Editorial comments-Psychological effects of patient surge in large-scale emergencies: a quality improvement tool for hospital and clinic capacity planning and response.

In most types of disasters, one of the important but neglected issues is the surge of persons needing psychological assessments and responses. This issue was reported previously by our group after a suicide bombing event 1 and during the second Lebanon war, 2 where the number of stress casualties exceeded the number of physically injured patients, so hospitals had to rearrange in order to give adequate response to this challenge. This phenomenon also has been described by other groups in diverse disaster scenarios. 3–6 The Israeli medical system prepares for this challenge as part of an organized systematic process of the Israeli healthcare system preparedness for disaster scenarios. It is conducted by an intensive collaboration between the Ministry of Health and the Medical Department of the Home Front Command. However, the comprehensive use of continuous quality improvement (CQI) methodology was not used previously in disaster preparedness. During mass toxicological events, a rapid establishment of a mild casualty center that is capable of responding to the surge of persons needing psychological assessment was outside of the hospital suggested, and large-scale drills have proven its effectiveness in diverting the surge of casualties from the hospital to the ambulatory care system. This enables the hospitals to focus on the casualties requiring hospital facilities. 7 We reported that the use of fetal ultra-sound by the Israeli Defense Forces after the earthquake in Turkey relieved the anxiety and fears of pregnant women. 8 In their article, Meredith et al address this neglected issue of disaster medicine by presenting, for the first time, a practical quality improvement tool for use by hospitals. It can be used in planning for and responding to the psychological consequences of catastrophic events that create a surge of psychological casualties who present at healthcare facilities for health care. They describe the development of the tool, present data on facility preparedness from 31 hospitals and clinics in Los Angeles County, and discuss how the tool can be used as a benchmark for targeting improvement. 9 Their data suggest that there is a strong need for a system of assessments and triage to rapidly identify those who are in greatest need for psychological intervention. Another wide gap in preparedness for most facilities is the lack of planned risk communication messages that can help to address psychological reactions of people seeking help in a medical facility as well as the staff who are providing …