Modeling to Optimize Hospital Evacuation Planning in EMS Systems.

Objective: To develop optimal hospital evacuation plans within a large urban EMS system using a novel evacuation planning model and a realistic hospital evacuation scenario, and to illustrate the ways in which a decision support model may be useful in evacuation planning.

Methods: An optimization model was used to produce detailed evacuation plans given the number and type of patients in the evacuating hospital, resource levels (teams to move patients, vehicles, and beds at other hospitals), and evacuation rules.

Results: Optimal evacuation plans under various resource levels and rules were developed and high-level metrics were calculated, including evacuation duration and the utilization of resources.

Disaster documentation for the clinician.

Documentation of the patient encounter is a traditional component of health care practice, a requirement of various regulatory agencies and hospital oversight committees, and a necessity for reimbursement. A disaster may create unexpected challenges to documentation. If patient volume and acuity overwhelm health care providers, what is the acceptable appropriate documentation? If alterations in scope of practice and environmental or resource limitations occur, to what degree should this be documented? The conflicts arising from allocation of limited resources create unfamiliar situations in which patient competition becomes a component of the medical decision making; should that be documented, and, if so, how? In addition to these challenges, ever-present liability worries are compounded by controversies over the standards to which health care providers will be held.

Acute embolic cerebral ischemia as an initial presentation of polycythemia vera: a case report.

Introduction: Patients with polycythemia vera are at high risk for vaso-occlusive events including cerebral ischemia. Although unusual, acute ischemic stroke may be an initial presentation of polycythemia vera. It had been previously assumed that cerebral ischemic events were due to increased blood viscosity and platelet activation within the central nervous system arterial vessels.

Cost utility analyses in international disaster responses-where are they?

International health care providers have flocked to Haiti and other disaster-affected countries in record numbers. Anecdotal articles often give "body counts" to describe what was accomplished, followed months later by articles suggesting outcomes could have been better. Mention will be made that various interventions were "expensive," or not the best use of limited funds.

Transportation resource requirements for hospital evacuation.

Hospitals are physical structures with the same risk as other large buildings; the physical plant is vulnerable to acts of nature and man. When hospitals need to evacuate the patient population, logistical support for patient transport will be required. However, a disaster impacting a hospital will likely also affect the surrounding community, and transport resources such as ambulances may be limited as they will also be needed to support the community response.

Working with interpreters during international health responses.

Health care providers face multiple difficulties in providing care to a disaster-stricken community. Training, preparation, and a good attitude are important, as is adequate logistical support. An often-ignored issue is the difficulty encountered with language barriers during a response, and how using interpreters affects the quality and impact of the health care provided.

Enhancing healthcare sector coordination through infrastructure and logistics support.

The International Response to the 2004 Southeast Asia Tsunami was noted to have multiple areas of poor coordination, and in 2005, the "Health Cluster"approach to coordination was formulated. However, the 2010 Haiti response suggests that many of the same problems continue and that there are significant limitations to the cluster meetings. These limitations include the inconsistent attendance, poor dissemination of information, and perceived lack of benefit to providers.

Vulnerable populations: Hurricane Katrina as a case study.

Mitigating disaster impact requires identifying risk factors. The increased vulnerability of the physically fragile is easily understood. Less obvious are the socio-economic risk factors, especially within relatively affluent societies.

Severe lactic acidosis secondary to minocycline in a teenager with infectious mononucleosis and mitochondrial myopathy.

Mitochondrial myopathies are heterogeneous disorders with diverse presentations including laboratory findings of lactic acidosis. Often times they are diagnosed in childhood or the early teenage years following an infectious illness. Minocycline is a common antibiotic used for the treatment of acne.

Disaster management of chronic dialysis patients.

The chronically ill are often the hardest hit by disruptions in the healthcare system--they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in disaster response should be prepared to care for individuals suffering from the complications of chronic illness, and they must have some idea of how to do so with limited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters.

Field triage and patient maldistribution in a mass-casualty incident.

Introduction: Management of mass-casualty incidents should optimize outcomes by appropriate prehospital care, and patient triage to the most capably facilities. The number of patients, the nature of injuries, transportation needs, distances, and hospital capabilities and availabilities are all factors to be considered. Patient maldistributions such as overwhelming individual facilities, or transport to facilities incapable of providing appropriate care should be avoided.

Barriers to disaster coordination: health sector coordination in Banda Aceh following the South Asia Tsunami.

Ecological disasters impact large populations every year, and hundreds of nongovernmental organizations, thousands of aid workers, and billions of dollars are sent in response. Yet, there have been recurring problems with coordination, leading to wasted efforts and funds. The humanitarian response to the December 2004 Earthquake and Tsunami in Asia was one of the largest ever, and coordination problems were apparent.

Barriers to Disaster Coordination: Health Sector Coordination in Banda Aceh following the South Asia Tsunami.

Ecological disasters impact large populations every year, and hundreds of nongovernmental organizations, thousands of aid workers, and billions of dollars are sent in response. Yet, there have been recurring problems with coordination, leading to wasted efforts and funds. The humanitarian response to the December 2004 Earthquake and Tsunami in Asia was one of the largest ever, and coordination problems were apparent.