Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-14T11:25:04.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Freestanding Emergency Critical Care During the Aftermath of Hurricane Sandy: Implications for Disaster Preparedness and Response

Published online by Cambridge University Press:  13 May 2016

Silas W. Smith ,
Catherine T. Jamin ,
Sidrah Malik ,
Liliya Abrukin ,
Keegan M. Tupchong ,
Ian Portelli ,
Glenn Asaeda ,
David J. Prezant ,
Binhuan Wang  and
Ming Hu
...Show all authors
Silas W. Smith*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York NYU Langone Medical Center Institute for Innovations in Medical Education, New York, New York
Catherine T. Jamin
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Sidrah Malik
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Liliya Abrukin
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Keegan M. Tupchong
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Ian Portelli
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Glenn Asaeda
Affiliation:
Office of Medical Affairs, The Fire Department of the City of New York, New York
David J. Prezant
Affiliation:
Office of Medical Affairs, The Fire Department of the City of New York, New York
Binhuan Wang
Affiliation:
Department of Population Health, Division of Biostatistics, NYU School of Medicine, New York, New York
Ming Hu
Affiliation:
Department of Population Health, Division of Biostatistics, NYU School of Medicine, New York, New York
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Chad M. Meyers
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York
*
Correspondence and reprint requests to: Silas W. Smith, MD, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, Bellevue Hospital Center, 462 First Avenue, Room A-345A, New York, New York 10016 (e-mail: Silas.Smith@nyumc.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy.

Methods

We retrospectively reviewed records of all patients in Bellevue’s EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated.

Results

Two hundred twenty-seven patients utilized the EICU, representing approximately 1.8% of freestanding ED patients. Ambulance arrival occurred in 31.6% of all EICU patients. Median length of stay was 11.55 hours; this was significantly longer for patients requiring airborne isolation (25.60 versus 11.37 hours, P<0.0001 by Wilcoxon rank sum test). After stabilization and treatment, 39% of EICU patients had an improvement in their disposition status (P<0.0001 by Wilcoxon signed rank test); upon interhospital transfer, the absolute proportion of patients requiring ICU and SDU resources decreased from 37.8% to 27.1% and from 22.2% to 2.7%, respectively.

Conclusions

An EICU attached to a freestanding ED achieved significant reductions in resource-intensive medical care. Flexible, adaptable care systems should be explored for implementation in disaster response. (Disaster Med Public Health Preparedness. 2016;10:496–502)

