Case managers in mass casualty incidents.

Area of Science:

• Emergency Medicine
• Trauma Care
• Healthcare Management

Background:

• Multiple Casualty Incidents (MCIs) can lead to chaotic patient management due to frequent relocations between medical teams.
• A hospital implemented a new policy assigning case managers to patients throughout their treatment cascade during MCIs.
• This change aimed to improve patient flow and care continuity compared to traditional team-based transfers.

Purpose of the Study:

• To evaluate the impact of case managers on patient evaluation, treatment, and outcomes during MCIs.
• To assess the effect of case managers on hospital staffing requirements in MCI scenarios.
• To determine if case management improves efficiency and patient care during mass casualty events.

Main Methods:

• Retrospective analysis of hospital database records for 17 MCIs between 2001 and 2006.
• Calculation of Injury Severity Scores (ISS) and comparison of staff utilization before and after policy implementation.
• Semi-structured interviews with 26 experienced staff members to gather qualitative data on patient care.

Main Results:

• No significant difference in event severity, manpower demands, or patient mortality before and after the policy change.
• Significant reductions observed in diagnostic workup times (e.g., chest x-rays), time to surgery, and length of hospital stay for critically injured patients.
• Majority of interviewed staff (62%) reported improvements in patient care, communication, and documentation.

Conclusions:

• Case managers enhance surge capacity during MCIs by improving workflow efficiency and resource utilization.
• Case management may lead to better patient care through increased accountability, continuity, and involvement in treatment decisions.
• The case management model offers a potential strategy for optimizing care delivery during mass casualty events.