Objectives: On September 18, 2003, Hurricane Isabel made landfall as a category 2 hurricane over the mid-Atlantic region, generating record conditions for the region's 27 years of monitoring. The purpose of this study was to investigate the impact of the hurricane on the number and type of emergency department (ED) patient visits and its impact on hospital admission rate from the day of landfall to day 5 postlandfall. Comparisons were made with a control group, which comprised average daily ED census during the six-month period preceding landfall and the average daily admission rates for the preceding six months.
Methods: Designed as an observational cohort study, daily ED patient visits and admissions through the ED were tracked from the day of landfall to day 5 postlandfall. The study population included all ED patient visits at a six-hospital urban health care system, including a Level 1 trauma center in the coastal southeastern region of Virginia, with an aggregate annual ED volume of 261,000. Daily patient volumes, complaint categories, and admission rates were measured during the study period and compared with a control population that included average daily patient volumes, complaint categories, and admission rates at the same facilities for six months before landfall. During a 30-day postlandfall period, 63 emergency physicians on staff at the study hospitals were sent an ad hoc survey and asked to report their experiences if they worked during the study period. The survey included requests for future preparedness recommendations based on their experiences and are reported.
Results: During the six-month period preceding Hurricane Isabel, the average number of aggregate ED visits per day was 670. The average daily number of patient visits by complaint category included six major traumas, 483 medical complaints, 169 minor traumas, and 13 psychiatric complaints. On the day of landfall, the total aggregate ED volume was 359 (-46%), which included two (-66%) major traumas, 263 (-46%) medical complaints, 88 (-48%) minor traumas, and six (-54%) psychiatric complaints. During the subsequent four days postlandfall, there was a significant increase in average daily aggregate ED census of 840 (+25%) patient visits, which included three (-50%) major traumas, 564 (+17%) medical complaints, 263 (+57%) minor traumas, and ten (-23%) psychiatric complaints. The largest single-day increase in ED visits was day 1 postlandfall, with a 35% increase in daily volume (905 patient visits). The percentage of admissions from the ED to an inpatient unit on the day of landfall also demonstrated a significant increase (19%) compared with the control group (13%). Admission rates through the ED had appeared to normalize on day 1 postlandfall (12%). Response rate to the ad hoc physician survey by those who worked during the study period was 31.2% (10 of 32). The most common problem areas reported included communication failures, access to on-call personnel, and provider and nursing understaffing during the immediate postlandfall period.
Conclusions: A significant overall reduction in ED visits by almost half the typical average volume was noted on the day of landfall (-46%). During the four days immediately following landfall, however, there was a marked increase in the overall ED census, with a particularly high increase on day 1 postlandfall. The largest complaint category increase was minor trauma (+57%). Hospital admission rates were highest on the day of landfall and seemed to return to baseline on day 1 postlandfall. These data may be useful for structuring ED personnel and hospital resource allocation to better serve its community during hurricane preparedness planning.