Planning for surge of disaster victims? Discharge the healthiest from every hospital, experts advise

A nationwide blue-ribbon panel of health care experts recommends that hospital plans for a surge of disaster victims should begin with a strategy to empty their beds of relatively healthier patients.

Preliminary data suggest that such a strategy could safely empty 70 percent of a hospitals inpatient population within 72 hours.

So-called "surge capacity" is tight in the nation's hospitals, shriveled by years of decreases in patient capacity, cost controls, managed care, regulation and nursing shortages.

Led by Gabor Kelen, M.D., head of emergency medicine at The Johns Hopkins Hospital and director of the Johns Hopkins Office of Critical Event Preparedness and Response, the panel concluded that all hospitalized patients at any given time should be routinely ranked according to how sick they are and assigned a constantly updated "score" based on their vital signs, present condition and prognosis. That number would put them at a moments notice into risk groups that would rapidly inform decisions to discharge them or send them to another facility should a major disaster occur.

There is consensus among health care officials that, whether dealing with a natural disaster like Hurricane Katrina, a possible terrorist attack like September 11, or epidemics like SARS or avian flu, affected hospitals have few means of making room for large numbers of incoming casualties, Kelen says.

In one common disaster response, medical centers would set up additional beds wherever they can (in hallways, cafeterias, etc.). But, concerned that staffing levels could not expand to care for so many new patients, the authors of the study, in the latest issue of the journal Lancet, say "disposition classification" is a must.

"Without this sort of system in place, the worry is that a hospitals resources would be quickly overwhelmed in a major crisis," says Kelen. "So not only would the disaster victims not get adequate treatment, but ne

Contact: Jeff Ventura
Johns Hopkins Medical Institutions

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