Page:Derailment of Amtrak Passenger Train 188 Philadelphia, Pennsylvania May 12, 2015.djvu/42

NTSB Within a hospital, the response to an MCI affects patients other than those injured in the MCI. Existing patients being treated in emergency departments may be transferred to inpatient beds before their evaluations are complete. Scheduled procedures or surgeries may be delayed or postponed to ensure sufficient staff, procedural beds, and intensive care beds are available to care for the acutely injured MCI victims. In addition, some outpatients with an urgent medical problem unrelated to the MCI who might normally go to a particular hospital may choose to delay their visit or to go elsewhere. Thus, when hospital resources become overwhelmed, some patients are inevitably forced to wait for care.

It is difficult to directly measure risks to other patients during an MCI. However, research shows that 30-day outcomes are worse for patients with chest pain and possible coronary syndromes who arrive at an emergency department simultaneously with a patient requiring a trauma team activation, compared to those arriving during periods without a trauma activation.

In addition, emergency department overcrowding (essentially, more patients in the emergency department than beds, with prolonged waiting times for patients in the waiting room) is associated with treatment delays for severe pain and pneumonia and worse cardiovascular outcomes for patients with chest pain. Emergency department overcrowding is more likely when the number of injured patients arriving from an MCI surpasses the hospital's triage, registration, and treatment capacity. Therefore, the NTSB concludes that matching patient arrival to hospital capacity in an MCI is crucial to ensuring optimal care can be provided for all patients.

During the transport phase of the EMS response to an MCI, a transport coordinator (the exact title may vary) is designated to coordinate transport for all patients to ensure the patient load does not overwhelm any one hospital's ability to care for the injured. Depending on the size of the MCI and local resources, the transport coordinator may be located on scene or in a dispatch center. Typically, in addition to information regarding the status of individual patients, there is two-way communication between the transport coordinator and the hospitals during the transport phase, as some patients may arrive on foot or be transported by family, friends, or bystanders. Hospitals can better prepare for individual patients if they know something about the type and degree of the patient's injuries before the patient arrives. This information begins with the transport coordinator and is expanded upon by communication from the transporting EMS providers during the ride to the hospital.

In the United States, patients with significant traumatic injury are usually evaluated, treated, and transported to a trauma center by EMS. However, sometimes the injured are 32