Disaster Planning Assumptions and the Dangers Therein – The Importance of Evidence-Based Planning

In an article that is extremely valuable to anyone in a healthcare sector emergency planning function, Erik Auf der Heide (2006) presents seven assumptions under which disaster planning is often based. His evaluation and deconstruction of those assumptions present some very interesting points to consider in the process of disaster planning. For example, his fifth assumption presented is that “casualties will be transported to hospitals appropriate for their needs and in such a manner that no hospitals receive a disproportionate number.” However, he goes on to prove that that is largely a fallacy in practice, and that, in reality, “most casualties are transported to the closest or most familiar hospitals” (p. 41).

This disparity between conventional wisdom and historically proven facts is of particular interest to me because of where I live and used to work at a large hospital. Washington, D.C. is considered a “Tier I city – a designation given to ‘high-threat, high-density urban areas’ that are at the ‘highest risk’ for acts of terrorism’” (HSDL, 2008, p. 1). What raises major concerns for me, however, are the research observations that Auf der Heide presents in context with the overall capacity that exists in D.C. to deal with acute trauma patients in a mass casualty situation.

Auf der Heide (2006) provides some very valuable possible solutions to the problems that accompany his fifth assumption. His suggestions to avoid the overwhelming of the hospitals that are either closest to the incident site or are the most familiar or respected for the treatment of traumas include: having ambulances avoid transporting patients to the closest hospital; establishing a predetermined amount of casualties that will be transported to each hospital based on a ratio in relation to the capabilities of other area hospitals; advising survivors of the incident that wait times at more distant hospitals will be shorter; and setting up “triage areas on major roads leading to the closest hospitals so that the patients could be redirected to the hospitals most appropriate for their needs” (p. 42).

The HDSL study (2008), however, highlights some major gaps in the capabilities of D.C. Level I trauma centers in being able to receive patients on mass casualty incident levels. The study found that, at a random time on a random day, the D.C. trauma centers were operating above capacity already, with no incident out of the ordinary having occurred (p. 1-2). This level of operations as a standard makes these facilities incapable of responding adequately on their own to the demands of a large-scale disaster or other mass casualty incident, so plans must be in place ahead of time to mitigate this situation through coordination and collaboration between regional agencies, organizations, and jurisdictions. This city is not unique in this regard, and this fact makes it vitally important for disaster planners to consider and implement suggestions such as those made by Auf der Heide. Disaster planning must be done based on established best practices and empirical evidence, not on assumptions.

References:

Auf der Heide, A. (2006). The importance of evidence-based disaster planning. Annals of Emergency Medicine, 47(1), 34-44.

Homeland Security Digital Library (HSDL). (2008). Snapshot of emergency surge capacity in Washington, DC. Retrieved March 28, 2012, from http://www.hsdl.org/?view&did=485722