Case managers in mass casualty incidents.

Abstract

To examine whether case managers affect patient evaluation/treatment/outcome and staffing requirements during Multiple Casualty Incidents (MCIs). Multiple patient relocations during MCIs may contribute to chaos. One hospital changed its MCI patient relocation policy during a wave of MCIs; rather than transfer patients from one medical team to another in each location, patients were assigned case-managers +/- teams who accompanied them throughout the diagnostic/treatment cascade until definitive placement. MCI data (n = 17, 2001-2006) were taken from the hospital database which is updated by registrars in real-time. ISSs were calculated retrospectively. Matched events before (n = 5)/after (n = 3) the change yielded data on staff utilization. Semi-structured interviews were conducted with 26 experienced staff members regarding the effect of the change on patient care. Twelve events occurred before (n = 379 casualties) and 5 occurred after (n = 152 casualties) the change. Event extent/severity, manpower demands and patient mortality remained similar before/after the change. Reductions were observed in: the number of x-rays/patient/1st 24-hour (P < 0.001), time to performance of first chest x-ray (P = 0.015), time from first chest x-ray to arrival at the next diagnostic/treatment location (P = 0.016), time from ED arrival to surgery (P = 0.022) and hospital lengths of stay for critically injured casualties (37.1 +/- 24.7 versus 12 +/- 4.4 days, P = 0.016 for ISS > or = 25). Most interviewees (62%, n = 16) noted improved patient care, communication and documentation. During an MCI, case managers increase surge capacity by improving efficacy (workup/treatment times and use of resources) and may improve patient care via increased personal accountability, continuity of care, and involvement in treatment decisions.