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Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event.

Sheuwen Chuang1,2, David D Woods3, Morgan Reynolds3

  • 1Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan. sheuwen@tmu.edu.tw.

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Summary

This study introduces a novel framework for hospital preparedness for mass casualty incidents (MCIs) beyond surge capacity. It details overload patterns and adaptations to enhance emergency department readiness for large-scale burn disasters.

Keywords:
Burn disasterEmergency medical serviceFormosa Fun Coast Dust ExplosionMass casualty incidentPreparedness planSurge capacity

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Area of Science:

  • Disaster Medicine
  • Emergency Preparedness
  • Public Health Response

Background:

  • Large-scale burn disasters pose significant threats to medical care systems.
  • Existing hospital preparedness plans may be insufficient for beyond-surge-capacity events.

Purpose of the Study:

  • To propose a new approach for developing hospital readiness and preparedness plans for mass casualty incidents (MCIs) exceeding surge capacity.
  • To analyze hospital responses to the Formosa Fun Coast Dust Explosion (FFCDE) to inform future preparedness strategies.

Main Methods:

  • Conducted in-depth interviews with clinicians from four initial receiving hospitals following the FFCDE.
  • Collected and analyzed hospital records, patient flow, and emergency department (ED) workload changes.
  • Utilized chronological process-tracing, synthesis, and comparison analysis to develop an integrated adaptations framework.

Main Results:

  • Developed a four-level ED overload pattern detailing patient load changes and surge capacity overwhelm over time.
  • Created an integrated 19 adaptations framework illustrating interrelations between preparedness strategies.
  • Demonstrated the utility of overload patterns and metrics for scenario design and planning.

Conclusions:

  • Solely relying on policies or guidelines is insufficient for true MCI readiness.
  • Hospitals should rethink preparedness planning beyond surge capacity using the study's findings.
  • The proposed framework serves as an auxiliary tool for directive planning and addressing preparedness insufficiencies.