Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-12T02:22:07.824Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital Responses to Acute-Onset Disasters: A Review

Published online by Cambridge University Press:  28 June 2012

Andrew Milsten
Andrew Milsten*
Affiliation:
Fellow in Emergency Medical Services, Department of Surgery, Division of Emergency Medicine, University of Maryland
*
*University of Maryland, Department of Surgery; Division of Emergency Medicine, 419 West Redwood Street, Suite 280, Baltimore, MD 21201USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Hospitals the world over have been involved in disasters, both internal and external. These two types of disasters are independent, but not mutually exclusive. Internal disasters are isolated to the hospital and occur more frequently than do external disasters. External disasters affect the community as well as the hospital. This paper first focuses on common problems encountered during acute-onset disasters, with regards to hospital operations and caring for victims. Specific injury patterns commonly seen during natural disasters are reviewed. Second, lessons learned from these common problems and their application to hospital disaster plans are reviewed.

Methods:

An extensive review of the available literature was conducted using the computerized databases Medline and Healthstar from 1977 through March 1999. Articles were selected if they contained information pertaining to a hospital response to a disaster situation or data on specific disaster injury patterns. Selected articles were read, abstracted, analyzed, and compiled.

Results:

Hospitals continually have difficulties and failures in several major areas of operation during a disaster. Common problem areas identified include communication and power failures, water shortage and contamination, physical damage, hazardous material exposure, unorganized evacuations, and resource allocation shortages.

Conclusions::

Lessons learned from past disaster-related operational failures are compiled and reviewed. The importance and types of disaster planning are reviewed.

