by off-loading the emergency department (ED) given their broad clinical expertise.

COVID-19 Seroprevalence in ED Health Care Professionals Study: A Cross-Sectional Study.

Introduction: ED health care professionals are at the frontline of evaluation and management of patients with acute, and often undifferentiated, illness. During the initial phase of the SARS-CoV-2 outbreak, there were concerns that ED health care professionals may have been at increased risk of exposure to SARS-CoV-2 due to difficulty in early identification of patients. This study assessed the seroprevalence of SARS-CoV-2 antibodies among ED health care professionals without confirmed history of COVID-19 infection at a quaternary academic medical center.

The Evolution of the National Special Pathogen System of Care.

Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach.

Applying the Plan-Do-Study-Act Approach to Support Healthcare Facilities in the Early COVID-19 Pandemic Response.

The identification of a novel respiratory pathogen in late December 2019 and the escalation in the number of infections in January 2020 required healthcare facilities to rapidly assess their planning and preparations to identify and manage suspected or confirmed cases. As a Regional Emerging Special Pathogens Treatment Center, many of the policies, resources, and tools Massachusetts General Hospital had developed before the COVID-19 pandemic were based on the Identify-Isolate-Inform concept to enable rapid identification of persons under investigation; isolation from other patients, visitors, and staff; and appropriate information sharing with internal and external parties to ensure continued safety of the facility and community. Our team sought to leverage these existing resources to support other healthcare facilities and implemented a modified Plan-Do-Study-Act approach to develop, refine, and disseminate a novel coronavirus toolkit.

The utility and sustainability of US Ebola treatment centers during the coronavirus disease 2019 (COVID-19) pandemic.

Objective: In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought to determine the ongoing sustainability of ETCs and to identify how ETC capabilities have affected hospital, local, and regional coronavirus disease 2019 (COVID-19) readiness and response.

Design: An electronic survey included both qualitative and quantitative questions and was structured into 2 sections: operational sustainability and role in the COVID-19 response.

COVID-19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end-of-life care.

Objective: To characterize the national distribution of COVID-19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end-of-life care.

Methods: Cross-sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID-19 pandemic, by trained study investigators using standardized instrument.

Results: Of the 352 hospitals studied, 326 (93%) had a COVID-19 hospital-wide visitor restriction policy and 164 (47%) also had an ED-specific policy.

Mobile app helps trainees manage emergencies at the bedside.

Background: Although emergency departments (ED) have standardized guidelines for low-frequency, high-acuity diagnoses, they are not immediately accessible at the bedside, and this can cause anxiety in trainees and delay patient care. This problem is exacerbated during events like COVID-19 that require the rapid creation, iteration, and dissemination of new guidelines.

Methods: Physician innovators used design thinking principles to develop EM Protocols (EMP), a mobile application that clinicians can use to immediately view guidelines, contact consultants (e.

Beyond the Hazard Vulnerability Analysis: Preparing Health Systems for Climate Change.

Introduction: Climate change is heightening both long-term adverse risks to human health and the immediate-term risk of injuries and illness following climate-related disaster events that are becoming more frequent and severe. In addition to its direct health effects, climate change poses new threats to the nation's health care infrastructure - with potential to negatively impact healthcare capacity amidst increasing demand - through risks of flooding, wind damage, heat stress, power outages, and other physical harm to facilities. The typical Hazard Vulnerability Analyses conducted annually by hospitals use historical data to assess risks; these analyses are likely now inadequate for future preparation due to the impact of climate change.

Unusual Presentation of Lipofibromatosis-Like Neural Tumor in an Adult: A Case Report.

Lipofibromatosis-like neural tumor (LPF-NT) is a rare variant of lipofibromatosis. Standard lipofibromatosis tumors show a predilection for the distal extremities of male children or young adults and are typically painless, slow-growing, subcutaneous or deep soft tissue masses. We present a case of a 50-year-old male with a slowly expanding, right foot mass.

Moving Forward from COVID-19: Organizational Dimensions of Effective Hospital Emergency Management.

Federal investment in emergency preparedness has increased notably since the 9/11 attacks, yet it is unclear if and how US hospital readiness has changed in the 20 years since then. In particular, understanding effective aspects of hospital emergency management programs is essential to improve healthcare systems' readiness for future disasters. The authors of this article examined the state of US hospital emergency management, focusing on the following question: During the COVID-19 pandemic, what aspects of hospital emergency management, including program components and organizational characteristics, were most effective in supporting and improving emergency preparedness and response? We conducted semistructured interviews of emergency managers and leaders at 12 urban and rural hospitals across the country.