Impacts of the 2017 Hurricanes on Emergency Department Admissions and Outcomes in St. Thomas, USVI

项目总结/摘要 2017年9月，美属维尔京群岛连续遭受两次5级飓风袭击：飓风伊尔玛 还有玛丽亚风暴对这些岛屿造成了巨大的破坏，包括部分摧毁了 施耐德地区医疗中心（SRMC）是圣托马斯唯一的医院， 床位从169张减少到<40张，摧毁了癌症中心和心导管实验室， 呼吸支持CT和MRI功能医疗服务的提供进一步受到阻碍， 医生和其他医务人员在飓风前后离开。人有 最严重的情况继续由空中救护车送往美国大陆的医院， 其他人则回到社区，接受崩溃的初级保健、公共卫生和社交网络。 留在岛上的医生认为死亡率上升了， 特别是在患有慢性病的贫困老年患者中：用一位医生的话来说，“他们只是 放弃和死亡” 目前的建议旨在提供文件和增加对简短和 2017年飓风的长期健康风险和影响，重点是SRMC应急部门 作为飓风过后圣托马斯医疗服务的主要接入点。研究将评估急性 a）在飓风造成的严重灾害情况下， 中断的医疗保健服务; B）个体患者因素;以及c）文化相关的社会崩溃 支持网络，特别是老年患者。数据将为急性干预措施提供依据， 长期的灾害管理规划，以促进复原力，并将纳入后续建模 努力的重点是美属维尔京群岛圣托马斯的非洲裔加勒比人特有的方面。具体目标 包括以下步骤： 目的1：描述医学差异（诊断、合并症、存在/不存在慢性 疾病，死亡率）和人口统计学因素（年龄，性别，种族/民族，SES，付款人身份） 和飓风后，并按处置（空中救护转移;入院，出院回 社区）。 目的2：随访300名55岁以上的灾后慢性内科疾病艾德患者出院 在两个时间段（12和24个月）返回社区以表征他们的人口统计学特征（年龄， 性别、人种/种族）;医疗保健利用（初级保健访视）;医学（合并症）;行为 （医疗依从性，应对方式，抑郁，自我报告的韧性）和社会网络状态， 确定这些因素与结局（死亡、再入院至艾德或医院;功能性 状态）。

Project Summary/Abstract The USVI was hit by two successive, Category 5 hurricanes in September 2017: Hurricanes Irma and Maria. The storms caused massive damage on the islands, including partial destruction of the Schneider Regional Medical Center (SRMC), the only hospital on St. Thomas, with a reduction in available beds from 169 to <40, destruction of its Cancer Center and heart catheterization laboratories and reduced respiratory support, CT, and MRI capabilities. Provision of medical services has been further hampered by pre- and post-hurricane related departures of physicians and other medical personnel. Persons with the most serious conditions continue to be sent by air ambulance to hospitals in the continental United States, with others discharged back to the community to collapsed primary care, public health, and social networks. There was a perception on the part of physicians remaining on the island that mortality rates were up, particularly among poor, elderly patients with chronic conditions: in the words of one physician, “they're just giving up and dying.” The current proposal seeks to provide documentation and increase understanding of the short and long term health risks and impacts of the 2017 hurricanes, focusing on the SRMC Emergency Department as the primary access point for medical care on St. Thomas post-hurricane. Studies will assess acute hurricane-related medical conditions and the exacerbation of chronic diseases in the setting of a) severely disrupted health care services; b) individual patient factors; and c) a collapse of culturally-relevant social support networks, particularly for aging patients. Data will provide a basis for acute interventions as well as long-term disaster management planning to promote resilience, and will feed into subsequent modeling efforts focused on aspects unique to the Afro-Caribbean population of St. Thomas, USVI. Specific Aims include: Aim1: Characterize the differences in medical (diagnosis, co-morbidities, presence/absence of chronic disease, mortality) and demographic factors (age, gender, race/ethnicity, SES, payer status) for periods pre- and post-hurricanes, and by disposition (air ambulance transfer; hospital admission, discharge back to community). Aim 2: Follow 300 post-disaster ED patients ages 55+ with chronic medical diseases who were discharged back to the community at two time epochs (12 and 24 months) to characterize their demographic (age, gender, race/ethnicity); health care utilization (primary care visits); medical (co-morbidities); behavioral (medical adherence, coping style, depression, self-reported resilience) and social network status and identify the association of these factors with outcome (death, readmission to ED or hospital; functional status).