Outbreak of NDM-1-Producing Escherichia coli in a Coronavirus Disease 2019 Intensive Care Unit in a Mexican Tertiary Care Center

The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.

Beirut Blast 2020: Cries and Bloodshed at the Busiest Hospital

On August 4, 2020, Beirut experienced a large explosion when 2750 tons of ammonium nitrate detonated in the Beirut port resulting in more than 220 deaths, 76 000 injuries, 300 000 people displaced, and 15 billion dollars loss in property damage. Hôtel-Dieu de France (HDF), one of the largest university hospitals in the capital, has an emergency department that typically accommodates 25 patients. On that night, it received the largest number of injuries and had to accommodate more than 700 casualties within a few hours of the blast. This article describes HDF’s preparedness, emergency response, as well as the distribution of admissions to the emergency department, operation rooms, and the general ward. Surge capacity and the triage system are also detailed.

Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

Optimal allocation of resources to healthcare workers or the general populace: a modelling study

We consider a model that distinguishes susceptible; infected, but not yet infectious; pre-symptomatic, symptomatic, asymptomatic, and hospitalized infectious; recovered and dead members of two groups: healthcare workers (HCW) and members of the community that they serve. Because of the frequency or duration of their exposures to SARS-CoV-2, a greater fraction of HCW would experience severe COVID-19 symptoms that require medical care, which reduces mortality rates, absent personal protective equipment (PPE). While N95 masks (and, possibly, other scarce medical resources) are available to members of both groups, they do not use them equally well (i.e. efficacy and compliance differ). We investigated the optimal allocation of potentially scarce medical resources between these groups to control the pandemic and reduce overall infections and mortality via derivation and analysis of expressions for the reproduction numbers and final size. We also simulated prevalence and cumulative incidence, quantities relevant to surge capacity and population immunity, respectively. We found that, under realistic conditions, the optimal allocation is virtually or entirely to HCW, but that allocation of surplus masks and other medical resources to members of the general community also reduces infections and deaths.

Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases—A pilot-study in Rwanda

Objective Surge capacity refers to preparedness of health systems to face sudden patient inflows, such as mass-casualty incidents (MCI). To strengthen surge capacity, it is essential to understand MCI epidemiology, which is poorly studied in low- and middle-income countries lacking trauma databases. We propose a novel approach, the “systematic media review”, to analyze mass-trauma epidemiology; here piloted in Rwanda. Methods A systematic media review of non-academic publications of MCIs in Rwanda between January 1st, 2010, and September 1st, 2020 was conducted using NexisUni, an academic database for news, business, and legal sources previously used in sociolegal research. All articles identified by the search strategy were screened using eligibility criteria. Data were extracted in a RedCap form and analyzed using descriptive statistics. Findings Of 3187 articles identified, 247 met inclusion criteria. In total, 117 MCIs were described, of which 73 (62.4%) were road-traffic accidents, 23 (19.7%) natural hazards, 20 (17.1%) acts of violence/terrorism, and 1 (0.09%) boat collision. Of Rwanda’s 30 Districts, 29 were affected by mass-trauma, with the rural Western province most frequently affected. Road-traffic accidents was the leading MCI until 2017 when natural hazards became most common. The median number of injured persons per event was 11 (IQR 5–18), and median on-site deaths was 2 (IQR 1–6); with natural hazards having the highest median deaths (6 [IQR 2–18]). Conclusion In Rwanda, MCIs have decreased, although landslides/floods are increasing, preventing a decrease in trauma-related mortality. By training journalists in “mass-casualty reporting”, the potential of the “systematic media review” could be further enhanced, as a way to collect MCI data in settings without databases.

A national survey of hospital readiness during the COVID-19 pandemic in Nigeria

Introduction The COVID-19 pandemic continues to overwhelm health systems across the globe. We aimed to assess the readiness of hospitals in Nigeria to respond to the COVID-19 outbreak. Method Between April and October 2020, hospital representatives completed a modified World Health Organisation (WHO) COVID-19 hospital readiness checklist consisting of 13 components and 124 indicators. Readiness scores were classified as adequate (score ≥80%), moderate (score 50–79.9%) and not ready (score <50%). Results Among 20 (17 tertiary and three secondary) hospitals from all six geopolitical zones of Nigeria, readiness score ranged from 28.2% to 88.7% (median 68.4%), and only three (15%) hospitals had adequate readiness. There was a median of 15 isolation beds, four ICU beds and four ventilators per hospital, but over 45% of hospitals established isolation facilities and procured ventilators after the onset of COVID-19. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff welfare (50%) and availability of critical items (47.7%). Conclusion Most hospitals in Nigeria were not adequately prepared to respond to the COVID-19 outbreak. Current efforts to strengthen hospital preparedness should prioritize challenges related to surge capacity, critical care for COVID-19 patients, and staff welfare and protection.

Surge capacity and capability of intensive care units across a large healthcare system: An operational blueprint for regional integration

Objective: Many hospitals were unprepared for the surge of patients associated with the spread of coronavirus disease 2019 (COVID-19) pandemic. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system.Setting: A large academic medical center in the Cleveland metropolitan area, with a network of 10 regional hospitals throughout Northeastern Ohio with a daily capacity of more than 500 intensive care unit (ICU) beds.Results: At the beginning of the pandemic, an equitable delivery of healthcare services across the healthcare system was developed. This distribution of resources was implemented with the potential needs and resources of the individual ICUs in mind, and epidemiologic predictions of virus transmissibility. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. We also describe an additional level of surge capacity, which is available to well-integrated institutions called “extension of capacity.” This refers to the ability to immediately have access to the beds and resources within a hospital system with minimal administrative burden.Conclusions: Large integrated hospital systems may have an advantage over individual hospitals because they can shift supplies among regional partners, which may lead to faster mobilization of resources, rather than depending on local and national governments. The pandemic response of our healthcare system highlights these benefits.

Whole-of-Government Crisis Management: From Research to Practice

When a crisis manifests, the problem or situation is often at a terrible point where sage and timely decisions are of critical importance. Ideally, the particular emergency has been known previously and various challenges, roadblocks, and solutions workshopped in a tabletop or other exercise. Whether in advance or at a sudden precipice, a whole-of-government approach can navigate, mitigate, and alleviate the disaster in a holistic and comprehensive manner that is tailored to the task at hand. Whole-of-government crisis management—at the local, state, national, or international level—involves several elements. First, those in command need to know the myriad of players who may have roles and responsibilities to play at pivotal moments. Every organization will not be required in every crisis, and a strategic mix and match is often valuable. Second, each agency needs to understand how it fits into the larger puzzle and adjust their internal culture accordingly to support interagency operations, regardless of who is providing a lead function and who is supporting. Then, the agencies must have the staff available to fulfill their tasks and surge capacity, making provisions for alternative personnel or a “backbench” to execute everyday operations while the frontlines are busy. Elements of whole-of-government approaches appear throughout all aspects of crisis management. A relatively recent term, whole of government is an expansive framework for coordinating interagency responses that is often invoked in policy documents, as well as examined in academic studies. As it is adopted by various administrations and organizations during times of calm and emergency, the whole-of-government approach has aspects that are enduring, countervailing, and aspirational. The instruments of national power—diplomatic, information, military, and economic (DIME)—provide one lens through which to examine whole-of-government crisis management. Past interagency responses demonstrate best practices and difficult lessons learned for future whole-of-government operations. A broad analysis of whole-of-government crisis management enables government leaders, practitioners, scholars, researchers, and others to create comprehensive and flexible strategies with delineated roles for dedicated interagency partners in advance of the next hurricane or terrorist attack.