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Kearns RD, Skarote MB, Peterson J, Stringer L, Alson RL, Cairns BA, Hubble MW, Rich PB, Cairns CB, Holmes JH, Runge J, Siler SM, Winslow J. Deployable, portable, and temporary hospitals; one state's experiences through the years. Am J Disaster Med 2014; 9:195-210. [PMID: 25348385 DOI: 10.5055/ajdm.2014.0171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article will review the use of temporary hospitals to augment the healthcare system as one solution for dealing with a surge of patients related to war, pandemic disease outbreaks, or natural disaster. The experiences highlighted in this article are those of North Carolina (NC) over the past 150 years, with a special focus on the need following the September 11, 2001 (9/11) attacks. It will also discuss the development of a temporary hospital system from concept to deployment, highlight recent developments, emphasize the need to learn from past experiences, and offer potential solutions for assuring program sustainability. Historically, when a particular situation called for a temporary hospital, one was created, but it was usually specific for the event and then dismantled. As with the case with many historical events, the details of the 9/11 attacks will fade into memory, and there is a concern that the impetus which created the current temporary hospital program may fade, as well. By developing a broader and more comprehensive approach to disaster responses through all-hazards preparedness, it is reasonable to learn from these past experiences, improve the understanding of current threats, and develop a long-term strategy to sustain these resources for future disaster medical needs.
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Affiliation(s)
- Randy D Kearns
- Administrator, EMS Performance Improvement Center, Chapel Hill, North Carolina; Program Director, North Carolina Burn Disaster Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mary Beth Skarote
- Healthcare Preparedness Response and Recovery Program Manager, North Carolina Office of EMS, Raleigh, North Carolina
| | - Jeff Peterson
- Healthcare Preparedness Response and Recovery Operations Manager, North Carolina Office of EMS, Raleigh, North Carolina
| | - Lew Stringer
- Medical Advisor, North Carolina State Medical Response System, National Mobile Disaster Hospital, Raleigh, North Carolina
| | - Roy L Alson
- Medical Advisor, North Carolina State Medical Response System, Raleigh, North Carolina; Associate Professor of Emergency Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Bruce A Cairns
- Director North Carolina Jaycee Burn Center, John Stackhouse Distinguished Professor of Surgery/ Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael W Hubble
- Professor and Director, Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina
| | - Preston B Rich
- Professor of Surgery and Chief, Trauma, Critical Care and Emergency Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Senior Advisor to the Deputy Assistant Secretary for Preparedness and Response/OEM Director, Regional Deputy Chief Medical Officer/NDMS, United States Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response, Washington, DC
| | - Charles B Cairns
- Professor and Chair of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - James H Holmes
- Associate Professor of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Director, Wake Forest Baptist Health Burn Center, Winston-Salem, North Carolina
| | - Jeff Runge
- Adjunct Professor of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sean M Siler
- Assistant Professor, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lead Regional Deputy Chief Medical Officer, National Disaster Medical System, United States Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response, Washington, DC
| | - James Winslow
- North Carolina Office of EMS, Raleigh, North Carolina; Associate Professor of Emergency Medicine, Wake Forest University, Winston-Salem, North Carolina
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Kearns RD, Skarote MB, Peterson J, Hubble MW, Winslow JE. Creating a state medical response system for medical disaster management: the North Carolina experience. South Med J 2014; 107:540-8. [PMID: 25188616 DOI: 10.14423/smj.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this work was to examine the creation and evolution of the North Carolina state medical response system (SMRS). During the past 30 years, states and local communities have developed a somewhat incongruent patchwork of medical disaster response systems. Several local or regional programs participated in the National Disaster Medical System; however, aside from the Disaster Medical Assistance Teams, most of these local resources lacked national standards and national direction. The September 11, 2001 terrorist attacks in Washington, DC and New York, and the anthrax-laced letters mailed to prominent individuals in the US media and others (bioterrorism) in the months that followed were tragic, but they served as both a tipping point and a unifying factor to drive preparedness activities on a national level. Each state responded to the September 11, 2001 attacks by escalating planning and preparedness efforts for a medical disaster response. The North Carolina SMRS was created based on the overall national direction and was tailored to meet local needs such as hurricane response. This article reviews the accomplishments to date and examines future aims. From regional medical response teams to specialty programs such as ambulance strike teams, burn surge planning, electronic inventory and tracking systems, and mobile pharmacy resources, the North Carolina SMRS has emerged as a national leader. Each regional coalition, working with state leadership, has developed resources and has used those resources while responding to disasters in North Carolina. The program is an example of how national leadership can work with state and local agencies to develop a comprehensive and effective medical disaster response system.
