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Upgrading central city hospitals would put them in the firing line

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Today a piece appeared in the Sydney Morning Herald calling for a specialist disaster response capacity to be established in central city hospitals across Australia.

The article likened this network of hospitals to frigates, able to rapidly respond with a high-tech, highly trained crew. Unfortunately, unlike a frigate, a hospital can’t move which might make them sitting ducks in an emergency. There’s a few reasons why central city hospitals aren’t the ideal facility to respond to a CBD based emergency:

  • Location: Their central city location which makes them close to the action, also makes them more vulnerable to being impacted by whatever hazard (natural, or man-made) is impacting the city. Not only might this reduce the hospital’s ability to perform its national security function, but the hospital itself could fall victim to whatever hazard is occurring or secondary effects such as power outages or communications failures.
  • Staff: A key aspect of hospital response in a mass casualty incident is surge capacity. This is the ability of hospitals to ‘ramp up’ their triage, emergency and surgical capacities to cope with a massive influx of patients. Surge capacity can include calling in off-duty staff. If the emergency has created gridlock these staff, without marked vehicles and flashing lights and sirens would find it even more difficult than emergency vehicles to reach the hospital. Even worse, for a central city hospital, many of these staff would rely on public transport to get them to the hospital. The public transport could itself be impacted preventing these staff from reaching the hospital.
  • Patients: Hospitals can also create surge capacity by discharging patients who are well enough to leave. If the emergency’s on the hospital’s doorstep they would be discharging these patients into harms way.
  • The Walking Wounded: Any disaster will create more minor casualties than serious ones. The seriously injured will still require transport to a hospital, whereas those with minor injuries are generally asked to wait, return home, or sent to other medical facilities by their own means. With knowledge of a specialist disaster centre close-by these walking wounded could overwhelm the triage facilities there making it harder for staff to identify those more seriously injured.
  • Redundancy: Putting all your eggs in one basket is never a good idea; in a disaster it can be fatal. Focusing disaster response capacity on just one hospital at the expense of spreading the capacities across a city could leave you without that capacity, just when you need it most.

In a mass casualty emergency many of the capabilities present at an emergency department are brought to the disaster scene. People are rescued and brought out of the ‘hot’ or danger zone to a triage and first aid area where specialist paramedics work alongside doctors and nurses who have been brought to the scene to assess, prioritise stabilise and transport the injured to a hospital for treatment. Highly trained paramedics and doctors work alongside rescue teams to bring life-saving aid to those who may be trapped. The disaster response paradigm expects that hospitals will be located well away from the disaster site. Often there can be gridlock at a disaster scene, but in many cases this is from having too many emergency resources turning up to help.

All emergency resources including hospitals, ambulance services and health departments need to be well-prepared to act in a swift and coordinated manner in the face of disaster. Staff and facilities need to be well trained and conduct regular mass casualty exercises to ensure that systems and plans will function well in an emergency. This needs to happen in all hospitals, not just those with specialist trauma capabilities and large emergency departments as you may never know when a smaller facility could be called upon to help.


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