Keywords

acute-onsetdisastersearthquakefloodshospitalshurricaneresponsetornado
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 15 , Issue 1 , March 2000 , pp. 40 - 53
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lewis, CP, Aghababian, RV: Disaster planning part I. Overview of hospital and emergency department planning for internal and external disasters. Emergency Medicine Clinics of North America 1996;14(2):439–451.CrossRefGoogle ScholarPubMed
2.Aghababian, R, Lewis, CP, Gans, L, et al: Disasters within hospitals. Ann Emerg Med 1994;23(4):771–777.CrossRefGoogle ScholarPubMed
3.Auf der Heide, E: Disaster planning, Part II: Disaster problems, issues, and challenges identified in the research literature. Emergency Medicine Clinics of North America 1996;14(2):453–474.CrossRefGoogle ScholarPubMed
4.Gough, AR, Gulliver, LS: Anchors, bites, and choppers: Media relations and legal issues in disasters. J Emerg Nurs 1990;16(4):259–262.Google Scholar
5.Sheppa, CM, Stevens, J, Philbrick, JR, et al.: The effect of a class IV hurricane on an emergency department. Am J Emerg Med 1993;11(5):464–467.CrossRefGoogle Scholar
6.Salinas, C, Salinas, C, Kurata, J:. The effect of the Northridge earthquake on the pattern of emergency department care. Am J Emerg Med 1998;16(3):254–256.CrossRefGoogle ScholarPubMed
7.Girodano, L: Lecture on the World Trade Center bombing, 26 February, 1993. New York City, NY, Disaster New York conference 02 April, 1997.Google Scholar
8.Hogan, DE: Lecture on Disaster Medicine. New York City, NY, Disaster New York Conference, 02 April, 1997.Google Scholar
9.Sloan, KA:. Volcano! Disaster management. J Emerg Nurs 1990;16(4):263–268.Google ScholarPubMed
10.Ford, RA: Medical impact of volcanism. Disaster Medicine: Newsletter from the American College of Emergency Physicians. Ed. Burstein JL. 1998;8(4):6–12.Google Scholar
11.Quinn, B, Baker, R, Pratt, J; Hurricane Andrew and a pediatric emergency department. Ann Emerg Med 1994;23(4):737–741.CrossRefGoogle Scholar
12.Brewer, RD, Morris, PD, Cole, TB: Hurricane related emergency department visits in an inland area: An analysis of the public health impact of Hurricane Hugo in North Carolina. Ann Emerg Med 1994;23(4):731–736.CrossRefGoogle Scholar
13.Hall, HI, Haugh, GS, Price-Green, PA, et al: Risk factors for hazardous substance releases that result in injuries and evacuations: Data from 9 states. Am J Public Health 1996;86(6):855–857.CrossRefGoogle ScholarPubMed
14.Feldstein, B: Disaster emergency medical services. Ann Emerg Med 1986:1254.CrossRefGoogle ScholarPubMed
15.Inui, A, Kitaoka, H, Majima, M, et al.: Effect of the Kobe earthquake on stress and glycemic control in patients with diabetes mellitus. Arch Intern Med 1998;158:274–278.CrossRefGoogle ScholarPubMed
16.Aoyama, N, Kinoshita, Y, Fujimoto, S, et al.:. Peptic ulcers after the Han-shin-Awaji earthquake: Increased incidence of bleeding gastric ulcers. Am J Gastroenterol 1998;93(3):311–316.CrossRefGoogle ScholarPubMed
17.Seaver, DJ:. Coping with internal disaster is a hospital priority. Hospitals 1977;51:167–172.Google ScholarPubMed
18.Bohonas, JJ: Tornadoes. Disaster medicine: Newsletter from the American College of Emergency Physicians 1997;8(2):2–3.Google Scholar
19.Sabatino, F: Hurricane Andrew: South Florida hospitals shared resources and energy to cope with the storm's devastation. Hospitals 1992;66:26–30.Google Scholar
20.Hudson, T: Riots in Los Angeles: Being prepared, a lesson well learned for area facilities. Hospitals 1992;66:18–25.Google ScholarPubMed
21.McGlown, KJ, Fottler, MD: The impact of flooding on the delivery of hospital services in the southeastern United States. Health Care Manage Rev 1996;21(3):55–71.CrossRefGoogle ScholarPubMed
22.Peters, MS: Hospitals respond to water loss during the Midwest floods of 1993: Preparedness and improvisation. J Emerg Med 1996;14(3):345–350.CrossRefGoogle ScholarPubMed
23.Jacoby, I: Lessons for hospitals from the Midwest floods of 1993. J Emerg Med 1996;14(3):379–380.CrossRefGoogle ScholarPubMed
24.Stensrud, KM: Floodwaters bring docs to the front. Minn Med 1997;80:14–18.Google Scholar
25.Tanaka, H, Iwai, A, Oda, J, et al.: Overview of evacuation and transport of patients following the 1995 Hanshin-Awaji earthquake. J Emerg Med 1998;16(3):439–444.CrossRefGoogle ScholarPubMed