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Affiliation(s)
- Randy D Kearns
- From the University of North Carolina School of Medicine, Chapel Hill, the North Carolina Office of Emergency Medical Services, Raleigh, Western Carolina University, Cullowhee, and Wake Forest University Baptist Health, Winston Salem, North Carolina
| | - Mary Beth Skarote
- From the University of North Carolina School of Medicine, Chapel Hill, the North Carolina Office of Emergency Medical Services, Raleigh, Western Carolina University, Cullowhee, and Wake Forest University Baptist Health, Winston Salem, North Carolina
| | - Jeff Peterson
- From the University of North Carolina School of Medicine, Chapel Hill, the North Carolina Office of Emergency Medical Services, Raleigh, Western Carolina University, Cullowhee, and Wake Forest University Baptist Health, Winston Salem, North Carolina
| | - Michael W Hubble
- From the University of North Carolina School of Medicine, Chapel Hill, the North Carolina Office of Emergency Medical Services, Raleigh, Western Carolina University, Cullowhee, and Wake Forest University Baptist Health, Winston Salem, North Carolina
| | - James E Winslow
- From the University of North Carolina School of Medicine, Chapel Hill, the North Carolina Office of Emergency Medical Services, Raleigh, Western Carolina University, Cullowhee, and Wake Forest University Baptist Health, Winston Salem, North Carolina
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Kearns RD, Myers B, Cairns CB, Rich PB, Hultman CS, Charles AG, Jones SW, Schmits GL, Skarote MB, Holmes JH, Cairns BA. Hospital bioterrorism planning and burn surge. Biosecur Bioterror 2014; 12:20-8. [PMID: 24527874 DOI: 10.1089/bsp.2013.0065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity.
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Kearns RD, Holmes JH, Skarote MB, Cairns CB, Strickland SC, Smith HG, Cairns BA. Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers. Burns 2014; 40:1121-32. [PMID: 24411582 DOI: 10.1016/j.burns.2013.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
Response to the 2010 Haitian earthquake included an array of diverse yet critical actions. This paper will briefly review the evacuation of a small group of patients with burns to burn centers in the southeastern United States (US). This particular evacuation brought together for the first time plans, groups, and organizations that had previously only exercised this process. The response to the Haitian earthquake was a glimpse at what the international community working together can do to help others, and relieve suffering following a catastrophic disaster. The international response was substantial. This paper will trace one evacuation, one day for one unique group of patients with burns to burn centers in the US and review the lessons learned from this process. The patient population with burns being evacuated from Haiti was very small compared to the overall operation. Nevertheless, the outcomes included a better understanding of how a larger event could challenge the limited resources for all involved. This paper includes aspects of the patient movement, the logistics needed, and briefly discusses reimbursement for the care provided.
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Affiliation(s)
- Randy D Kearns
- North Carolina Burn Disaster Program, EMS Performance Improvement Center, University of North Carolina School of Medicine, United States.
| | - James H Holmes
- WFBMC Burn Center, Wake Forest Baptist Health System, Wake Forest University School of Medicine, United States
| | - Mary Beth Skarote
- Healthcare System and Hospital Preparedness Program Coordinator, North Carolina Office of EMS, United States
| | - Charles B Cairns
- Department of Emergency Medicine, University of North Carolina School of Medicine, United States
| | - Samantha Cooksey Strickland
- ESF8 Program Manager, Bureau of Preparedness and Response, Emergency Preparedness and Community Support/Florida Department of Health, United States
| | - Howard G Smith
- Burn Center, Orlando Regional Medical Center, University of Central Florida College of Medicine, United States
| | - Bruce A Cairns
- North Carolina Jaycee Burn Center, University of North Carolina School of Medicine, United States
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