Biomedical Engineering Reference
In-Depth Information
drug errors do not occur. The longer a facility
remains operational, the more demands must be
made on both its environment of care and the
process of care delivery to make sure they are in
line with high standards of care. These demands
can ensure that, while expedient care may be given,
substandard care is never allowed.
The possibility of surge hospitals operating on
a long-term basis adds a third dimension to the
concept of the emergency event itself. Health care
organizations are used to thinking about emer-
gency events on two levels of magnitude, each
with its own response. The first level of emer-
gency can be called the major incident. Exam-
ples include a school bus accident with multiple
casualties, or an industrial explosion producing
numerous burn victims. The local hospital needs
to respond by activating its emergency manage-
ment plan in order to have enough staff available to
manage the situation; however, this type of event is
usually short-lived—lasting perhaps 24 hours—and
the community and its hospital both remain intact.
The second type of emergency event can
be characterized as the disaster. For example,
Hurricane Katrina was a disaster in Gulf Port
and Biloxi, Mississippi, because the health care
infrastructure was damaged as was the infrastruc-
ture of the community. The disaster presents as a
community-wide problem that can extend for many
weeks or months and may need extensive state and
federal resources to ameliorate the situation.
The third level of emergency, virtually unvisited
by health care planners until recent events thrust it
into view, can be described as the catastrophe: a
series of disasters occurring to the same community
in a short period of time. What happened in New
Orleans after the levees broke was a catastrophe.
First, the hurricane hit, causing serious but manage-
able damage. Then the levees broke, flooding the
city. As a consequence, the community's entire
infrastructure broke down: sewer, water, and elec-
trical power were all disabled. The ability of health
care and emergency medical services to respond
was totally disrupted. Finally, civil disturbance
occurred as desperate people fought to survive.
This event was unprecedented in recent U.S. history
and can only be compared to the San Francisco
earthquake and fire of 1906, which ranks as
one of the most serious natural disasters of all time.
What happened in New Orleans has forced
health care organizations to think about how surge
hospitals can be used on a long-term basis to supply
needed medical care. Most pointedly, Charity
Hospital, which was significantly damaged in the
disasters, has prompted the need for patients who
would normally be treated at the hospital to instead
seek care at surge hospitals in the area. The surge
hospital that was initially established in this area
(and which will be developed further in two addi-
tional phases) could be used by the Federal Emer-
gency Management Agency (FEMA) as a model
for the nation.
The initial stage of the surge hospital that was
set up after Charity Hospital was severely damaged
was the tent hospital established on October 8,
2005, in the parking lot of the old Charity Hospital.
This surge hospital remained in place when this
publication went to press. The next phase being
considered is a hard-sided shelter system with indi-
vidual rooms, each with its own bathroom.
Louisiana State University (LSU), which oper-
ated Charity Hospital, expects to set up a modular
component structure over the next six months that
has been used nationwide and meets all Joint
Commission standards. Such a structure may repre-
sent a permanent solution to the problem of a
replacement for hospitals that must be rebuilt
due to extensive damage from a disaster. This
type of premanufactured component construction
is assembled on site and is built to last for years.
Alternatively, the permanent facility might evolve
into a site that has a main hospital downtown
with eight satellite offices that could accommodate
outpatient surgery suites or clinics. These satellites
could be converted into surge hospital space within
hours. Other options were being considered as this
paper went to press.
Possible development of Joint
Commission standards for surge
hospitals
In the aftermath of the hurricanes that caused
significant damage to health care organizations on
