DISASTER PLANNING: DEMAND FOR “SPECIAL MEDICAL CARE”

Purpose: Disaster planning often overlooks the medical care needs of those with preexisting medical conditions. We estimate the population that will require special medical care following a disaster, independent of the direct impact of the incident.

Methods:  We defined “special medical care” as those not needing hospitalization but likely to require significant medical care. We used data from the National Health Interview Survey, National Hospital Discharge Survey, and National Nursing Home Survey.  We identified “special medical care” patients using minimum (threshold) numbers of: emergency room (ER) or emergency department visits, surgeries, health care home visits, overnight hospital stays, office visits and self-rated health.  For those requiring “special medical care” and hospitalization, we identified them with one or more of the following conditions: heart problems, hypertension, stroke, respiratory problems, musculoskeletal/ connective tissue problems, cancer, and diabetes. We estimated rate per million displaced persons needing special medical care, need for daily hospitalization, demand for hospital beds, and number of nursing home patients.

 Results: Using thresholds of >12 office visits or >=6 ER visits or >=6 surgeries or >4 home visits or >6 overnight hospital stays during last 12 months, approximately 66,000 [95% CI = 62,268–69,833]/million displaced would need special medical care independent of the effect of a disaster. Of those, 53,825 [95% CI = 50,539–57,111]/million would have at least one of the seven chronic medical conditions. On average, 348 [95% CI = 270–444]/million would require hospitalization on a daily basis. The daily demand for hospital beds would be 1,504 beds [95% CI =1,044–2,116]/million. The number of people that would require long-term care in nursing homes would be 5,094 [95% CI = 5,040–5,148]/million. Changing the threshold to only those who self-rated as either “poor” or “fair” health and had > 6 or >12 office visits per year, respectively, reduced the estimate of special medical care to 28,988 (95% CI = 26,669-31,216)/million displaced.

 Conclusions: Disaster plans often focus on those injured by the event. However, to avoid overwhelming emergency medical care operations, disaster planners should also plan to provide additional medical care to those with pre-existing conditions that cannot access their usual source of medical care.