Disaster Outreach Severity Score

Paul Rega, MD, FACEP

Churton Budd, RN, EMT-P

Kelly Burkholder-Allen, RN, MSEd, CEN

Click HERE to download the the DOSS worksheet in WordPerfect 5.1 format

INTRODUCTION:

The outreach program initiated by DMATs during Hurricane Andrew and continued during subsequent disasters has been acknowledged to have been an essential component of health care delivery during a difficult time. The purpose of this program was to take medical care to the indigenous population as their ability to seek medical attention might have been impaired or non-existent. DMAT members align themselves with military units and in military vehicles and venture into pockets of dwellers providing medical assessments and treatments. As each DMAT arrived its outreach team would focus on and evaluate areas previously untouched by earlier teams. It was the perception of the authors that no matter how successful the outreach team, there were still aspects that could be improved.

Problems encountered during Hurricane Andrew:

• There was no formal attempt to provide medical follow up for earlier encounters.
• There was no ability to define what areas required continuous follow-up (ie: hot spots).
• There was no ability to collate particular problems so as to be better able to manage them effectively at a later date.
• There was a lack of standardization and no mechanism to hand off of one DMAT's outreach data to subsequent DMATs to provide continuity of care.

PROPOSAL:

A data gathering instrument was developed to provide a quantifiable needs-assessment for outreach contacts. The instrument Disaster Outreach Severity Score (DOSS) could be initiated by each team and the DMAT members would evaluate and quantitate the information collected from the disaster-struck victims. DOSS is divided into four sections: Medical, Psychiatric, Environmental, and Demographic. The heavy emphasis on medical information is in keeping with the DMAT mission. The scoring allows subjective and objective information to be developed into an easily quantifiable format. Scores are generated for each sub-section as well as one total score encompassing all areas of inquiry. The lower the score, the more critical the situation mandating immediate or rapid follow-up. The scoring was developed to be compatible with triage concepts so that any health care professional on the team could accomplish it quickly and efficiently. Much of the scoring is based on the interviewer's perceptions as to how the victim is managing based on information provided. This was done purposely to take into account a certain gestalt factor that is developed by such people in critical times and is the rationale for team members doing the interviewing. Any acute needs would be managed as previously, but the instrument allows the team to account for that situation and comment on it. Once the data is brought back to base, the scores could be collected, tabulated and plotted on maps in order to plan follow-up trips more efficiently. Data could be displayed by physical location or by block group on a Geographical Information System (GIS).

LIMITATIONS:

The DOSS has not been utilized during actual disaster conditions. It has however been used during a TADMAT drill. Each interview process took less than 3 minutes and the scoring aspects were easily accomplished. Determination of a baseline score or normal score in a disaster has not yet been done. However, any score above the average would be highlighted.

POTENTIAL:

1. The DOSS could be programmed into a pen-top computer so that the scoring could be done automatically. A summary of scores for an area could be electronically transferred to a central location for real time tabulation of scores.
2. The information can be made available to any and every agency, especially if it is tabulated electronically.
3. The DOSS provides a method for identifying which victims are at risk for certain problems and when follow-up visits should be initiated.
4. By gradation of scores into sub-scores there is the possibility of identifying certain health matters and coordinating the efforts of experts to attend to those matters in an efficient and timely manner. For example, if there are areas with high scores in the pediatric category, this could alert teams of pediatricians to attend to those matters specifically.
5. Going out into the community doing outreach and utilizing the DOSS provides a sense of "we're here for you" within the affected community and furthers the role of DMATs as goodwill ambassadors.
6. Adoption of an instrument of this kind would allow for a specific type of disaster research not previously done.