Full-Scale Disaster Drill Assessing the Impact to ER Flow By Utilizing a Pre-Identified Ebola Treatment Room

Summary: Emergency Department (ED) evaluation of suspected Viral Hemorrhagic Fever (VHF) patients can significantly disrupt an institution’s ED operations. Given the significant risk of contamination, best practice is to close off areas where the patient has been present. While designed to protect healthcare workers and other patients, this can have unintended consequences, such as closing off access to critical areas and supplies. A full-scale disaster drill was conducted at a New York City (NYC) designated Ebola Receiving Center. A fictitious patient suspected of VHF was taken to the designated VHF treatment area through EMS and walk-in triage. The impact on normal patient/staff flow and access to critical resources was documented by trained observers. The following areas were unintentionally blocked due to patient transport to the designated VHF treatment room: 1. Arrival via EMS: a) critical elevators to OR, MICU, SICU, and Labor and Delivery, b) ED Radiology including X-Ray, CT, and ultrasound. 2. Arrival via walk-in: a) waiting room, b) triage area, c) the entirety of the non-critical adult emergency department, approximately 81 patient treatment locations. This drill highlighted the potential for significant disruptions to ED operations when managing VHF patients, even when using a pre-identified VHF treatment room. By identifying feasible access to appropriate care areas, hospitals can mitigate these challenges and ensure the continuity of daily operations. EDs should consider similar strategies when developing their VHF response plan. The Division of Disaster Preparedness & ED administrators assessed the ED’s architectural blueprint to locate areas of entry/egress and the ED’s treatment/diagnostic areas. Multiple attempts to find a space within the emergency department to care for VHF patients without closing the ED proved difficult. However, after reviewing the blueprint, an ideal area outside the ED treatment areas was identified.