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Principles of Emergency Department Facility Design for Optimal Management of Mass-Casualty Incidents

Published online by Cambridge University Press:  16 May 2012

Pinchas Halpern ,
Scott A. Goldberg ,
Jimmy G. Keng  and
Kristi L. Koenig
Pinchas Halpern
Affiliation:
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Scott A. Goldberg*
Affiliation:
Department of Emergency Medicine, The Mount Sinai Medical Center, New York, New York USA
Jimmy G. Keng
Affiliation:
Department of Emergency Medicine, Changi General Hospital, Singapore, Malaysia
Kristi L. Koenig
Affiliation:
Department of Emergency Medicine, University of California, Irvine, Orange, California USA
*
Correspondence: Scott Goldberg, MD Department of Emergency Medicine The Mount Sinai Medical Center 1 Gustave Levy Place, Box 1620 New York, NY 10029 USA E-mail scott.goldberg@mountsinai.org
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Abstract

Introduction

The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center.

Report

In the authors’ experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services.

Discussion

Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED.

Conclusion

This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and staff safety.

Halpern P, Goldberg SA, Keng JG, Koenig KL. Principles of Emergency Department facility design for optimal management of mass-casualty incidents. Prehosp Disaster Med. 2012;27(2):1-9.

Keywords

DisasterDisaster planningEmergencyHospital design and constructionMass-casualty incidents
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 2 , April 2012 , pp. 204 - 212
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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