Welcome to ZZ Maria Parham Medical Center

Patient Management

The fundamental goal of emergency management planning is to protect life and prevent disability. The manner in which care, treatment, and services are provided may vary by type of emergency. However, certain activities are so fundamental to patient safety (this can include decisions to modify or discontinue services, make referrals, or transport patients) that the organization should take a proactive approach in considering how they might be accomplished.

The emergency triage process will typically result in patients being quickly treated and discharged, admitted for a longer stay, or transferred to a more appropriate source of care. A disaster may result in the decision to keep all patients on the premises in the interest of safety or, conversely, in the decision to evacuate all patients because the facility is no longer safe. Planning for clinical services must address these situations accordingly, particularly in the face of escalating events or in potentially austere care conditions.

(EP2) Code Triage is the hospital's response to a situation (such as the arrival of mass casualties) that exceeds normal operation capabilities. Code Orange is a hazardous materials event that may affect the hospital.  (See Code Triage Response Plan.)

MPMC goals when responding to a mass casualty event as recommended by AHRQ for Mass Medical Care:

Increase space capacity within the hospital through rapid patient discharge and transfer, addition of beds/cots, facilitation of home-based care, and use of alternative care site such as urgent care clinics for ambulatory patients to be retriaged and receive care for minor injuries.

Increase staff capacity through schedule changes, staff sharing, promotion of home care, and the use of licensed/certified volunteers.

Institute administrative changes to facilitate processes, reimbursements, reassignment of the staff, and schedules.

Ensure security for the staff and supplies.

Plan for mass mortuary needs.

Develop strategies to identify large numbers of young children who may be separated from parents and cannot give information that would help them to be reunited.

Short Term Strategies
Increase space capacity by:
Rapid discharge of emergency department and other outpatients who can continue their care at home safely.

Rapid discharge of inpatients who can safely continue their care at home (or at alternative facilities if they are available)

Cancellation of elective surgeries and procedures, with reassignment of surgical staff members and space.

Reduction of the usual use of imaging, laboratory testing, and other ancillary services.

Expansion of critical care capacity by placing select ventilated patients on monitored or step-down beds; using pulse oximetry (with high/low alarms) in lieu of cardiac monitors; or relying on ventilator alarms (which should alert for disconnect, high pressure, and apnea) for ventilated patients, with spot oximetry checks.

Conversion of single rooms to double rooms or double rooms to triple rooms if possible.

Designation of wards or areas of the facility that can be converted to negative pressure or isolated from the rest of the ventilation system for cohorting contagious patients; or use of these areas to cohort those health care providers caring for contagious patients to minimize disease transmission to uninfected patients.

Use of cots and beds in flat space areas (e.g., classrooms, lobbies, ACU, Rehabilitation areas) within the hospital for noncritical patient care.

Transfer of patients to other institutions within the State, region, or nationally.

Facilitation of home-based care for patients in cooperation with public health and home care agencies.

Establishment of mobile or temporary evaluation and treatment facilities in the community to supplement usual clinic locations.  These locations also may be used to screen those with mild symptoms when medications are available and must be taken early in the course of illness to be effective.

Expand staff capacity by:
Call in of appropriate staff members.

Changes in staff scheduling (e.g., duration of shifts, staffing ratios, changes in staff assignments).

Requests for supplemental staff members from partner hospitals through the use of Mutual Aid Agreements, clinics, SMAT, the Medical Reserve Corps (MRC), the local American Red Cross, public health, public works, schools, or other agencies and State and Federal sources.

Promotion of home care and discouragement of the "worried well" from seeking hospital evaluation and care through the use of media campaigns and access to community health call centers.

Establishment of guidelines and public messaging describing how to evaluate symptoms, what treatment can be safely delayed, and how to care for themselves at home
Sharing of small numbers of specialized staff members (e.g., burn nurses, pediatric critical care staff members) with hospitals in need.

Activation of Mutual Aid Agreements with regional and distant hospitals, health systems, or State disaster medical assistance teams.

Allocating Scarce Resources
Patient Assessment:

The American Medical Association (AMA) has identified five important criteria to consider when the allocation of scarce resources is required: likelihood of benefit, change in quality of life, duration of benefit, urgency of need, and amount of resources required.  According to the AMA guidance, all five of these criteria must be considered.  If there is no differentiation in the criteria between patients, then resources should be allocated on a "first come, first served" basis.

At a minimum, patient assessment should include the following factors:

The patient's need for the resource.

Potential to return to the baseline state.

Overall acute resource needs of the patient

Age and functional assessment (e.g., Quality Adjusted Life Years or other tools when significant functional differences are present between patients).

Underlying health and prognosis related to an underlying disease(s).

Event-specific or injury-specific prognostic factors.

Increase access to supplies by:

MPMC collaborations and procurement

Working through our vendors.

Activation of MOU's with commercial companies for supply chain continuity.

Patient Triage:
There are three basic types of triage.  Primary triage is the first triage of patients into the medical system at which point patients are assigned an acuity level based on the severity of their illness/disease.  Secondary triage is the reevaluation of the patient's condition after initial medical care.  This may occur at the hospital following EMS interventions or after initial interventions in the ED.  Tertiary triage is the reevaluation of the patients' response to treatment after further interventions and is ongoing during their hospital stay. This is the least practiced and least well-defined type of triage.

Historically, triage has involved four levels of priority for traumatic injuries:

Green delayed treatment has minor injuries or illness and should not pose a threat to life or limb.

Yellow intermediate has injuries or illness that may result in death or disability but pose no immediate threat to life or limb.

Red critical has injuries or illness that will result in death within the hour unless interventions occur.

Black expectant or deceased is expected to die because of severity of illness or injuries or has died.

Patient personal hygiene and sanitation: Personal hygiene and sanitation needs of our patients will be continually met even during an emergency.

Patient clinical information.  MPMC will utilize hard copy forms to document and track patients' clinical information until the forms can be entered into MPMC data systems.
Mental health services:

MPMC will alert the In-Take Mental Health Coordinator and MPMC Chaplain service.

Mass Mortuary:
MPMC will work with Vance County Emergency Management to facilitate a temporary morgue location.  Every effort will be made to adjust standards of care as appropriate to the situation, to advise and involve the public and faith-based communities in these decisions, and to ensure that the minimum level of disruption to usual cultural practices and the maximum level of dignity are afforded the deceased and their families.

See support doc.

(Attach Emergency Department EOP/Document)

US Patent Numbers 7,720,998 B2, 7,836,207