Deployable, portable, and temporary hospitals; one state's experiences through the years

Randy D. Kearns, DHA, MSA; Mary Beth Skarote, NREMT-P, LPN; Jeff Peterson, NREMT-P, BS; Lew Stringer, MD, FACA; Roy L. Alson, MD, PhD, FACEP, FAAEM; Bruce A. Cairns, MD, FACS; Michael W. Hubble, PhD, MBA, NREMT-P; Preston B. Rich, MD, MBA, FACS; Charles B. Cairns, MD, FACEP, FAHA; James H. Holmes IV, MD, FACS; Jeff Runge, MD, FACEP; Sean M. Siler, DO, MBA, FACEP, FAAEM; James Winslow, Md, MPH

doi:10.5055/ajdm.2014.0171

Authors

Randy D. Kearns, DHA, MSA
Mary Beth Skarote, NREMT-P, LPN
Jeff Peterson, NREMT-P, BS
Lew Stringer, MD, FACA
Roy L. Alson, MD, PhD, FACEP, FAAEM
Bruce A. Cairns, MD, FACS
Michael W. Hubble, PhD, MBA, NREMT-P
Preston B. Rich, MD, MBA, FACS
Charles B. Cairns, MD, FACEP, FAHA
James H. Holmes IV, MD, FACS
Jeff Runge, MD, FACEP
Sean M. Siler, DO, MBA, FACEP, FAAEM
James Winslow, Md, MPH

DOI:

https://doi.org/10.5055/ajdm.2014.0171

Keywords:

field hospital, temporary hospital, deployable hospital

Abstract

This article will review the use of temporary hospitals to augment the healthcare system as one solution for dealing with a surge of patients related to war, pandemic disease outbreaks, or natural disaster. The experiences highlighted in this article are those of North Carolina (NC) over the past 150 years, with a special focus on the need following the September 11, 2001 (9/11) attacks. It will also discuss the development of a temporary hospital system from concept to deployment, highlight recent developments, emphasize the need to learn from past experiences, and offer potential solutions for assuring program sustainability. Historically, when a particular situation called for a temporary hospital, one was created, but it was usually specific for the event and then dismantled. As with the case with many historical events, the details of the 9/11 attacks will fade into memory, and there is a concern that the impetus which created the current temporary hospital program may fade, as well. By developing a broader and more comprehensive approach to disaster responses through all-hazards preparedness, it is reasonable to learn from these past experiences, improve the understanding of current threats, and develop a long-term strategy to sustain these resources for future disaster medical needs.

Author Biographies

Randy D. Kearns, DHA, MSA

Administrator, EMS Performance Improvement Center, Chapel Hill, North Carolina; Program Director, North Carolina Burn Disaster Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Mary Beth Skarote, NREMT-P, LPN

Healthcare Preparedness Response and Recovery Program Manager, North Carolina Office of EMS, Raleigh, North Carolina

Jeff Peterson, NREMT-P, BS

Healthcare Preparedness Response and Recovery Operations Manager, North Carolina Office of EMS, Raleigh, North Carolina

Lew Stringer, MD, FACA

Medical Advisor, North Carolina State Medical Response System, National Mobile Disaster Hospital, Raleigh, North Carolina

Roy L. Alson, MD, PhD, FACEP, FAAEM

Medical Advisor, North Carolina State Medical Response System, Raleigh, North Carolina; Associate Professor of Emergency Medicine, Wake Forest University, Winston-Salem, North Carolina

Bruce A. Cairns, MD, FACS

Director North Carolina Jaycee Burn Center, John Stackhouse Distinguished Professor of Surgery/Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Michael W. Hubble, PhD, MBA, NREMT-P

Professor and Director, Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina

Preston B. Rich, MD, MBA, FACS

Professor of Surgery and Chief, Trauma, Critical Care and Emergency Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Senior Advisor to the Deputy Assistant Secretary for Preparedness and Response/OEM Director, Regional Deputy Chief Medical Officer/NDMS, United States Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response, Washington, DC.

