EVALUATION OF HOSPITAL SURGE MANAGEMENT STRATEGIES FOR COPING WITH MASS CASUALTY INCIDENTS ALONG NAKURUELDORET- MALABA A-104 ROAD, KENYA

Abstract

victims of mass casualty incidents (MCI) which may include man-made and natural disasters. Despite the awareness of the fact that poor response strategies lead to increased morbidity and mortality, many hospitals are ill prepared to adequately respond to victims of mass casualty incidences citing many system deficiencies which are unique to different health care facilities. The general objective of this study was to evaluate hospital surge management strategies for coping with mass casualty incidents along Nakuru- Eldoret- Malaba A-104 Road, Kenya. The specific objectives were; to examine predisposing factors for patient surge at the Emergency Departments, the Wards operating theatre and the ICU; to evaluate the status of critical resources required for mass casualty incidences with unusual high patient surges; to assess strategies applied to cope with surge during mass casualty incidences. The study was grounded on the General System Theory approach. The study adopted descriptive and evaluative research designs. The study population comprised of health care workers, hospital administrators, patients, civil society organizations and the Police. Simple random, convenience and purposive sampling techniques were utilized. Sample size - 286 using sample size selection chart. Data was collected using questionnaires, interviews, FGDs and observation. Quantitative data was analyzed using SPSS 25 and Ms Excel then summarized as percentages, frequencies for descriptive statistics while inferential statistics were extracted thematically. The quantitative data was presented inform of charts, graphs and tables. Qualitative data was presented in narratives and in verbatim quotations. In line with objective one, the results indicated that 74% of the respondents had either experienced or responded to a major emergency incident in the workplace, 72% of the respondents reasoned that job action sheets were available in hospital, 91.6% of the respondents stated that such supplies were available in hospital stations, Further, (83.3%) responded that such a resource was available and in good condition. Further, the study found that increasing staff capacity during mass casualty incidents was an effective strategy during patient surge with 56.48% of the respondents agreeing, A chi-square test was conducted on the relationship between the number of years that the respondents have served in the facilities and experience of major emergency incidence. The chi- square value was 12.607 (p< 0.05) and was found to be significant. Regarding presence of designated care areas used temporarily by the hospital, isolation areas rate highest 51.7% availability while auditorium presence rates 53.3% least available. The overall conclusion of the study is that patient surge management strategies are still weak and as such cannot give effective emergency response to mass casualty incidents along Nakuru- Eldoret- MalabaA-104 road, Kenya. Based on the conclusions the study makes the following recommendations; firstly, that there is need for the hospital management to increase the number of staff and increase capacity in terms of equipment and instill a multidepartment approach and culture of emergency management to enhance sustainable emergency management system during mass casualty incidents; Secondly, the study recommends that capacity of critical resources be expanded (staffing, equipment, and prioritization of care). Lastly the study recommends that hospital facilities should improve on staff, adequate equipment and proper infrastructure to help in responding to a mass casualty incident. Information derived from the study will help institutions in the study area plan better on resource placement and policy for management of mass casualties.