Hospitals eye disaster response

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Terrorists strike or a hurricane descends: The sudden surge of casualties in a disaster poses a monumental challenge for the nation's hospitals. Who gets care -- and who doesn't? A group of public health and safety specialists has some advice.

Health care facilities should rank their patients into five numerical categories based on the severity of their condition and quickly discharge the least vulnerable to accommodate incoming ill and injured in a worse-case scenario.

This classification process -- called "reverse triage" -- has been developed by a panel of 39 physicians, nurses, administrators, homeland security advisers and disaster management specialists assembled by Johns Hopkins University's Office of Critical Event Preparedness and Response during a recent "warfare analysis" exercise.

"Without this sort of system in place, the worry is that a hospital's resources would be quickly overwhelmed in a major crisis," says Dr. Gabor Kelen, head of emergency medicine at Hopkins and the office's director.

Such a strategy, which could send low-risk patients for care at nursing homes, public health centers or home, could safely empty 70 percent of a hospital's inpatient population in 72 hours, Dr. Kelen said.

Only a scorecard system can "take the emotion" out of difficult decision-making in the midst of catastrophe, he added, while streamlining hospital bureaucracy and paperwork. The disaster plan would also provide an "ethical framework" of operation to decide who must leave the hospital -- and who stays.

"The focus is to concentrate resources on the most severely injured or ill ... making the most of available resources," Dr. Kelen noted in an analysis of the panel's findings, published in the Lancet, a British medical journal, on Tuesday.

The U.S. can use that idea. An analysis of federal and state preparedness for major public health emergencies released Wednesdayby the Trust for America's Health only gave the federal agencies a "D-plus" for their efforts while half the states scored less than 5 out of the 10 key emergency preparedness indicators. The analysis also found a third of hospitals have no plans in place for a rush of extra patients in the event of an attack or disaster.

Some health care systems are taking their own simple but effective initiatives to meet unpredictable challenges of a post-September 11 world. North Carolina's Statewide Program for Infection Control and Epidemiology developed wall posters identifying bio- and chemical terrorism agents for display in hospital emergency rooms -- with a "phenomenal" response, according to spokeswoman Karen K. Hoffmann. Hospitals in 25 states have requested copies.

The Hopkins panel concluded that every hospitalized patient should be assigned a ranking score, updated according to their vital signs and other factors. Dr. Kelen, who plans a future test run of the system on 4,000 patients nationwide, also thinks the method "could have a substantial effect on the safe management of hospital capacity on a routine daily basis."