Charles B. Cairns, MD, FACEP, FAHA

Professor and Chair of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina

James H. Holmes IV, MD, FACS

Associate Professor of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Director, Wake Forest Baptist Health Burn Center, Winston-Salem, North Carolina

Jeff Runge, MD, FACEP

Adjunct Professor of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Sean M. Siler, DO, MBA, FACEP, FAAEM

Assistant Professor, Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lead Regional Deputy Chief Medical Officer, National Disaster Medical System, United States Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response, Washington, DC.

James Winslow, Md, MPH

Medical Director, North Carolina Office of EMS, Raleigh, North Carolina; Associate Professor of Emergency Medicine, Wake Forest University, Winston-Salem, North Carolina

References

Bentonville Battlefield. Civil War—A National Historic Landmark. 2013. Available at http://www.nchistoricsites.org/bentonvi/bentonvi.htm. Accessed October 1, 2013.

Stark RB, Stark JC: Surgical care of the Confederate States Army. US Armed Forces Med J. 1959; 10(1): 50-68.

Cunningham HH: The Confederate medical officer in the field. US Armed Forces Med J. 1958; 9(11): 1580-1604.

Sink AE: The Grit Behind the Miracle. Lanham, MD: University Press of America, Incorporated, 1998.

Gibson L: Miracle of Hickory. Our State, North Carolina. January 2009. Our State, 2009.

Catawba County Historical Association: The Miracle of Hickory: The 1944 Emergency Polio Hospital 2013. Available at http://www.catawbahistory.org/miracle_of_hickory.php. Accessed October 1, 2013.

Centers for Disease Control and Prevention: North Carolina and the Great Pandemic. The Great Pandemic, The United States 1918-1919. 2013. Available at http://www.flu.gov/pandemic/history/1918/your_state/southeast/northcarolina/. Accessed October 1, 2013.

Adams HG: A Local Chronicle of the Influenza Epidemic of 1918. As Gleaned from Newspaper Accounts of the Day N C Med J. 1964; 25: 397-400.

Adams HG: A Local Chronicle of the Influenza Epidemic of 1918. N C Med J. 1964; 25: 351-354.

Healthcare Preparedness Capabilities, National Guidance for Healthcare System Preparedness. 2012; 73. Available at http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf. Accessed December 9, 2012.

US House of Representatives: A Failure of Initiative; Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. 2006. Available at http://www.uscg.mil/history/katrina/docs/USHouseOfRepKatrina2006MainR1eport.pdf. Accessed September 4, 2013.

Cline JS, Tolbert EL, Pratt D, et al.: State Takes Steps to Prepare for Medical Response to Terrorist Event. 2002. Available at http://web.archive.org/web/20020616030104/http://www.ncems.org/bioterrorism.htm. Accessed July 26, 2013.

Blackwell T, Bosse M: Use of an innovative design mobile hospital in the medical response to Hurricane Katrina. Ann Emerg Med. 2007; 49(5): 580-588.

Perrone LA, Tumpey TM: Reconstruction of the 1918 pandemic influenza virus: How revealing the molecular secrets of the virus responsible for the worst pandemic in recorded history can guide our response to future influenza pandemics. Infect Disord Drug Targets. 2007; 7(4): 294-303.

Markel H, Lipman HB, Navarro JA, et al.: Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007; 298(6): 644-654.

Markel H, Stern AM, Navarro JA, et al.: Nonpharmaceutical influenza mitigation strategies, US communities, 1918-1920 pandemic. Emerg Infect Dis. 2006; 12(12): 1961-1964.

Stern AM, Cetron MS, Markel H: The 1918-1919 influenza pandemic in the United States: Lessons learned and challenges exposed. Public Health Rep. 2010; 125(Suppl 3): 6-8.

US Department of Transportation: Transportation Performance Management Economic Analysis Primer. 2013. Available at http://www.fhwa.dot.gov/infrastructure/asstmgmt/primer03.cfm. Accessed December 16, 2013.

