Security at the Time of Disaster: Design Solutions for Surge Capacity Improvement and Violence Reduction in Emergency Departments

Shabboo Valipoor University of Florida

Emergency departments (EDs) are the first line of emergency medical care in mass casualty incidents (MCIs). To manage the large influx of patients during disasters, EDs need to design and practice a comprehensive mass casualty management plan, in which security is a key component. Without adequate security, no phase of the MCI response can be performed effectively. The results of a literature review, presented at EDRA 2017 by the author, highlighted three groups of facility design considerations for MCI preparedness in EDs. In a follow-up study, an online questionnaire was sent to ED personnel nationwide to ask them about the effectiveness of identified design strategies in improving ED performance during MCIs. Results showed that the most effective and agreed-upon solutions were maximizing the care area for critical patients by establishing an alternate care facility with separate entrance and exit doors from the ED for the least critical patients. Another highly-rated strategy was expandability of the ED. EDs with flexible and scalable floor plans can accommodate changing care requirements by opening and closing care zones. The third highest rated strategy was expanding the ED to non-emergency areas by turning other hospital spaces to ED care areas to increase the ED’s capacity. In response to unexpected patient influx, sometimes EDs have no other choice except for turning as many spaces as possible to patient care areas to increase treatment and bed capacity. This may include changes in inpatient rooms, using support and administrative spaces as care areas, or even placing beds in common areas such as hallways. In the symposium, similarities and areas of divergence between design strategies for disaster planning and solutions for security enhancement will be discussed, and practical approaches to reach both goals will be explored.