Assessing Healthcare Facilities Preparedness for Mass Fatalities Incident

Marisol Peña-Orellana, Ralph Rivera-Gutiérrez, Juan A. Gónzalez-Sánchez, Nilsa Padilla-Elías, Heriberto Marín Centeno, Héctor Alonso-Serra, Liza Millán-Pérez, Patricia Monserrate-Vázquez

Center for Public Health Preparedness, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Center for Public Health Preparedness, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; 2Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Center for Public Health Preparedness, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Department of Emergency Medicine, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.

DOI: 10.4236/ijcm.2013.412091                

Abstract

Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics; emergency plans; equipment and infrastructure; collaborative agreements; personnel trainings; emergency communications; laboratory facilities; treatment protocols; security; and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.

Keywords

Hospitals; Morgues; Mass Casualties; Mass Fatalities; Puerto Rico

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	WHO-World Health Organization, “Mass Casualty Management Systems: Strategies and Guidelines for Building Health Sector Capacity,” Health Action in Crises Injuries and Violence Prevention, WHO Publications, Geneva, 2007, p. 38.
[2]	M. Matzo, T. Powell, J. Surbeck and C. Erickson-Hurt, “Palliative Care Considerations in Mass Casualty Events with Scarce Resources,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Vol. 7, No. 2, 2009.
[3]	L. A. Levy, et al., “Interdisciplinary Approach to All-Hazards Preparedness: Are You Ready? How Do We Know?” Journal of Public Health Management Practice, Vol. 15, No. 2, 2009, pp. S8-S12. http://dx.doi.org/10.1097/01.PHH.0000345979.67724.80
[4]	C. Perera, “After the Tsunami: Legal Implications of Mass Burials of Unidentified Victims in Sri Lanka,” PLoS Medicine, Vol. 2, No. 6, 2005, pp. 185-187. http://dx.doi.org/10.1371/journal.pmed.0020185
[5]	S. Doocy, et al., “Tsunami Mortality in Aceh Province, Indonesia,” Bulletin of the World Health Organization, Vol. 85, 2007, pp. 273-278. http://dx.doi.org/10.2471/BLT.06.033308
[6]	C. K. Brands, et al., “Complete Self-Sufficiency Planning: Designing and Building Disaster-Ready Hospitals,” Southern Medical Journal, Vol. 106, 2013.
[7]	R. W. Niska and C. W. Burt, “Bioterrorism and Mass Casualty Preparedness in Hospitals: United States, 2003,” Advance Data from Vital and Health Statistics, No. 364, National Center for Health Statistics, Hyattsville, 2005, p. 15.
[8]	R. W. Niska and I. M. Shimizu, “Hospital Preparedness for Emergency Response: United States, 2008,” N.S. Report, US Department of Human and Health Services, Bethesda, 2011.
[9]	R. M. Walk, T. F. Donahue, R. P. Sharpe and S. D. Safford, “Three Phases of Disaster Relief in Haiti—Pediatric Surgical Care on Board the United States Naval Ship Comfort,” Journal of Pediatric Surgery, Vol. 46, No. 10, 2011, pp. 1978-1984. http://dx.doi.org/10.1016/j.jpedsurg.2011.04.014
[10]	S. M. Watkins, et al, “State-Level Emergency Preparedness and Response Capabilities,” Disaster Medicine and Public Health Preparedness, Vol. 5, Suppl. S1, 2011, pp. S134-S142. http://dx.doi.org/10.1001/dmp.2011.26
[11]	O. Morgan and C. de Ville de Goyet, “Dispelling Disaster Myths about Dead Bodies and Disease: The Role of Scientific Evidence and the Media,” Revista Panamericana de Salud Pública, Vol. 18, No. 1, 2005, pp. 33-36. http://dx.doi.org/10.1590/S1020-49892005000600006