26.Vasudevan, P, Wade, K: Total facility evacuation at Helena Regional Medical Center. J Arkansas Med Soc 1997;94(2):76–77.Google ScholarPubMed
27.Square, D: Hospital evacuated, mental-health issues dominated as Manitoba coped with flood of century. CMAJ. 1997;156(12):1742–1745.Google ScholarPubMed
28.Nozaki, H, Hori, S, Shinozawa, Y, et al.: Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med 1995;21:1032–1035.CrossRefGoogle ScholarPubMed
29.Thanabalasingham, T, Beckett, MW, Murray, V:. Hospital response to a chemical incident: Report on casualties of an ethyldichlorosilane spill. BMJ 1991;302:101–102.CrossRefGoogle ScholarPubMed
30.Olson, KR: Hazmat-o-phobia: Why aren't hospitals ready for chemical accidents? West J Med 1998;168(1):32–33.Google ScholarPubMed
31.Amundson, SB, Burkle, AM: Golden minutes: The Oklahoma City bombing-two ED nurses' stories. J Emerg Nurs 1995;21(5):401–407.CrossRefGoogle ScholarPubMed
32.Anteau, CM, Williams, LA: The Oklahoma bombing: Lessons learned. Critical Care Nurs Clinics of North Am 1997;9(2):231–237.CrossRefGoogle ScholarPubMed
33.Hudson, T: Disaster in Oklahoma City. Hospitals and Health Networks 1995; 28–34.Google Scholar
34.Suzuki, S, Sakamoto, S, Koide, M, et al: Hanshin-Awaji earthquake as a trigger for acute myocardial infarction. Am Heart J 1997;134(5 part 1):974–977.CrossRefGoogle ScholarPubMed
35.Saito, K, Kim, JI, Maekawa, K, et al.: The great Hanshin-Awaji earthquake aggravates blood pressure control in treated hypertensive patients. AJH 1996;10(2):217–221.Google Scholar
36.Kuwagata, Y, Oda, J, Tanaka, H, Oda, J, et al.: Analysis of 2,702 traumatized patients in the 1995 Hanshin-Awaji earthquake. J Trauma 1997;43(3):427–430.CrossRefGoogle Scholar
37.Oda, Y, Shindoh, M, Yukioka, H, et al.: Crush syndrome sustained in the 1995 Kobe, Japan, earthquake: Treatment and outcome. Ann Emerg Med 1997;30(4):507–510.CrossRefGoogle ScholarPubMed
38.Nakamori, Y, Tanaka, H, Oda, J, et al: Burn injuries in the 1995 Hanshin-Awaji earthquake. Burns 1997;23(4):319–322.CrossRefGoogle ScholarPubMed
39.Takakura, R, Himeno, S, Kanayma, Y, et al.: Follow-up after Hanshin-Awaji earthquake: Diverse influences on pneumonia, bronchial asthma, peptic ulcer, and diabetes mellitus. Int Med 1997;36(2):87–91.CrossRefGoogle ScholarPubMed
40.Kario, K, Ohashi, T: After a major earthquake, stroke death occurs more frequently than coronary heart disease in very old subjects. JAGS 1998;46(4):537–538.CrossRefGoogle Scholar
41.Yoshimura, N, Nakayoma, S, Nakegiri, K, et al: Profile of chest injuries arising from the 1995 Southern Hyogog Prefecture earthquake. Chest 1996;110(3):759–761.CrossRefGoogle ScholarPubMed
42.Reitherman, RP: How to prepare your hospital for an earthquake. J Emerg Med 1986;4:119–131.CrossRefGoogle Scholar
43.Chavez, CW, Binder, B: A hospital as victim and responder: The Sepul-veda VA Medical Center and the Northridge earthquake. J Emerg Med 1996;14(4):445–454.CrossRefGoogle ScholarPubMed
44.Armenian, HK, Melkonian, A, Noji, EK, Hovanesian, AP, et al: Deaths and injuries due to the earthquake in Armenia: A cohort approach. International J Epi 1997;26(4):806–812.CrossRefGoogle Scholar
45.Center for Disease Control: Earthquake-associated deaths — California. MMWR 1989;38(45):767–770.Google Scholar
46.Center for Disease Control: Tornado disaster — Texas, May 1997. MMWR 1997;46(45):1069–1073.Google Scholar
47.Center for Disease Control: Tornado-associated fatalities — Arkansas, 1997. MMWR 1997;46(19):412–416.Google Scholar
48.Anderson, GV, Feliciano, DV: The Centennial Olympic Park bombing: Grady's response. J Med Assoc Georgia 1997;86:42–46.Google Scholar
49.Nye, PJ, Tytle, TL, Jarman, RN, Eaton, BG, et al: The role of radiology in the Oklahoma City bombing. Radiology 1996;200(2):541–543.CrossRefGoogle ScholarPubMed
50.Noordergraaf, GJ, Bouman, JH, Van den Brink, EJ, et al: Development of computer-assisted patient control for use in the hospital setting during mass casualty incidents. Am J Emerg Med 1996;14(3):257–261.CrossRefGoogle ScholarPubMed
51.Halstead, MA: Fire drill in the operating room. AORN J 1993;8(4):697–702.CrossRefGoogle Scholar
52.O'Hara, JF, Higgins, TL: Total electrical power failure in a cardiothoracic intensive care unit. Crit Care Med 1992;20(6):840–845.CrossRefGoogle Scholar
