Turning Chaos into Order : Preparedness, Concepts and Lessons Learned in Disaster Medicine

Optimal care for a sudden, unexpected large number of victims from a mass casualty incident (MCI) is demanding and challenging for every healthcare system. It requires paradigm shift from regular trauma care. Instead of focusing on the individual patient with unlimited resources the focus of care should be on the benefit of the largest number of people, with limited resources. The Dutch healthcare system has a unique solution to increasing the resilience and preparedness of the healthcare system: a hospital dedicated to the handling of surge capacity from MCIs, the Major Incident Hospital (MIH). The on-going development of systems, the design of new concepts, and the evaluation of their deployment to gain lessons learned are the focus of this thesis. Several other dedicated MCI hospitals have been built or are presently under construction. The local circumstances should be taken into account during their design, to determine the functionality for both short-term solutions for surge capacity and as fortified structures to withstand under-siege situations, depending on the challenges and risk countries face. The MIH continuously seeks to optimise their preparedness, for example by improving patient tracking and tracing systems. The development of the Patient Barcode Registration System (PBRS) started 20 years ago and is under constant improvement. Documentation is an important element of patient care and is obligatory by law. The documentation during mass casualty incidents is however secondary to patient treatment and almost non-existent. By creating simplified and short forms designed for mass casualty situations, documentation in the MIH has shown improvement. A high level of preparedness is needed to treat a patient with a highly contagious infectious disease. In 2014 the MIH admitted a patient with Ebola virus disease. Lessons learned confirmed the need of clear protocols, education, training and buddy systems. A high demand on hospital resources and staff was experienced. Full-scale major incident exercises are a great benchmark for the medical response in the acute phase of relief. The MIH was shown to be highly prepared to admit an entire evacuating hospital or large groups of patients in two deployments and a full scale exercise. To further develop evaluation of full scale MCI drills a new technique was developed using point of view cameras, to capture the patient’s perspective during a MCI response. The footage has provided new insights and the patient centred approach can be implemented in disaster medicine as well. Engaging health care professionals in crisis management training has proven difficult due to the lack of exposure. By using a financial stimulus package the Dutch government has succeeded in raising awareness and training. However, consolidation of training and skills should be taken into account. Preparedness should include integration of systems and exchange of knowledge throughout the entire medical chain, in the end no chain is stronger than its weakest link