Vidyya Medical News Service
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States need way to track victims of terrorist attacks

The FBI is warning of another possible terrorist attack. However, if there is another attack, states are still not prepared to accurately track the numbers of people injured or killed, and assess the attack's full impact on state health care systems.

"Some state health officials think they already have the ability to track this information, but they don't,' says Liz Garthe, president of Garthe Associates, a Marblehead, Mass., firm that specializes in analyzing health care and injury data.

In October's Journal of Trauma issue, Garthe and colleague Nick Mango describe a new coding method that would allow state health officials to determine not only injuries, illnesses and fatalities from such disasters as terrorist or bioterrorist attacks, but also evaluate the use of health care resources. With the new method, health officials also could track all follow-up treatment of the victims.

"This method applies to any type of terrorist attack as well as natural disaster, major highway or aviation crash, or any other incident of special interest to the state or federal governments," adds Garthe. "And, the method can be implemented quickly".

The new method piggybacks on existing systems that states use to record hospital stays, emergency department visits and deaths. It would use a unique code created at the state level for a specific event. The code is designed to correspond with a specific event and time period. The code structure proposed by Garthe and Mango can readily be entered into the existing health care computer systems without costly and time consuming modifications. It is compatible with all the injury, illness, cause of injury and terrorist codes presently in use in hospital and death data.

Here's how it works: if there is another attack on New York, health officials could send out an alert instructing all health care providers and medical examiner's offices in the state to use code U9999 to identify all individuals injured or killed by the attack. Afterward, state health officials could analyze how many hospital beds were used, services that were provided, length of stay, and charges related specifically to each attack. Weeks or months later, rehabilitation for burns or broken bones also could be tracked by using this Mass Casualty Incident (MCI) coding system.

Current coding systems can only identify the numbers of people killed or injured in a disaster, and the nature of their injuries. But they don't distinguish among casualties from specific attacks. For example, victims of a terrorist attack occurring in New York in November, may not be possible to distinguish from another attack in December. This is an important feature of MCI codes - for example, this method can help states determine what health system capacity is needed for different types and levels of incidents. For states experiencing hurricanes, earthquakes or other damaging natural events, the same concept applies. For example, this tracking method can help states determine what health system capacity is needed for a hurricane packing 140 mph winds, compared with one traveling at 95 mph.

MCI codes also can help states obtain a much clearer picture of health care resources needed for long-term follow-up from a disaster. "We doubt there is a process in place today to find out how many people are coming in with psychiatric diagnoses from delayed reactions to the September 11 attacks," says Garthe.

As the United States grapples with the prospect of future terrorist attacks, knowing the health care capacity needed in the event of a disaster is critical. "States are stressed now," Mango notes. "The federal government is telling them to have surge capacities of 500 beds, but they don't know what that looks like. Where are these beds: how many are needed in intensive care, surgery, burn units, etc.?"

With a relatively small investment for an implementation team and minimal staff training, states that begin MCI coding can substantially enrich their data-gathering abilities and disaster preparedness. Says Garthe, "This is tracking for now, but planning for the future."

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