The Impact of an All-Hazard Mass Casualty Event on Emergency Department Operations: A Retrospective Analysis

Introduction: Mass Casualty Events (MCI) have a direct and persistent impact on the safety and well-being of an emergency department (ED) and its staff. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their health or physical safety. In our study, we considered the unique operational challenges encountered and management strategies adopted by the ED staff and its leadership in response to an all-hazard MCI impacting an academic urban emergency department. Methods: We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving at the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from the analysis. Patient demographics, ED resource utilization, throughput, disposition, and other pertinent data were considered. An analysis was done of three distinct patient populations, including the event group, a non-event group, and a control group. Descriptive statistics were used to evaluate observational findings. Results: We reviewed the records of 8,527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as casualties from the MCI, and 3,563 patients were identified as presenting with complaints not related to the event. Our control group consisted of the 4,681 patients who presented in the two weeks before the MCI. Conclusion: Findings from our observational qualitative study suggested that, in the absence of larger public health interventions, a manmade MCI, with direct threats to an ED and its staff, could force a department to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity is likely to be encountered by select specialty consult services.