Keywords

critical caredisasteremergency departmentfreestandingHurricane Sandy
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Special Issue 3: Superstorm Sandy , June 2016 , pp. 496 - 502
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lee, DC, Smith, SW, McStay, CM, et al. Rebuilding emergency care after Hurricane Sandy. Disaster Med Public Health Prep. 2014;8:119-122.CrossRefGoogle ScholarPubMed
2. Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47:34-49.CrossRefGoogle ScholarPubMed
3. Intas, G, Stergiannis, P, Chalari, E, et al. The impact of ED boarding time, severity of illness, and discharge destination on outcomes of critically ill ED patients. Adv Emerg Nurs J. 2012;34:164-169.CrossRefGoogle ScholarPubMed
4. Institute of Medicine (IOM) Committee on the Future of Emergency Care in the United States Health System. Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press; 2006.Google Scholar
5. Nguyen, HB, Rivers, EP, Havstad, S, et al. Critical care in the emergency department: aphysiologic assessment and outcome evaluation. Acad Emerg Med. 2000;7:1354-1361.CrossRefGoogle Scholar
6. Dellinger, RP, Levy, MM, Rhodes, A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637.CrossRefGoogle ScholarPubMed
7. Nelson, M, Waldrop, RD, Jones, J, et al. Critical care provided in an urban emergency department. Am J Emerg Med. 1998;16:56-59.CrossRefGoogle Scholar
8. Magid, DJ, Sullivan, AF, Cleary, PD, et al. The safety of emergency care systems: results of a survey of clinicians in 65 US emergency departments. Ann Emerg Med. 2009;53:715-723:e1.CrossRefGoogle ScholarPubMed
9. Goldstein, RS. Management of the critically ill patient in the emergency department: focus on safety issues. Crit Care Clin. 2005;21:81-89, viii-ix.CrossRefGoogle ScholarPubMed
10. Haupt, MT, Bekes, CE, Brilli, RJ, et al. Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med. 2003;31:2677-2683.CrossRefGoogle ScholarPubMed
11. Gajic, O, Afessa, B. Physician staffing models and patient safety in the ICU. Chest. 2009;135:1038-1044.CrossRefGoogle ScholarPubMed
12. Capuzzo, M, Valpondi, V, Sgarbi, A, et al. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med. 2000;26:1779-1785.CrossRefGoogle Scholar
13. Headquarters – Department of the Army. Field Manual No. 8-10-6. Medical Evacuations in a Theater of Operations: Tactics, Techniques, and Procedures. Washington, DC: Department of the Army; 2000.Google Scholar
14. Grathwohl, KW, Venticinque, SG. Organizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems. Crit Care Med. 2008;36(7 suppl):S275-S283.CrossRefGoogle ScholarPubMed
15. Chambers, LW, Green, DJ, Gillingham, BL, et al. The experience of the US Marine Corps' Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom. J Trauma. 2006;60:1155-1161; discussion 61-64.CrossRefGoogle ScholarPubMed
16. Sallee, DR, Love, JW, Welling, LE. The United States Marine Corps Shock Trauma Platoon: the modern battlefield's emergency room. Prehosp Emerg Care. 2008;12:80-86.CrossRefGoogle ScholarPubMed
17. Eastridge, BJ, Costanzo, G, Jenkins, D, et al. Impact of joint theater trauma system initiatives on battlefield injury outcomes. Am J Surg. 2009;198:852-857.CrossRefGoogle ScholarPubMed
18. Hacon, WS. Echelons of medical care. Can Med Assoc J. 1962;87:1153-1156.Google ScholarPubMed
19. D’Amore, AR, Hardin, CK. Air Force expeditionary medical support unit at the Houston floods: use of a military model in civilian disaster response. Mil Med. 2005;170:103-108.Google ScholarPubMed
20. City of New York, Mayor Michael R. Bloomberg. PlaNYC: A Stronger, More Resilient New York. New York: City of New York; 2013. http://www.nyc.gov/html/sirr/html/report/report.shtml. Published June 11, 2003. Accessed March 30, 2016.Google Scholar
21. Smith, SW, Braun, J, Portelli, I, et al. Prehospital indicators for disaster preparedness and response: New York City Emergency Medical Services in Hurricane Sandy. Disaster Med Public Health Prep. [published online January 7, 2016]. doi: 10.1017/dmp.2015.175.Google Scholar
22. Pettypiece, S, Deprez, E. Post-Sandy hospital closures signal wider safety threat. Bloomberg Business. http://www.bloomberg.com/news/articles/2012-12-07/post-sandy-hospital-closures-signal-wider-safety-threat. Published December 7, 2012. Accessed March 31, 2016.Google Scholar
23. Office of Inspector General, Department of Health and Human Services. Hospital Emergency Preparedness and Response during Superstorm Sandy (OEI-06-13-00260). Washington, DC: Department of Health and Human Services; 2014. http://oig.hhs.gov/oei/reports/oei-06-13-00260.pdf. Published September 2014. Accessed March 31, 2016.Google Scholar
24. Joint Commission Resources, Quality & Safety Network. Joint Commission Resources Quality & Safety Network Resource Guide. What You Need to Know About Emergency Management. Oakbrook Terrace, IL: Joint Commission Resources; 2013.Google Scholar
25. Roberts, DJ, Bobrovitz, N, Zygun, DA, et al. Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study. Ann Surg. [published online October 1, 2015]. doi: 10.1097/SLA.0000000000001347.Google Scholar
26. Dettmer, M, Holthaus, CV, Fuller, BM. The impact of serial lactate monitoring on emergency department resuscitation interventions and clinical outcomes in severe sepsis and septic shock: an observational cohort study. Shock. 2015;43:55-61.CrossRefGoogle ScholarPubMed
27. McCoy, JV, Gale, AR, Sunderram, J, et al. Reduced hospital duration of stay associated with revised emergency department-intensive care unit admission policy: a before and after study. J Emerg Med. 2015;49:893-900.CrossRefGoogle ScholarPubMed
28. Hogan, DE, Waeckerle, JF, Dire, DJ, et al. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med. 1999;34:160-167.CrossRefGoogle ScholarPubMed