Stein JJ: The California physician and civil defense. Calif Med. 1950; 73(5): 449-455.

Wilson WL: Medical plans for civil defense and disaster relief. US Armed Forces Med J. 1950; 1(4): 462-475.

Regional organization of medical civil defense. J Indiana State Med Assoc. 1951; 44(6): 460-469.

Masterson JJ: Medicine's responsibility in civil defense. N Y State J Med. 1 1951; 51(5): 596.

Schade FF: Medical schools and civil defense. J Med Educ. 1951; 26(4): 260-265.

Green E: Civil Defense Museum (Virtual). 2013. Available at http://www.civildefensemuseum.com/cdmuseum2/cdeh.html. Accessed November 10, 2013.

Teague RE: The story of Civil Defense 200-bed emergency hospital units. J Ky Med Assoc. 1961; 59: 926-927.

Reider F, Stokes FD: The civil defense emergency hospital in Kentucky. J Ky Med Assoc. 1964; 62: 36-37.

Parrino PS: Civil defense emergency hospital—Plans and training for maximum utility. J Indiana State Med Assoc. 1964; 57: 780-782.

Dodge AH: The 1962 civil defense emergency hospital program. N Y State J Med. 1963; 63: 3144-3146.

Wachtel TL, Cowan ML, Reardon JD: Developing a regional and national burn disaster response. J Burn Care Rehabil. 1989; 10(6): 561-567.

Franco C, Toner E, Waldhorn R, et al.: The National Disaster Medical System: Past, present, and suggestions for the future. Biosecur Bioterror. 2007; 5(4): 319-325.

National Disaster Medical System, Serving the Federal Response with Disaster Medical Services. 2010. Available at http://ndms.fhpr.osd.mil/. Accessed December 7, 2012.

Yeskey K: The Key Role of NDMS in Disaster Response 2010; Statement by Kevin Yeskey M.D. on The Key Role of NDMS in Disaster Response before the Committee on Homeland Security and Governmental Affairs, for the United States Senate. Available at http://www.hhs.gov/asl/testify/2010/07/t20100722a.html. Accessed December 7, 2012.

Hogan J, Rega P, Forkapa B: A civilian-sponsored DMAT: A community's collaboration among three hospitals. J Emerg Nurs. 1990; 16(4): 245-247.

Rodenbeck SE: The needs of a disaster medical assistance team for environmental support services. Mil Med. 1990; 155(1): 12-13.

Lewis-Rakestraw L: Response of the New Mexico Disaster Medical Assistance Team in St. Croix after Hurricane Hugo. J Emerg Nurs. 1991; 17(3): 162-164.

Henderson AK, Lillibridge SR, Salinas C, et al.: Disaster medical assistance teams: Providing health care to a community struck by Hurricane Iniki. Ann Emerg Med. 1994; 23(4): 726-730.

DMAT teams: There when disaster strikes. ED Manag. 1996; 8(9): 104-105.

Alson RL, Leonard RB, Stringer LW: Disaster response in North Carolina. N C Med J. 1997; 58(4): 248-252.

Alson R, Alexander D, Leonard RB, et al.: Analysis of medical treatment at a field hospital following Hurricane Andrew, 1992. Ann Emerg Med. 1993; 22(11): 1721-1728.

Leonard RB, Spangler HM, Stringer LW: Medical outreach after hurricane Marilyn. Prehosp Disaster Med. 1997; 12(3): 189-194.

Murphy JK: After 9/11: Priority focus areas for bioterrorism preparedness in hospitals. J Healthc Manag. 2004; 49(4): 227-235.

Kearns RD, Skarote MB, Peterson JB, et al.: Creating a state medical response system for medical disaster management: The North Carolina experience. South Med J. 2014.

Brice JH, Alson RL: Emergency preparedness in North Carolina: Leading the way. N C Med J. 2007; 68(4): 276-278.

National Emergency Management Association: Emergency Management Assistance Compact. 2011. 1995-2009 Copyright: Emergency Management Assistance Compact Home Page. Available at www.emacweb.org. Accessed December 7, 2012.

