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

项目摘要/摘要 2017年9月，美国遭受了连续两次5级飓风的袭击：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)，圣托马斯岛上唯一一家可用医院减少 床位从169张增加到40张，摧毁了癌症中心和心脏插管实验室，并减少了 呼吸支持、CT和MRI能力。医疗服务的提供因以下原因而进一步受阻 与飓风前后有关的医生和其他医务人员离职。有以下情况的人 最严重的情况继续由空中救护车送往美国大陆的医院， 其他人被遣送回社区，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在上升， 特别是在患有慢性病的贫穷、老年患者中：用一位医生的话说，他们只是 放弃，然后死去。“ 目前的提案旨在提供文件，并增加对短期和 2017年飓风的长期健康风险和影响，重点是SRMC急诊部 作为飓风过后圣托马斯的主要医疗接入点。研究将评估急性 与飓风有关的医疗条件和慢性病的恶化 卫生保健服务中断；b)个别病人因素；c)与文化相关的社会因素崩溃 支持网络，特别是针对老年患者的支持网络。数据将为急性干预以及 长期灾害管理规划，以提高复原力，并将纳入后续建模 工作的重点是美属维尔京群岛圣托马斯的非洲裔加勒比人口所特有的方面。具体目标 包括： 目的1：描述医学(诊断、合并症、有无慢性疾病)的差异 疾病、死亡率)和人口因素(年龄、性别、种族/族裔、社会经济地位、付款人身份) 和飓风后，以及处置(空中救护车转送；入院、出院) 社区)。 目的2：跟踪300名55岁以上慢性内科疾病患者出院的灾后急救 在两个时期(12个月和24个月)返回社区，以描述他们的人口统计特征(年龄， 性别、种族/族裔)；卫生保健利用(初级保健就诊)；医疗(共病)；行为 (医疗依从性、应对方式、抑郁、自我报告的复原力)和社交网络状况以及 确定这些因素与预后的关系(死亡、再次入院急诊或住院；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).