Hospital preparedness and SARS

Abstract

On May 23, 2003, Toronto experienced the second phase of a severe acute respiratory syndrome (SARS) outbreak. Ninety cases were confirmed, and >620 potential cases were managed. More than 9,000 persons had contact with confirmed or potential case-patients; many required quarantine. The main hospital involved during the second outbreak was North York General Hospital. We review this hospital's response to, and management of, this outbreak, including such factors as building preparation and engineering, personnel, departmental workload, policies and documentation, infection control, personal protective equipment, training and education, public health, management and administration, follow-up of SARS patients, and psychological and psychosocial management and research. We also make recommendations for other institutions to prepare for future outbreaks, regardless of their origin.

Figure 1

Tent assessment clinic built on ambulance loading dock for assessment of the general public for any symptom suggestive of severe acute respiratory syndrome. A, 40- x 20-foot tent constructed on the ambulance bay of the emergency department provided a spacious waiting area adjacent to the clinic area; B, inside the tent, eight cubicles were constructed with metal pipe frames and thick plastic walls, each ventilated with a custom-built ventilation system.

figure 2

Standardized follow-up checklist of patients with severe acute respiratory syndrome. BP, blood pressure; CBC, complete blood count; LDH, lactate dehydrogenase; AST, aspartate transaminases; PCR, polymerase chain reaction; RR, respiratory rate; P, pulse; ALP, alkaline phosphatase; CK, creatine kinase; ESR, erythrocyte sedimentation rate; Ca, calcium; PO4, phosphate; Mg, magnesium; F/u, follow-up; NP, nasopharangeal; PA, posterior-anterior.