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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.

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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.
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    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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