Biomedical Engineering Reference
In-Depth Information
promote visibility, officials must maintain commu-
nications with the public through personal visits to
the hospital site as well as through media inter-
views and appearances.
Disasters happen locally, requiring a local
response. As such, the states within the U.S.
have various designated government officials who
possess the authority to call for the establishment
of surge hospitals. In Texas, for example, the
country judge has the power to order the creation
of a surge hospital. However, if it becomes clear
that the emergency will have a statewide effect,
the governor takes charge of the effort and dele-
gates the establishment of surge hospitals to the
senior medical officer in the state, usually the
commissioner of health or director of the public
health department. This is what occurred as Texas
prepared for Hurricane Rita.
and training programs and helping establish these
programs statewide.
Effective communication in and with surge
hospitals
Communication is often the weakest link in mass
casualty incident responses [3]. This fact is borne
out by the experience of those who worked in
the post-Katrina surge hospitals in Louisiana and
Texas. The surge hospital at the empty former retail
store site was no exception to this rule. Cellular
access was sporadic at best and often not available
for an hour or more. Radio communication with
arriving buses or emergency services vehicles was
essentially nonexistent. Inside the facility itself,
communication posed a separate challenge because
of the size and acoustic environment of the facility.
A redundant communications system that
includes two telephone systems, two-way radios,
more reliable paging systems, and better satellite
communications needs to be explored to mitigate
the negative effects of poor communication on
patient care.
The state's senior medical officer's role in
surge hospitals
The senior medical officer in the state appoints
a medical director of the surge hospital, who
then assembles a set-up team. Sometimes the
person recommended to oversee the creation of
a surge hospital is a physician who has devel-
oped a relationship with state officials and has
become a trusted advisor. This is the way Raymond
Swienton, M.D., FACEP, was given the authority
to recommend the sites for and supervise the
opening of the surge hospitals at Louisiana State
University and at an empty former retail store
a few blocks from the Earl K. Long Medical
Center in Baton Rouge. Swienton is the co-
director of Emergency Management Services of the
Disaster Medicine and Homeland Security Section,
and associate professor, Division of Emergency
Medicine in the Department of Surgery at the
University of Texas Southwestern Medical Center
at Dallas. In addition, Swienton served as a senior
advisor to the State of Louisiana's Secretary of
Health as well as the State Health Officer and
staff. Over the previous two years, he has become
well known to the senior state health care leader-
ship by providing disaster preparedness education
Other issues to consider
Sufficiency of care
Ideally, the goal of the surge facility is to main-
tain high standards of care. In practice, however,
medical treatment in a surge hospital may reach
only the level of sufficiency of care because of the
challenging circumstances under which the facility
must operate (see Figure H.1 for an illustration of
the difference between the standard of care and
sufficiency of care).
In a sufficiency-of-care facility, the medical staff
faces challenges such as limited privacy for patient
assessments, crowded conditions, limited access to
medical records, and inadequate access to testing
capabilities. For example, of all the surge hospitals
set up after Hurricane Katrina, the empty former
retail store veered the furthest from the accepted
standard of care—but it still delivered sufficient
care. The goal of any sufficiency-of-care-facility is
to treat each patient and then transfer him or her to
a facility with full capability to treat patients at an
