Swedish emergency hospital surgical surge capacity to mass casualty incidents

The Impact of Exposure to Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland: Hospital disaster surge capacity preparedness

OBJECTIVE

As disasters are rare and high-impact events, it is important that the learnings from disasters are maximized. The aim of this study was to explore the effect of exposure to a past disaster or mass casualty incident (MCI) on local hospital surge capacity planning.

METHODS

The current hospital preparedness plans of hospitals receiving surgical emergency patients in Finland were collected (n = 28) and analyzed using the World Health Organization (WHO) hospital emergency checklist tool. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not.

RESULTS

The overall median score of all key components on the WHO checklist was 76% (range 24%). The median surge capacity score was 65% (range 39%). There was no statistical difference between the surge capacity score of the hospitals with history of a disaster or MCI compared to those without (65% for both, P = 0.735).

CONCLUSION

Exposure to a past disaster or MCI did not appear to be associated with an increased local hospital disaster surge capacity score. The study suggests that disaster planning should include structured post-action processes for enabling meaningful improvement after an experienced disaster or MCI.

Hospital surge capacity preparedness in disasters and emergencies: a systematic review

BACKGROUND

Adequate and effective emergency preparedness for hospital surge capacity is a prerequisite to ensuring standard healthcare services for disaster victims. This study aimed to identify, review, and synthesize the preparedness activities for and the barriers to hospital surge capacity in disasters and emergencies.

METHODS

We systematically searched seven databases (PubMed, MEDLINE, CINAHL, Scopus, Embase, Ovid, and PsycINFO). We included all English peer-reviewed studies published in January 2016 and July 2022 on surge capacity preparedness in hospital settings. Two independent researchers screened titles and abstracts, reviewed the full texts, and conducted data extractions using CADIMA software. We assessed the rigor of the included studies using the NIH quality assessment tools for quantitative studies, the Noyes et al. guidelines for qualitative studies, and the MMAT tool for mixed methods studies and summarized findings using the narrative synthesis method. We also used PRISMA reporting guidelines.

RESULTS

From the 2560 studies identified, we finally include 13 peer-reviewed studies: 10 quantitative, one qualitative, and two mixed methods. Five studies were done in the USA, three in Iran (n = 3), and the remaining in Australia, Pakistan, Sweden, Taiwan, and Tanzania. The study identified various ways to increase hospital surge capacity preparedness in all four domains (staff, stuff, space, and system); among them, the use of the Hospital Medical Surge Preparedness Index and the Surge Simulation Tool for surge planning was noteworthy. Moreover, nine studies (69%) recognized several barriers to hospital surge capacity preparedness.

CONCLUSION

The review provides synthesized evidence of contemporary literature on strategies for and barriers to hospital surge capacity preparedness. Despite the risk of selection bias due to the omission of gray literature, the study findings could help hospital authorities, public health workers, and policymakers to develop effective plans and programs for improving hospital surge capacity preparedness with actions, such as enhancing coordination, new or adapted flows of patients, disaster planning implementation, or the development of specific tools for surge capacity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022360332.

Determining surgical surge capacity with a hybrid simulation exercise

Background

To help test and improve surgical surge capacity, mass casualty incident (MCI) exercises generate valuable information. Both large scale table-top exercises (TTX) and full-scale exercises (FSX) have limitations if you want to test an organisation's capability and structure. A hybrid exercise incorporating the advantages of TTX and FSX is a possible way forward, but is no standardised exercise method, yet. This study aims at evaluating the exercise results to determine the feasibility of a hybrid TTX/FSX exercise for an organization's capability and structure.

Methods

A hybrid MCI simulation using moulaged figurants and simulation cards was designed, where the emergency department of a level 1 trauma centre receives 103 casualties over 4 h. After registration and triage, all casualties are expected to be resuscitated in real time and are transferred for further treatment inside the hospital (radiology, operating theatres, intensive care unit (ICU)/postop and wards). When reaching operation theatre, ICU or ward, figurants are replaced by simulation cards. Observers ensured that those procedures performed were adequate and adhered to realistic times. Use of resources (materials, drugs etc.) were registered. Primary endpoint was average time spent in the emergency department, from time of arrival, to transfer out. Secondary endpoints were related to patient flow and avoidable fatalities.

Results

The hospital managed to deal with the flow of patients without collapse of existing systems. Operating theatres as well as ICU and ward beds were available at the end of the exercise. Several details in the hospital response were observed that had not been noticed during previous TTX.

Conclusion

FSX have a valuable role in training, equipping, exercising, and evaluating MCI management. Hybrid simulations combining both FSX and TTX may optimise resource utilisation and allow more frequent exercises with similar organisational benefit.

Prehospital Preparedness for Major Incidents in Sweden: A National Survey with Focus on Mass-Casualty Incidents

INTRODUCTION

Major incidents (MIs) put great demands on the medical response to effectively organize and redistribute resources and personnel, in prehospital care as well as hospital care, and coordinating functions. Studies indicate that regular training and well-established contingency plans are vital for the medical response to MIs. Previous assessments have concluded that Swedish disaster preparedness requires improved organization and coordination. There is currently no method to easily follow-up the preparedness work of the prehospital medical response organizations for MIs in Sweden.

