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Tragedy Meets GME: The Impact of the October 1st Mass Casualty Incident on Academic Attending and Resident Physicians
- Suzanne Roozendaal, Gregory Guldner, Hoda Abou-Zaid, Jason Siegal, Ross Berkeley, Dylan Davey, Michael Allswede
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- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue s1 / May 2019
- Published online by Cambridge University Press:
- 06 May 2019, p. s72
- Print publication:
- May 2019
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Introduction:
On October 1, 2017, a gunman fired on a festival in Las Vegas, Nevada, killing 58 people and wounding over 500. Multiple casualties were received at two nearby hospitals that sponsor residency programs: Sunrise Hospital and Medical Center and University Medical Center.
Aim:To evaluate the impact of the most lethal mass-shooting event in US history on graduate medical education (GME) at the involved hospitals.
Methods:Anonymized surveys were sent to 210 physicians at SMC and 110 physicians at UMC. Surveys incorporated 4 validated instruments: The Post Traumatic Growth Inventory (PTGI), The Impact of Events Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), and The Team Cohesion Factor (TCF).
Results:Sixty-six physicians completed the surveys (38 attendings; 17 residents). 10% of physicians scored in the likely posttraumatic stress disorder (PTSD) range and 15% found themselves avoiding or struggling with managing similar patients, though overall survey response rate was low. The majority of physicians did not believe the event impacted their specific GME activities. No attending physician rated the event as negative in terms of global impact on GME, and 34% rated it as positive. However, 12 of 17 residents rated the event as a hurdle in its GME impact. A regression model predicting the IES-R score demonstrated a trend that those with higher pre-event stress and lower social support reported more adverse impact (p<0.06).
Discussion:We believe our study is the first to examine the impact of mass casualty traumatic events on graduate medical education. Attendings and residents differ in their global perception of the impact, with attendings viewing it as a positive event and residents as a challenge. Pre-event level of stress and perceived social support predicted the impact of the event and may partially explain these results if residents and attendings vary on these parameters.
Financial Implications of Hospital Response to Bioterrorism Based on Diagnosis-Related Group Analysis
- Joe Suyama, Lucy Savitz, Helen Chang, Michael Allswede
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- Journal:
- Prehospital and Disaster Medicine / Volume 22 / Issue 2 / April 2007
- Published online by Cambridge University Press:
- 28 June 2012, pp. 145-148
- Print publication:
- April 2007
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Introduction:
During an infectious disease outbreak, the ability of a hospital to continue routine operations depends upon its ability to absorb expected losses in revenue when the routine charge base is replaced by infectious disease-related charges.
Objective:The purpose of this study was to determine the probable financial impact of a bioterrorism event or an infectious disease outbreak on an academic and a community hospital.
Methods:During the fiscal year 01 July 2002–30 June 2003, the average number of inpatient charges identified by the diagnosis-related-groups (DRGs) of an academic, tertiary care, Level-1 trauma center (PUH) and a community hospital (StM) were obtained retrospectively. Per diem charges were determined for patients with: (1) gastroenteritis; (2) sepsis; (3) meningitis; (4) tuberculosis (TB); and (5) pneumonia. These charges were used to simulate the financial coding of patients exposed to biological agents.
Results:The total average PUH per diem charges per patient for all 31,530 discharges was (US)$10,516. Specifically, the average changes were $20,499 for patients with transplants, $14,406 for receiving critical care services, $12,650 for the provision of cardiac care, $11,576 for trauma/orthopedic care, and $8,259 for services for patients who suffered a stroke. For patients with infectious diseases, the average per diem charges per patient were: (1) $6,184 for patients with gastroenteritis; (2) $7,842 for patients with sepsis; (3) $10,831 for patients with meningitis; (4) $6,118 for patients with TB; and (5) $4,586 for patients with pneumonia. Per patient per day, PUH would generate a potential net on average loss of: (1) $4,332 for gastroenteritis; (2) $2,674 for sepsis; (3) $4,398 for TB; and (4) $5,930 for pneumonia replaced an admission. Patients with meningitis on average generated a net gain ($315) compared to the average, but would not compensate for the denial of transplant, cardiac, trauma/orthopedic, and some critical care services during the event. Total average StM per diem charges per patient for all 10,470 discharges equaled $3,008. Specifically, $4,965 for critical care, $3,022 for cardiac care, $4,397 for trauma/orthopedic care, and $3,037 for stroke services. For infectious diseases, the average per diem charge per patient was: (1) $2,273 (+$735) for gastroenteritis; (2) $3,047 (+$39) for sepsis; (3) $2,504 (-$504) for meningitis; (4) $2,887 ($120) for TB; and (5) $2,652 (-$356) for pneumonia (net loss/gain in parenthesis).
Conclusions:Through DRG analysis, the probable financial impact of a bioterrorist attack on a Health Care Delivery System is largely detrimental. Preparedness for a biological event must include an assessment of hospital capability and capacity to handle these types of patients, but also must consider the financial ability to absorb expected losses in charges or ways in which to recover the losses.
Prevalence of Radioactive Signals from Surveillance of an Emergency Department
- Frank Guyette, Joe Suyama, Jerry Rosen, Michael Allswede
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- Journal:
- Prehospital and Disaster Medicine / Volume 21 / Issue 4 / August 2006
- Published online by Cambridge University Press:
- 28 June 2012, pp. 276-281
- Print publication:
- August 2006
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Introduction:
Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.
Objective:The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).
Methods:A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).
Results:A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.
Conclusion:The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.