Crowded Hospitals May Pose Problem in a Pandemic

By Jacqueline Ruttimann
Capital News Service
Friday, Oct. 21, 2005

WASHINGTON - With the threat of an avian flu pandemic looming, hospital emergency rooms must find ways to combat patient overflow so they can quickly accommodate the extra patient burden such a disaster might bring.

Emergency rooms have long been America's safety net for health care services, but increasing usage and declining numbers of beds over the past 25 years have brought increased patient wait times and diversions to nearby hospitals.

Called surge capacity, it is the ability of the hospitals to receive a sudden influx of mass casualties and injuries.

"It's the biggest hurdle that hospitals have to deal with," said Maryland Hospital Association spokeswoman Nancy Fiedler. "Surge capacity is bigger than the avian flu. It comes up in all emergency preparedness discussions."

The Maryland Institute for Emergency Medical Services Systems has set up a daily tracking system to monitor the frequency and duration of yellow alerts, the time area hospitals divert less-critical patients to nearby hospitals.

Hospitals try to limit the time on yellow alert to eight hours or less, said John New, director of quality management at MIEMSS.

"The issue is that when things like the flu hits . . . the durations go up," said New, who added that from November to February, which coincides with regular flu season, is also peak time for yellow alerts.

"The avian flu could make it worse," he said.

The Maryland Hospital Association and the state Department of Health and Mental Hygiene are working with hospitals to establish the best ways to deal with hospital overflow, according to State Emergency Medical Services Director Dr. Richard Alcorta. He said they're working to make 10 percent of an area hospital's beds available in a non-stressed situation and 20 percent available in a true disaster.

The bottom line, said Alcorta, is that "we don't have huge surge capacity for hospitals."

That's why many health care officials urge patients to use emergency rooms judiciously. Should an avian flu pandemic occur, they caution that only patients who display flu-like symptoms should enter the hospitals. The rest of the public should treat any epidemic like a snow day by staying at home and limiting travel.

Maryland hospitals are rising to the challenge of limited surge capacity. In fact, MIEMSS last May lauded the St. Joseph Medical Center in Baltimore for its multi-agency approach to curbing yellow alert hours.

The hospital last year decreased its yellow alert hours by 74 percent, from 22.5 in 2003 to 5.9 in 2004. It achieved the numbers by holding daily meetings among different department members to assess patient numbers and locations, as well as increasing off-hour staffing.

Said Alcorta, "They are the gold standard."