Beyond surge

Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion

Sheuwen Chuang, Kuo Song Chang, David D. Woods, Hsiao Chun Chen, Morgan E. Reynolds, Ding Kuo Chien

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. Material and methods: The critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge. Results: Fifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead. Conclusion: In the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.

Original languageEnglish
JournalBurns
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Mass Casualty Incidents
Explosions
Dust
Taiwan
Hospital Emergency Service
Disasters
Stretchers
Disaster Planning
Interviews
Patient Admission
Body Surface Area
Task Performance and Analysis
Workload
Resuscitation
Uncertainty
Medical Records
Exercise
Delivery of Health Care

Keywords

  • Cognitive systems engineering
  • Disaster planning
  • Emergency management continuum
  • Formosa Fun Coast Dust Explosion
  • Mass burn casualty
  • Surge capacity

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Beyond surge : Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion. / Chuang, Sheuwen; Chang, Kuo Song; Woods, David D.; Chen, Hsiao Chun; Reynolds, Morgan E.; Chien, Ding Kuo.

In: Burns, 01.01.2018.

Research output: Contribution to journalArticle

Chuang, Sheuwen ; Chang, Kuo Song ; Woods, David D. ; Chen, Hsiao Chun ; Reynolds, Morgan E. ; Chien, Ding Kuo. / Beyond surge : Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion. In: Burns. 2018.
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