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Comparative Study
. 2004 Jan;43(1):6-14.
doi: 10.1016/j.annemergmed.2003.08.005.

An emergency department response to severe acute respiratory syndrome: a prototype response to bioterrorism

Kum-Ying Tham  1
Affiliations
Comparative Study

An emergency department response to severe acute respiratory syndrome: a prototype response to bioterrorism

Kum-Ying Tham. Ann Emerg Med. 2004 Jan.

Abstract

Study objective: On March 13, 2003, Singapore physicians were alerted about an outbreak of atypical pneumonia that became known as severe acute respiratory syndrome (SARS). I describe the application of an emergency department (ED) disaster response plan to manage the SARS outbreak.

Methods: The ED implemented protection for staff, patients, and facility; infection control measures; and disaster-response workflow changes. The Ministry of Health, Singapore, centralized SARS cases in the hospital, and the ED became the national screening center. A screening questionnaire and a set of admission criteria were applied after assessment of clinical features and chest radiograph findings.

Results: For the duration of the outbreak that ended on May 31, 2003, the ED screened 11,461 persons for SARS, of whom 1,386 (12.9%) were admitted to rule out SARS and 235 (17%) were confirmed to have SARS. Among 10,075 persons discharged from the ED, there were 28 reattending patients who were admitted and diagnosed with SARS, giving an undertriage rate of 0.3% (95% confidence interval [CI] 0.1% to 0.4%). The sensitivity of an ED admission for SARS was 89.4% (95% CI 85.6% to 93.1%), and specificity was 89.7% (95% CI 89.2% to 90.3%). The positive predictive value was 17% (95% CI 15.7% to 18.4%), and the negative predictive value was 99.7% (95% CI 99.6% to 99.8%). No patient contracted SARS as a result of an ED visit. After full implementation of protective measures, 1 ED nurse with undiagnosed diabetes mellitus was treated for suspected SARS.

Conclusion: Although the SARS outbreak was not a bioterrorism event, the ED disaster response was applicable in the outbreak's management. The use of a screening questionnaire and admission criteria enabled the ED to screen, treat, and safely discharge the majority of the patients.

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Figures

Figure 1
Figure 1
ED workload from March 13 to May 31, 2003.
Figure 2
Figure 2
Outcome of SARS screening. ∗Reattendance cases confirmed to have SARS after admission.
See this image and copyright information in PMC

Comment in

  • The limits of techne and episteme.
    Wears RL. Wears RL. Ann Emerg Med. 2004 Jan;43(1):15-6. doi: 10.1016/j.annemergmed.2003.08.007. Ann Emerg Med. 2004. PMID: 14707934 Free PMC article. No abstract available.

References

    1. Ministry of Health, Singapore. Health Facts Singapore 2002. Available at: http://app.moh.gov.sg/sta/sta0101.asp and http://app.moh.gov.sg/sta/sta0105.asp. Accessed April 4, 2003.
    1. Ministry of Health, Singapore. Ministry of Health Medical Alert: Outbreak of Atypical Pneumonia in Hong Kong, Vietnam and Guangdong Province in China. Ministry of Health publication No. MH 34:03, Vol. 14.
    1. Office of Quality Management. Trends of Tan Tock Seng Hospital Emergency Department Attendances. Office of Quality Management, Tan Tock Seng Hospital, Singapore.
    1. Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS): updated interim domestic infection control guidance in the health care and community setting for patients with suspected SARS. Available at: http://www.cdc.gov/ncidod/sars/infectioncontrol.htm. Accessed April 26, 2003.
    1. Ministry of Health, Singapore. Update (II) on atypical pneumonia cases in Singapore, March 15, 2003, press release. Available at: http://app.moh.gov.sg/new/new02.asp. Accessed April 4, 2003.

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