If I can draw your attention to:
http://www.ncbi.nlm.nih.gov/pubmed/10159733
While this was initially meant for austere and major disaster type situations, I am sure I am not alone in discovering that in the modern state of healthcare, both in the US and abroad, total system resources are constantly stretched to maximum.
Most hospitals do not have substantial immediate surge capacity, like any other logistically challenging crisis, in order to mobilize in hospital resources it takes time.
There are also 2 aspects of MCI response that doesn't often occur to EMS providers.
First, the hospital must still deal with the the normal patient load that comes through the front door and is admitted by other physicians. (in various states of need)
Second, in disasters involving dozens of people or more, the victims do not all sit around and wait for EMS resources to properly triage them.
This really puts a hurt on hospital resources when there are a certain number of critical patients being delivered by EMS in the back door, with as many or more critical patients coming through the front door. (been there done that)
At the very least it takes a physician out of the mix to triage the disaster scene that has simply migrated from its origin to the hospital.
I have done some trsaveling in my healthcare career, I can tell you that most internal and external disaster plans for hospitals will not last even one second during an actual event before they completely break down.
They simply make assumptions or fail to account for realities. For example, equipment and facility access. EDs are usually closed departments, which means people without appropriate badges can't even get in. Once in, they have no idea where equipment is or procedures for taking care of emergent patients in an emergent situations. It basically turns these practicioners into extra hands or transporters. But at a cost of reducing the effectiveness of flow.
(that is just one example, but I could fill a book with them)
So when you show up at a scene as an EMS provider, you must be aware of the capabilities of the total system. What resources are where, how you utilize them, and most importantly, conserve them.
For example, it is pointless to send a red priority patient suspected of a head injury to a hospital with a CT scanner, but without a neurosurgeon. Even if that hospital claims they can take 5 red patients.
With system capabilities already taxed, the normal paperwork and requirements not practical, interfacility transport all but shuts down.
As if that were not enough, basic necessities of the people filling up the hospital become a problem. (restrooms, water, food, etc.) I can tell you I have not seen one hospital disaster plan that addresses this in any of my travels. Which means as time goes on into hours, people not cared for will get sicker, requiring higher levels of resources.
Another poorly thought out issue is hospital provider fatigue. When the pt surge goes away, the hospital returns to baseline patient load. Think of the consequences of that for a bit.
Also consider things like child care when whole families show up at the hospital with injured or ill parents but healthy children. Family members also like to go looking for each other at hospitals.
Remember, I am not talking about a major earthquake or something. Maybe 20-30 victims of various seriousness.
So when you send your red (priority) patient to the hospital, what are the likely resources needed? the ED? A surgical theatre? an ICU bed? All of those things?
What is the chance the patient will survive or even be permitted to begin their treatment?
In my earlier example, you think the 86 y/o unable to maintain airway, GCS 3, heavy blood loss guy is going to be taken to an OR? Blood equal to his volume or more expended on him? Will he make 30 or so days in the ICU after?
We are not even talking quality of life, just mere survival to downgrading.
Now I know many EMS providers live in their own little world, but regardless of the type of EMS agency you are, who owns or pays for you, EMS is part of the healthcare system.
The decisions you make, affect people and patients you may never see or hear about during normal operations, but especially in an MCI.
There is more to being professional than pay and status. It requires the ability to think about more than just your 1 patient at a time. It requires you to be part of the healthcare team.
Just as I encourage you not to be a simpleton with individual patient care, don't be a simpleton of MCI response.
Remember, large incidents are not mitigated by individual treatment, they are mitigated by logistics.
Be a part of the team and come play with the al- stars instead of the little league.
Think big. Master your system. Be more than a moron who only understands a 3 criteria color coding system for driving people around.
My 2 year old could probably assign color tags on who should go to the hospital first. (before you think that is an exaggeration, she has her own stethoscope, paramedic texts(so she doesn't trash the good books), and loves to look at the pictures in both my neonatal and pathology texts)
I expect more from EMS providers.
