Date of Award
Doctor of Science (DSc) in Emergency Management
Jane Kushma, Professor of Emergency Management
This study explores planning considerations for patients needing rehabilitative care in the event of mass casualty incidents, in particular, patient surge. While planning for a patient surge usually considers prehospital and hospital care, the final step for many disaster patients, rehabilitation is often overlooked. Rehabilitative care begins in the hospital, before discharge, with the consultation of a physician specialist. By including early physiatrist care there are documented decreases in hospital length of stay, fewer medical complications and better functional outcomes.
Based on past disaster studies, the variables of Simple Triage and Rapid Treatment (START), Injury Severity Score (ISS), and hospital discharge were chosen as benchmarks. The quantitative study research questions are:
- Can START classifications predict whether a patient will need to be admitted into a rehabilitation facility after a disaster?
- Can ISS scores predict which patients will need to be admitted into a rehabilitative facility after a disaster?
A secondary disaster dataset was constructed from the 2011 National Trauma Data Bank (NTDB) dataset for patients injured during a disaster. Analysis of this empirical data provided evidence that the selected variables did predict rehabilitation admission, and thus can be used in pre-disaster and operational medical planning.
Qualitative methods were used to investigate how rehabilitation considerations might be incorporated in surge planning. A Haddon matrix for surge planning provided the conceptual framework and aided in the development of interview questions. Six themes were analyzed based on the interview question responses: barriers to planning; multiple surges; planning for v resources; planning to prevent injuries; optimal time to look for rehabilitation beds; and, additional recommendations. The insights of subject matter experts revealed many new strategies to improve surge planning and patient outcomes. This study concludes that a reconceptualization of surge planning to include three phases of field, hospital, and rehabilitation is a needed improvement to medical disaster planning.