Table 4 Notable situations and adaptations between overload patterns in the mass-casualty incident

Extreme

(Mackay Memorial Hospital Tamsui Branch)

No clear news had been reported regarding the disaster when the first seven burn patients were received

The burn patients arrived unexpectedly quickly

Several acuity patients required emergency intubation, but intubation experts were not immediately fully available

The already overcrowded ED became swiftly congested with burn patients, on-and-off-duty staff members, and non-hospital persons

The workload peak was almost four times the normal capacity

Shortage of space, bag valve masks, portable ventilator equipment, stretchers, and ambulances

(F0-2) ERP alarm was activated to call for assistance from onsite staff members after two severe burn patients were treated

(F4) An ED physician urgently called for job prioritization of on-duty physicians to assist with intubation. In total, 20 patients were intubated in the ED

(F3-1) Simple treatments for low-acuity patients (e.g., wound flushing and covering with wet gauze) were administered at the triage area before the patients were moved into the main ED. Only 10 patients were treated with burn ointment in the ED

(F10) An ED manager of the MM network hospital initiated the reconfiguration of the chaos ED space upon his arrival 50 min after that of the first wave of burn patients

(F5) Irregular rooms (e.g., meeting rooms, and shower rooms) were opened to allow low-acuity patients to flush their own burns to reduce wound temperature and pain

(F7) A young non-ED physician who anticipated that burn ointment would run out after patient transfers requested an urgent delivery of burn ointment and other supplies from vendors

High

(Taipei Hospital, Ministry of Health and Welfare)

The hospital VP saw an early-stage news report offsite regarding the disaster

The hospital has no burn specialists and little experience with burn care

The director of the surgical department took charge of the emergency care of burn patients

The hospital had no prior experience with MCIs involving more than 15 patients

Shortage of burn care supplies

(F0-1) Anticipating an influx of burn patients and a shortage of burn experts and clinicians, the VP proactively initiated an alerting call to mobilize ED and surgical managers

(F0-2) The ERP alarm was activated to call for assistance from onsite staff members before the burn patients’ arrival

(F3-1) No acuity patients were intubated in the ED, but one was intubated in the ICU. All patients were treated with burn ointment in the ED

(F6) A nurse returned to her ICU for more burn ointment

(F7) External supplies were mobilized from alliance hospitals to the ED in the early stages of the MCI

Moderate

(Taipei Municipal Wan Fang Hospital)

This hospital was informed that it would be receiving a large number of patients with mild burns transported by bus. But, the actual number was lower and distributed by ambulances, some of the patients had severe burns

No beds were available in the burn ward or the ICU

(F5) The hospital lobby adjacent to the ED was prepared as a temporary treatment area waiting for all patients with mild burns. They were later moved back to the ED

(F3-1) The acuity patients were given preliminary treatment in ED. Three of them were intubated in the ED and then quickly transferred to the ICU or the burn ward after relocation of the existing patients in ICU and burn ward

Low

(Shuang Ho Hospital)

The hospital was informed of the incoming arrival of lots of burn patients

The available ED space was larger than that in the other hospitals

The burn patients’ arrival was slow. And the ED workload was below regular ED capacity in this night

(F0-2) The ERP alarm was activated to call for assistance from onsite staff members after two burn patients had already arrived

(F5) To streamline patient flow for triage and registration, the ED was divided into two areas with different routes for FFCDE patients and non-FFCDE patients

(F3-1) An otolaryngologist used an endoscope to check the patients’ respiratory tracts