Background: Hospital disaster response has historically been the purview of emergency medicine and surgery, without significant involvement of hospitalists themselves or consideration of how mass casualty incidents impact the hospital as a whole. However, many disaster modalities, e.g. pandemic infectious disease or bioterrorism, are outside of the surgical scope of practice and require involvement of hospital medicine. Yet despite their expertise in patient triage, multidisciplinary care, and quality improvement, no studies have established the role of hospitalists in disaster response.

Purpose: We aim to incorporate Hospital Internal Medicine into the greater Hospital Incident Command Structure (which guides an organized response to emergency scenarios) and to develop a hospitalist-driven effort, applicable to a variety of disaster scenarios, that improves patient throughput and augments hospital surge capacity.

Description: Our current efforts focus on developing and testing protocols that facilitate rapid admission of medical patients with high probability of admission (including both those affected by the incident and those already present in the ED). Integration of such protocols into the standard incident response process is achieved by creating Job Action Sheets that clearly describe the specific duties for the team of hospitalists executing those protocols.
Early testing of our protocols showed that rapid admission of patients already in the Emergency Department to Medicine services alone could augment ED bed capacity and allow for more efficient intake of incident patients. In one instance of protocol testing in a true mass-trauma scenario, 17 patients were admitted over a 96-min period, a 5-fold increase in standard admission rates that led to a 23% increase in room availability to our 74-bed emergency department. Moreover, qualitative feedback suggests that these protocols help to “cognitively unload” ED physicians and allow them to focus on critically ill patients.

Conclusions: Developing clear, concise disaster response protocols that do not require extensive training in emergency management can result in measurable increase in ED bed capacity. Expansion of protocols into other areas of patient throughput by facilitating rapid discharge of stable inpatients could further enhance hospital disaster response.