Beyond surge: Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion.
PURPOSE
To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster.


MATERIAL AND METHODS
The critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge.


RESULTS
Fifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead.


CONCLUSION
In the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.
['Chuang|Sheuwen|S|', 'Chang|Kuo-Song|KS|', 'Woods|David D|DD|', 'Chen|Hsiao-Chun|HC|', 'Reynolds|Morgan E|ME|', 'Chien|Ding-Kuo|DK|']
D000293:Adolescent D000328:Adult D001830:Body Surface Area D002056:Burns D002059:Burns, Inhalation D004636:Emergency Service, Hospital D005107:Explosions D005260:Female D006742:Hospital Bed Capacity D006801:Humans D007362:Intensive Care Units D008297:Male D054527:Mass Casualty Incidents D012151:Resuscitation D012189:Retrospective Studies D058254:Stretchers D055872:Surge Capacity D013624:Taiwan D013647:Task Performance and Analysis D016526:Workload D055815:Young Adult
Mass burn casualty Formosa Fun Coast Dust Explosion Disaster planning Cognitive systems engineering Emergency management continuum Surge capacity