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Hospitals and EMS Surge Capacities in Major Incidents and disasters.

 Can new technologies help?

30/07/2024

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Updates on Hospital and EMS Surge Capacity

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Surge Capacity in Major Incidents and Disasters depends on two medical systems: the Emergency Medical System and the Hospital System. A recent review paper has addressed hospital surge capacity preparedness in disasters and emergencies (1). Staff, stuff, space, and systems have been confirmed as the framework domains under which surge must take place. Multiple suggestions to upgrade surge capacity in these domains are addressed from better and faster staff recruitment and collaborative strategies with retired medical personnel and with other facilities, to the creation of additional intensive care Units, surgical theaters, and reuse of supplies with collaboration strategies to share supplies between facilities in the stuff domain. Relatively to the space domain the increase of stockpiling areas, the opening of unlicensed beds, the use of non-clinical areas, and the canceling of elective surgery have been addressed. However, in large countries, upgrading aeromedical pre-hospital transport capacity has also been recognized as a problem. For the System domain, it is underlined how important it is that hospitals constantly review their surge capacity through tools such as the Marcozzi Hospital Medical Surge Preparedness Index (2) to assess preparedness scores. Optimization models based on scenario planning are also available (3) and can be used with confidence.

However, barriers to surge capacity still exist and affect healthcare response in major incidents and disasters. These barriers mainly depend on the country's health systems and socio-economic conditions and are represented by a shortage of staff and equipment in developing countries. Furthermore, it’s represented by a lack of standardized and systematic metrics or models for assessing surge capacity, different hospital admission systems, and the threat of physical damage to infrastructure.

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The best framework present in the literature on the Surge capacities of EMS is that of the Center for Disease Control and Prevention (4). It is a major document that can be utilized as a tool for EMS operators to do medical surge planning and to integrate EMS into community preparedness plans.
This EMS Framework addresses the partnerships, resources, and planning needed to implement four strategies for expanding EMS system capacity during an emergency resulting in medical surge:​​​

 
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  1. Tiered Dispatch: Strategies to preserve EMS resources, including caller screening to determine acuity, the use of prerecorded messages to selectively direct calls, and referral of non-life-threatening calls to advice lines.

  2. Modified Treatment and Transport Strategies: Strategies to modify routine treatment and transport protocols to allow EMS personnel to assess, treat, release, and refer patients without transport and, when needed, to transport patients away from a hospital.

  3. Coordinated Transport to Alternate Destinations: Strategies to transport patients to facilities that do not traditionally receive 9-1-1 patients (e.g., clinics, urgent care, surgery centers, and alternate care sites) by establishing surge protocols.

  4. Support for Rapid Implementation of Patient Interventions: Strategies to allow EMS personnel to assist larger community and public health response efforts by delivering vaccines, pharmaceuticals, non-pharmaceuticals, and personal protective equipment (PPE) to both patients and caregivers at home.

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The ESCORT project is dealing with new technologies that will help EMS and Hospital personnel in facing Surge for MCI and Disasters also in view of cross- border events. The tools that the project is planning to develop are looking into 3 major scenarios:

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  1. A large scale sudden onset natural disaster, creating the need for rapidly deployed surge capacities in both pre-hospital as well as intra-hospital capacities

  2. Increasing the capacity to track and monitor patients at “home care”, thus increasing patient comfort, quality of care, and hospitalization capacity.

  3. Tools for a large-scale, cross-border health emergency, requiring monitoring and follow-up to large numbers of possibly “exposed” individuals.​​​

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References: 

  1. Md.K. Hasan, S.M. Nasrullah, A. Quattrocchi, P. Arcos González, R. Castro-Delgado, Hospital surge capacity preparedness in disasters and emergencies: a systematic review, Public Health, Volume 225, 2023,Pages 12-21, ISSN 0033-3506,
    https://doi.org/10.1016/j.puhe.2023.09.017. (https://www.sciencedirect.com/science/article/pii/S0033350623003578)

  2. D.E. Marcozzi, R. Pietrobon, J.V. Lawler, M.T.French, C. Mecher, J. Peffer, et al. Development of a hospital medical surge preparedness index using a national hospital survey Health Serv Outcome Res Methodol, 20 (1) (2020 Mar 1), pp. 60-83

  3. A.F. Mills, J.E. Helm, Y. Wang Surge capacity deployment in hospitals: effectiveness of response and mitigation strategies
    Manuf Serv Oper Manag, 23 (2021), pp. 367-387

  4. https://www.cdc.gov/orr/readiness/resources/healthcare/Expanding-EMS-Systems.htm

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