53.Pointer, JE, Michaelis, J, Saunders, C, et al.: The 1989 Loma Prieta earthquake: Impact on hospital patient care. Ann Emerg Med 1992;21(10):73–78.CrossRefGoogle ScholarPubMed
54.Larson, E: Time Magazine 07 September, 1998: 62–66.Google Scholar
55.Haynes, BE, Freeman, C, Rubin, JL, et al.:. Medical response to catastrophic events: California' planning and the Loma Prieta earthquake. Ann Emerg Med 1992;21(4):368–374.CrossRefGoogle ScholarPubMed
56.Center for Disease Control:. Flood-related mortality — Missouri, 1993. MMWR 1993;42(48):941–943.Google Scholar
57.Center for Disease Control: Flood-related mortality — Georgia. MMWR 1994;43(29):526–530.Google Scholar
58.Center for Disease Control: Community needs assessment and morbidity surveillance following an ice storm — Maine, January 1998. MMWR 1998;47(17):351–354.Google Scholar
59.Federal Emergency Management Agency: Exemplary practices in emergency management. (Online). 1997 Path: www.fema.gov/pte/exp22.html.Google Scholar
60.Federal Emergency Management Agency: Seismic hazard mitigation program for hospitals. 1998 (Online). Path: www.fema.gov/IG/shmpbk.html.Google Scholar
61.Center for Disease Control: Update: Work-related electrocutions associated with Hurricane Hugo — Puerto Rico. MMWR 1989;38(42):718–725.Google Scholar
62.Center for Disease Control: Injuries and illnesses related to Hurricane Andrew — Louisiana. MMWR 1993;42(13):242–243.Google Scholar
63.Center for Disease Control: Comprehensive assessment of health needs 2 months after Hurricane Andrew — Dade County, Florida, 1992. MMWR 1993;42(22):434–437.Google Scholar
64.Center for Disease Control: Epidemiologic notes and reports hurricanes and hospital emergency-room visits — Mississippi, Rhode Island, Connecticut. MMWR 1986;34(51–52):765–770.Google Scholar
65.Center for Disease Control: Deaths associated with Hurricane Georges — Puerto Rico, September 1998. MMWR 1998;47(42):897–898.Google Scholar
66.Center for Disease Control: Deaths associated with Hurricane Marilyn and Opal — United States, September-October 1995. MMWR 1996;45(2):32–38.Google Scholar
67.Alleyne, GA. Health situation grave in Central America. Pan Am Health Org. 1998 (online). Path: www.paho.org/english/DPI/rl981119.html.Google Scholar
68.Teeter, DS: Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge earthquake. Milit Med 1996;161:526–530.CrossRefGoogle ScholarPubMed
69.Hendrickson, LA, Vogt, RL: Mortality of Kauai residents in the 12-month period following Hurricane Iniki. Am J Epidemiol 1996;144(2):188–191.CrossRefGoogle ScholarPubMed
70.Norcross, ED, Elliott, BM, Adams, DB, Crawford, FA, et al.: Impact of a major hurricane on surgical services in university hospital. Am Surg 1993;59(1):28–33.Google Scholar
71.Friedman, FD: Public relations in disaster management and planning for emergency physicians. J Emerg Med 1995;13(5):661–668.CrossRefGoogle ScholarPubMed
72.MacPherson, P: Are hospitals ready to respond? Hospitals & Health Networks. 1996; January:70(1):39–40.Google ScholarPubMed
73.Friedman, E: Coping with calamity: How well does health care disaster planning work? JAMA 1994;272(23):1875–1879.CrossRefGoogle ScholarPubMed
74.De Lorenzo, RA, Augustine, JJ: Lessons in emergency evacuation from Miamisburg train derailment. Prehospital and Disaster Medicine 1996;11(4):270–275.CrossRefGoogle ScholarPubMed
75.Martchenke, J, Pointer, JE: Hospital disaster operations during the 1989 Loma Prieta earthquake. Prehospital and Disaster Medicine 1994;9(3):146–152.CrossRefGoogle ScholarPubMed
76.Dunmeyer, S: “Will Your Hospital be prepared when disaster strikes?” 1998 ACEP Scientific Assembly, Lecture Tape # 207. 10–14 October. 1998.Google Scholar
77.Pretto, E, Angus, DC, Abrams, JI, et al.: An analysis of prehospital mortality in an earthquake. Prehospital and Disaster Medicine 1994;9(2):107–114.CrossRefGoogle Scholar
78.Noji, E: International Workshop on Earthquake Injury Epidemiology for Mitigation and Response. The Johns Hopkins University, Baltimore. 10–12 July 1989Google Scholar
79.Krug, EG, Kresnow, M, Peddicord, JP, et al.: Suicide after natural disasters. N Engl J Med 1998;338(6):373–378.CrossRefGoogle ScholarPubMed
80.Saenz, R, Bissell, R: Post-disaster malaria in Costa Rica. Prehosptial and Disaster Medicine 1995;10(3):154–160.CrossRefGoogle ScholarPubMed