PROBLEM

The aim of the study was to assess qualifications and training requirements for central individual roles, to examine frequency and focus of training and simulation, as well as to examine current regional routines for MIs in Sweden. The aim was also to identify, to evaluate, and to investigate areas for improvement in prehospital health care preparedness for MIs in Sweden.

METHODS

Descriptive comparative study of Sweden's prehospital organization, planning, education, and training for MIs through a web-based survey sent to all 21 regions in Sweden. The survey included 64 questions and was based on national legislation and guidelines for preparedness and previous investigations of real MIs.

RESULTS

A total of 37 answers to the survey were collected representing 17/21 regions (80.9%) from which Regional Management Individuals (RMIs) were selected from 15 regions and used as representative primary responses. The initial routines regarding alarm and establishment of management functions were mainly in-line with national guidelines. Staffing and qualification requirements for certain leadership roles differed substantially between regions. The requirements for the health care staff's knowledge of the contingency plan were generally low and routines for follow-up were often lacking. The frequency of exercises in certain areas were deficient.

CONCLUSIONS

The results of the study showed several potential areas for improvement within the prehospital emergency medical preparedness for MIs in Sweden. Methodology and adherence of national guidelines for medical response preparedness differ between regions in Sweden, which motivates recurring assessments. It is possible to use a well-prepared questionnaire study to follow-up and to examine parts of the regional prehospital preparedness work and organization for MIs.

Evaluation of Medical Staff Satisfaction for Workplace Architecture in Temporary COVID-19 Hospital: A Case Study in Gdańsk, Poland

This article analyses the architecture that was used in the temporary AmberExpo hospital in Gdańsk, Poland which was installed during the COVID-19 pandemic. The construction of this type of facility is often based on experimental approaches, aimed at caring for patients suffering from an infectious disease in emergency conditions. In order to assess the level of employee satisfaction with the architectural and technical elements used in the first period of the hospital's activity, medical staff were asked to fill out a questionnaire. The analysis of the survey's results indicated that the majority of employees expressed satisfaction with the architectural and technical elements, with the design of the spatial layout of the individual medical zones receiving the most positive feedback. However, frequently selected drawbacks in the design included the lack of natural daylight, the artificial light that was used and the acoustics of the facility. This detailed examination of the satisfaction and feedback from medical employees working in this type of emergency facility enables the development of solutions that in the future will allow for the improved adaptive reuse and implementation of such structures, with enhanced time and economic efficiency, and most importantly, the ability to provide a safer workplace.

Hospital preparedness for major incidents in Sweden: a national survey with focus on mass casualty incidents

INTRODUCTION

Mass-casualty incidents, MCI, pose a constant threat on societies all over the world. It is essential that hospital organizations systematically prepare for such situations. A method for repeated follow-up and evaluation of hospital disaster planning is much needed.

AIMS

To evaluate Swedish hospitals´ disaster preparedness with focus on MCI through a web-based survey to highlight areas in need of improvement to ensure better preparedness and resilience.

MATERIALS AND METHODS

An online survey was sent to all Swedish emergency hospitals (n = 87, 49 emergency hospitals). One respondent per hospital answered questions about the hospital's disaster planning, training, key functions, and preparedness. The survey was developed based on current knowledge on key areas of interest for all-hazard preparedness, including the WHO's guidelines. The survey was open between September 6th and November 1st, 2021.

RESULTS

39 hospitals (34 emergency hospitals) from 18/21 regions participated. Main findings included marked differences between regions and hospital types regarding contingency plans, organization, formal education for key functions, disaster training and triage systems.

CONCLUSIONS

Generally, Swedish hospitals cover most key areas in disaster preparedness, but no hospital appears to have a full all-hazards coverage, which leaves room for improvement. There are large variations between the different hospitals' preparedness, which need to decrease. Several hospitals expressed a need of national guidelines for developing equivalent contingency plans. The study-method could be used for monitoring compliance with current laws and guidelines.

Analytical observational study evaluating global pandemic preparedness and the effectiveness of early COVID-19 responses in Ethiopia, Nigeria, Singapore, South Korea, Sweden, Taiwan, UK and USA

OBJECTIVES

An analysis of early country-specific COVID-19 strategies and the impact of policies, healthcare resources and cultural influences on their effectiveness.

DESIGN

Analytical observational study.

SETTING

USA, UK, Sweden, South Korea, Singapore, Taiwan, Ethiopia and Nigeria.

MAIN OUTCOME MEASURES

OxCGRT indices were used to quantify variations in governments' responses, and effectiveness was measured by the number of deaths as a proportion of the population. Hofstede's cultural dimensions, and the availability of healthcare resources, were analysed for their potential impact on effectiveness.

RESULTS

Effective strategies reflect factors such as speed of governmental intervention, cultural norms, population demographics and available resources. While biases, confounders and lack of data at the beginning of the pandemic make inferences challenging, publicly available data suggest that South Korea, Singapore and Taiwan were most successful through rapid identification and isolation of cases, and effective contact tracing systems.