Federal Emergency Management Agency: FEMA 322 Public Assistance Guide. 2007. Available at http://www.fema.gov/pdf/government/grant/pa/paguide07.pdf. Accessed December 7, 2012.

UNC Hospitals: UNC Hospitals' Hurricane Katrina Response Blog. UNC Hospitals' Hurricane Katrina Response Blog. Vol 2013. Available at http://unchospitals.blogspot.com/2005/09/home-briefly.html. Blogspot. July 26, 2005.

Litch B: Building from the ground up: Georgia hospital survives a direct tornado hit. Healthc Exec. 2008; 23(6): 28-30, 32, 35.

Georgia hospital hit by F3 tornado—All patients evacuated through the ED. ED Manag. 2007; 4: 37-39.

Ablah E, Tinius AM, Konda K, et al.: Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado. Disaster Med Public Health Prep. Nov 2007; 1(2): 90-95.

Barr P: A year later: Joplin hospitals rebuild, become better prepared. Mod Healthc. 2012; 42(21): 16.

Carlton PK, Bringle D: Business continuity after catastrophic medical events: The Joplin medical business continuity report. Am J Disaster Med. 2012; 7(4): 321-331.

Martin D: Joplin tornado offers response lessons. Health Facil Manag. 2013; 26(7): 48.

Shagets FW: Thoughts on the May 2011 Joplin, Missouri tornado. South Med J. 2013; 106(1): 113-114.

Kellermann AL, Peleg K: Lessons from Boston. N Engl J Med. 2013; 368(21): 1956-1957.

Kearns RD, Conlen K, Valenta AL, et al.: April 2013, from Massachusetts to Texas, disasters that remind us of our own preparedness needs. J Burn Care Res. 2014; 35(1): e53.

Fiscal Year 2012 Public Health and Social Services Emergency Fund. 2012. Justification of Estimates for Appropriations Committees. Available at http://www.hhs.gov/about/budget/fy2012/phssef_cj_fy2012.pdf. Accessed December 30, 2012.

Stuart JJ, Johnson DC: Air Force disaster response: Haiti experience. J Surg Orthop Adv. 2011; 20(1): 62-66.

Walk RM, Donahue TF, Stockinger Z, et al.: Haitian earthquake relief: Disaster response aboard the USNS comfort. Disaster Med Public Health Prep. 2012; 6(4): 370-377.

Kirsch T, Sauer L, Guha Sapir D: Analysis of the international and US response to the Haiti earthquake: Recommendations for change. Disaster Med Public Health Prep. 2012; 6(3): 200-208.

Bochicchio D: Response capabilities of the National Guard: A focus on domestic disaster medical response. Am J Disaster Med. 2010; 2010: 49-55.

Price O, West DF, Mancuso JD: Preventive medicine support to Operation Lifeline: Pakistan 2005. US Army Med Dept J. 2007: 65- 72.

Fernald JP, Clawson EA: The mobile army surgical hospital humanitarian assistance mission in Pakistan: The primary care experience. Mil Med. 2007; 172(5): 471-477.

Peake JB: The Project HOPE and USNS Mercy tsunami “experiment”. Mil Med. 2006; 171(10 Suppl 1): 27-29.

Pryor T: Health diplomacy through collaboration and a story of hope in tsunami-ravaged Banda Aceh, Indonesia: A U.S. Public Health Service nurse officer perspective. Mil Med. 2006; 171(10 Suppl 1): 44-47.

Kost GJ, Sakaguchi A, Curtis C, et al.: Enhancing crisis standards of care using innovative point-of-care testing. Am J Disaster Med. 2011; 6(6): 351-368.

Kearns RD, Hubble MW, Lord GC, et al.: Disaster Planning: Financing a Burn Disaster, Where do you turn and what are your options when your hospital has been impacted by a Burn Disaster in the United States? J Burn Care Rehabil. 2014: 1-74.