81.Aghababian, R, Teuscher, J: Infectious diseases following major disasters. Ann Emerg. Med 1992;21(4):362–367.CrossRefGoogle ScholarPubMed
82.Orlowski, J: Floods, Hurricanes and Tsunamis. Medicine for Disasters. Baskett, P (Ed). Wright. 1988. pp 291–307.Google Scholar
83.Bissell, R: Delayed-impact infectious disease after a natural disaster. J Emerg Med 1983;1:59–66.CrossRefGoogle ScholarPubMed
84Malilay, J: Tropical cyclones. The Public Health Consequences of Disasters, Noji, E (Ed), Oxford Press: 1997. pp 207–227.Google Scholar
85.Levitin, H, Siegelson, H: Hazardous materials: Disaster medical planning and response. Emerg Med Clin North Amer 1996;14(2):327–349.CrossRefGoogle ScholarPubMed
86. Final Report: Alfred P. Murrah Federal Building Bombing 19 April, 1995. Fire Protection Publications: Oklahoma State University. 1996.Google Scholar
87.Burkle, F: Acute-phase mental health consequences of disasters: Implications for triage and emergency medical services. Ann Emerg. Med 1996;28(2):119–128.CrossRefGoogle ScholarPubMed
88.Mitchell, JT, Everly, GS: Critical Incident Stress Management: The Basic Course Workbook. International Critical Incident Stress Foundation Inc. 2nd ed. 1998Google Scholar
89.Alcorta, RL: Statement of Richard L. Alcorta, State EMS Medical Director for the Maryland Institute for Emergency Medical Services Systems (MIEMSS) and Representative of ACEP before the Subcommittee on Public Health Committee on Health, Education, Labor, and Pensions. United States Senate. 25 March, 1999.Google Scholar
90.Oda, J, Tanaka, H, Yoshioka, T, et al: Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma 1997;42(3):470–475. discussion 475–476.CrossRefGoogle ScholarPubMed
91.Garshnek, V, Burkle, FM: Telecommunications systems in support of disaster medicine: Application of basic information pathways. Ann Emerg Med 1999;34(2):213–218.CrossRefGoogle ScholarPubMed
92.Brennan, RJ, Waeckerle, JF, Sharp, TW, Lillibridge, SR: Chemical warfare agents: Emergency medical and emergency public health issues. Ann Emerg Med 1999;34(2):191–204.CrossRefGoogle ScholarPubMed
93.Burgess, JL, Kirk, M, Borron, SW, Cisek, J: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999;34(2):205–212.CrossRefGoogle ScholarPubMed
94.Pons, P, Dart, RC: Chemical incidents in the emergency department: If and when. Ann Emerg Med 1999;34(2):223–225.CrossRefGoogle ScholarPubMed
95.Eckstein, M: The medical response to modern terrorism: Why the “Rules of Engagement” have changed. Ann Emerg Med 1999;34(2):219–221.CrossRefGoogle ScholarPubMed
96.Keim, M, Kaufmann, AF: Principles for emergency response to bioterrorism. Ann Emerg Med 1999;34(2):177–182.CrossRefGoogle ScholarPubMed
97.Richards, CF, Burstein, JL, Waeckerle, JF, Hutson, HR: Emergency physicians and biological terrorism. Ann Emerg Med 1999;34(2):183–189.CrossRefGoogle ScholarPubMed
98.Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR: Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34(2):160–167.CrossRefGoogle ScholarPubMed
99.Danzig, R, Berkowsky, PB: Why should we be concerned about biological warfare? JAMA 1997;278(5):431–432.CrossRefGoogle ScholarPubMed
100.Simon, JD: Biological terrorism: Preparing to meet the threat. JAMA 1997;278(5):428–430.CrossRefGoogle ScholarPubMed
101.Osterholm, MT: The Medical impact of a bioterrorist attack. Postgraduate Med 1999;106(2):121–130.CrossRefGoogle ScholarPubMed
102.Zilinskas, RA: Iraq's biological weapons. JAMA 1997;278(5):418–424.CrossRefGoogle ScholarPubMed
103.Leitenberg, M: Production and use of biological weapons: Need for international sanctions?. JAMA 1997;278(5):387–388.CrossRefGoogle ScholarPubMed
104.Hogan, DE, Askins, DC, Osburn, AE: The May 3,1999, tornado in Oklahoma City. Ann Emerg Med 1999:34(2):225–226.CrossRefGoogle Scholar
105.Sapira, A, Oster, NS: Top five lessons learned in disaster medicine. Ann Emerg Med 1999;34(4):S38. Abstract.CrossRefGoogle Scholar
106.Toole, MJ: Communicable diseases and disease control. The Public Health Consequences of Disasters. Noji, E (Ed), Oxford Press. 1997. pp 79–100.Google Scholar
107.Gerrity, ET, Flynn, BW. Mental health consequences of disasters, The Public Health Consequences of Disasters, Noji, E (Ed), Oxford Press 1997. pp 101–119.Google Scholar