CONCLUSION

The rapid spread of the highly transmissible SARS-CoV-2 virus took many countries by surprise and the delayed global response contributed to the severity of the COVID-19 pandemic. The speed at which strategies were implemented is highly correlated to the number of deaths. Factors such as cultural norms and healthcare resources impact effectiveness significantly, implying that implementation of a global 'one size fits all' approach is challenging. Global preparedness should focus on effective surveillance and preparedness strategies to enable timely identification and containment of future threats.

Risk factors for COVID-19-related death, hospitalization and intensive care: a population-wide study of all inhabitants in Stockholm

Since the beginning of the Covid-19 pandemic, the scientific community has explored determinants of Covid 19 disease severity. However, the majority of studies are based on in-hospital patients with high risk of collider- or selection bias. The present investigation details risk factors associated with overall mortality, hospitalization and intensive care unit (ICU) admission in Covid-19 infections, with complete population coverage and high-resolution data on patient characteristics and comorbid conditions This population-based observational study comprises all residents 18 years and older in Stockholm Region-1.8 million inhabitants-using the real-time Covid-19 monitoring framework. The observation period lasted between March 1 to December 31, 2020. Hazard ratios (HR) for risk factors of Covid-19 disease severity were assessed using Cox proportional hazard models. In total, 3322 deaths, 11,508 hospitalizations and 1423 ICU-admissions related to Covid-19 occurred during the study period. Kidney failure, diabetes and obesity increased risk of mortality and so did heart failure and ischemic heart disease. However, atrial fibrillation and hypertension did not. Risk of hospitalization follow a similar pattern, whereas admission to intensive care differs; triage processes where clearly present as certain co-morbid conditions were associated with lower ICU admission. Observed differences in risk of mortality and hospitalization among patients with Covid 19 raise important questions about potentially protective comedication which will be further addressed using the real-time Covid-19 monitoring framework.

Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners

Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority.

Learning from terrorist mass casualty incidents: a global survey

BACKGROUND

Reports published directly after terrorist mass casualty incidents frequently fail to capture difficulties that may have been encountered. An anonymised consensus-based platform may enable discussion and collaboration on the challenges faced. Our aim was to identify where to focus improvement for future responses.

METHODS

We conducted a mixed methods study by email of clinicians' experiences of leading during terrorist mass casualty incidents. An initial survey identified features that worked well, or failed to, during terrorist mass casualty incidents plus ongoing challenges and changes that were implemented as a result. A follow-up, quantitative survey measured agreement between responses within each of the themes using a Likert scale.

RESULTS

Thirty-three participants responded from 22 hospitals that had received casualties from a terrorist incident, representing 17 cities in low-middle, middle and high income countries. The first survey identified themes of sufficient (sometimes abundant) human resource, although coordination of staff was a challenge. Difficulties highlighted were communication, security, and management of blast injuries. The most frequently implemented changes were education on specific injuries, revising future plans and preparatory exercises. Persisting challenges were lack of time allocated to training and psychological well-being. The follow-up survey recorded highest agreement amongst correspondents on the need for re-triage at hospital (90% agreement), coordination roles (85% agreement), flexibility (100% agreement), and large-scale exercises (95% agreement).

CONCLUSION

This survey collates international experience gained from clinicians managing terrorist mass casualty incidents. The organisation of human response, rather than consumption of physical supplies, emerged as the main finding. NHSH Clinical Effectiveness Unit project registration number: 2020/21-036.

Regional Flexible Surge Capacity—A Flexible Response System

Surge capacity is the ability to manage the increased influx of critically ill or injured patients during a sudden onset crisis. During such an event, all ordinary resources are activated and used in a systematic, structured, and planned way to cope with the situation. There are, however, occasions where conventional healthcare means are insufficient, and additional resources must be summoned. In such an event, the activation of existing capabilities within community resources can increase regional surge capacity in a flexible manner. These additional resources together represent the concept of Flexible Surge Capacity. This study aims to investigate the possibility of establishing a Flexible Surge Capacity response system to emergencies by examining the main components of surge capacity (Staff, Stuff, Structure, System) within facilities of interest present in the Western Region of Sweden. Through a mixed-method and use of (A) questionnaires and (B) semi-structured key-informant interviews, data was collected from potential alternative care facilities to determine capacities and capabilities and barriers and limitations as well as interest to be included in a flexible surge capacity response system. Both interest and ability were found in the investigated primary healthcare centers, veterinary and dental clinics, schools, and sports and hotel facilities to participate in such a system, either by receiving resources and/or drills and exercises. Barriers limiting the potential participation in this response system consisted of a varying lack of space, beds, healthcare materials, and competencies along with a need for clear organizational structure and medical responsibility. These results indicate that the concept of flexible surge capacity is a feasible approach to emergency management. Educational initiatives, drills and exercises, layperson empowerment, organizational and legal changes and sufficient funding are needed to realize the concept.