Biomedical Engineering Reference
In-Depth Information
backlog of emergency and urgent cases. A triage
system is necessary to accommodate this patient
stream while continuing to provide care for trauma
victims. Many busy operating rooms already run
at or near-capacity during normal operations.
They manage contingency patients by keeping one
or more operating rooms reserved for unsched-
uled cases. Often, these rooms run continuously
throughout the day. After the first 8-12 hours of
patient surge, staff fatigue will begin to take its
toll. A transition to shift work will need to occur.
Rotating 8-12 hour shifts with periodic breaks
should be planned. Planning should include a
means to accommodate large numbers of personnel
to sleep in-house. Offices and lounges can be
temporarily converted.
ambulatory waiting areas). Nurse/patient ratios,
similarly, can be temporarily altered to provide
coverage to an expanded case-load. Under extreme
circumstances, awake, stable, spontaneously venti-
lating patients should be transported directly to
patient floors if necessary.
13.5 Patient Flow and Infectious
Considerations
During mass-casualty contingencies involving
WMDs, consideration should be given to
patient flow and isolation; especially if viru-
lent, airborne transmissible infectious agents may
be present (pneumonic plague, smallpox, and
SARS) (Figure 13.4). Early in an event, patients
may make it to the OR before being identi-
fied as being contaminated or infectious. Under
stressful, chaotic conditions, some patients may
not receive full decontamination and continue to
pose a risk to surgical personnel. A method for
secondary decontamination should be available
and practiced. Double gloves, waterproof surgical
gowns and HEPA filtered respirators (PAPRs)
will provide adequate protection, assuming all
staff have been trained in advance. Hypochlorite
continues to provide the best and most accessible
universal decontamination.
Operating rooms are normally ventilated with
filtered, positive pressure systems to keep out
infectious contamination. When airborne trans-
missible infectious agents are present a reverse
situation occurs. Negative pressure is desired to
prevent dispersion of airborne agents to adjacent
areas. Facilities management should be contacted
to reverse the direction of airflow. This can best
be achieved with prior planning and should be part
of the facilities management contingency plan. It
may, unfortunately, result in contaminated duct-
work and HVAC equipment which will require
decontamination before restoration to normal use.
Portable, HEPA filtered forced air systems have
been used to convert large rooms (gymnasiums)
into negative pressure wards and should be consid-
ered a viable option, especially for expansion
areas [10]. An alternative to air flow reversal is to
13.4 Expansion of Capacity
In most scenarios, all surgical suites can be
opened up in a matter of a few hours. Out-
patient ORs can be utilized rapidly since most
scheduled procedures in these facilities tend to be
short. Many hospitals have excess surgical space
which is used for storage or other purposes. These
rooms normally continue to have piped medical
gasses and suction. They can be utilized as minor
procedure rooms even if not equipped with anes-
thesia machines. Alternatively, ICU ventilators or
even bag-valve-mask (BVM) devices with trans-
port monitors can be substituted and intravenous-
only anesthesia can be administered. Even office
space can be transformed in this manner if needed.
Endoscopy suites and regional anesthesia proce-
dure rooms, likewise, may be pressed into service
as surgical treatment rooms. Obstetrical caesarean
section rooms, also can be used for non-obstetrical
procedures, however, emergency c-sections will
continue to occur and it is unwise to commit 100%
of capacity.
The greatest problem occurs as traditional
postoperative areas (PACU and ICU) rapidly
fill up with the initial wave of post-operative
patients. Increased throughput can be achieved
by temporarily relaxing standards for discharge
during the contingency and by expansion to adja-
cent spaces normally used for other purposes (i.e.,