[12]	O. Morgan, P. Sribanditmongkol, C. Perera, Y. Sulasmi, D. Van Alphen and E. Sondorp, “Mass Fatality Management Following the South Asian Tsunami Sisaster: Case studies in Thailand, Indonesia, and Sri Lanka,” PLoS medicine, Vol. 3, No. 6, 2006, pp. 809-815. http://dx.doi.org/10.1371/journal.pmed.0030195
[13]	P. Sahelangi and M. Novita, “Role of Dentists in Indonesian Disaster Victim Identification Operations: Religious & Cultural Aspects,” Journal of Forensic Odontostomatology, Vol. 30, No. 1, 2012, p. 11.
[14]	CDC Center for Disease Control and Prevention, “The State of CDC, FISCAL YEAR 2005,” US Department of Human Health Services, 2005.
[15]	I. Babar and R. Rinker, “Direct Patient Care during an Acute Disaster: Chasing the Will-o’-the-Wisp,” Critical Care, Vol. 10, No. 1, 2006, p. 206. http://dx.doi.org/10.1186/cc3943
[16]	A. Bhattacharjee and R. Lossio, “Evaluation of OCHA Response to the Haiti Earthquake,” Final Report, 2011. p. 118.
[17]	S. Doocy, M. Cherewick and T. Kirsch, “Mortality Following the Haitian Earthquake of 2010: A Stratified Cluster Survey,” Population Health Metrics, Vol. 11, No. 5, 2013.
[18]	A. Fuse and H. Yokota, “Lessons Learned from the Japan Earthquake and Tsunami, 2011,” Journal of Nippon Medical School, Vol. 79, No. 4, 2012, pp. 312-315. http://dx.doi.org/10.1272/jnms.79.312
[19]	A. Ishigaki, H. Hogashi, T. Sakamoto and S. Shibahara, “The Great East-Japan Earthquake and Devastating Tsunami: An Update and Lessons from the Past Great Earthquakes in Japan since 1923,” Tohoku Journal of Experimental Medicine, Vol. 229, No. 4, 2013, pp. 287-299. http://dx.doi.org/10.1620/tjem.229.287
[20]	P. Dunbar, H. McCullough, G. Mungov, J. Varner and K. Stroker, “Tohoku Earthquake and Tsunami Data Available from the National Oceanic and Atmospheric Administration/National Geophysical Data Center. Geomatics,” Natural Hazards & Risk, Vol. 2, No. 4, 2011, pp. 305-323. http://dx.doi.org/10.1080/19475705.2011.632443
[21]	NOVA Research Company, QDSTM, “Questionnaire Development System,” Bethesda, 2010.
[22]	SAS Institute Inc., “Base SAS® 9.3 Procedures Guide B.S.P. Guide,” Cary, 2011.
[23]	B. Adini, A. Goldberg, D. Laor, R. Cohen, R. Zadok and Y. Bar-Dayan, “Factors That May Influence the Preparation of Standards of Procedures for Dealing with MassCasualty Incidents,” Prehospital and Disaster Medicine, Vol. 22, No. 3, 2007, pp. 175-180.
[24]	B. Adini, A. Goldberg, D. Laor, R. Cohen, R. Zadok and Y. Bar-Dayan, “Assessing Levels of Hospital Emergency Preparedness,” Prehospital and Disaster Medicine, Vol. 21, No. 6, 2006, pp. 451-457.
[25]	E. K. Noji, “The Public Health Consequences of Disasters,” Oxford University Press, New York, 1997.
[26]	Commonwealth of Puerto Rico, “Ley Para Declarar la Muerte en Casos de Eventos Catastróficos,” Ley Núm 1 del 12 de Diciembre de 1985. http://www.lexjuris.com/LEXMATE/salud/lexmuertes.htm
[27]	FEMA, “Humberto Vidal Building Explosion,” 1996. http://www.fema.gov/humberto-vidal-building-explosion-1996
[28]	O. Morgan and M. Tidball-Binz, “Management of Dead Bodies after Disasters: A Field Manual for First Responders,” Panamerican Health Organization, 2009.
[29]	World Health Organization, “Hospital Emergency Response Checklist: An All-Hazards Tool for Hospital Administrators and Emergency Managers,” WHO, Regional Office for Europe, Copenhagen, 2011.