1. Marrelli, Tina M. MSN, MA, RN

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We would all like to be prepared for whatever disaster may come-and then hope we never need to act and operationalize it. Unfortunately, this may not be the case.

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I read with trepidation the following: "A nationwide blue-ribbon panel of experts recommends that hospital plans for a surge of disaster victims should begin with a strategy to empty their beds of relatively healthier patients." The report also stated that "such a strategy could safely empty 70% of a hospital's inpatient populations within 72 hours[horizontal ellipsis] There is consensus among health officials that, whether dealing with a natural disaster like Hurricane Katrina, a possible terrorist attack like September 11, or epidemics like SARS or avian flu, affected hospitals have few means of making room for large numbers of incoming casualties," according to Gabon Keen, MD, head of emergency medicine at The Johns Hopkins (JH) Hospital and Director of the JH Office of Critical Event Preparedness and Response ("Planning for surge," 2007).


Where is home health and community health in this proposition? Imagine if 70% of patients in your community were discharged from all surrounding hospitals in your service/catchment areas in a short period of time. Think of who is in the hospital. People they may consider to be the "healthiest" still would need some kind of skilled care, otherwise (without the untoward event) they would still be in the hospital. Consider surgical patients. They may be considered the "healthiest" depending on their health history and illness trajectories, but older patients who are 1 or 2 days postoperative still have significant pain and debilitation, and when they go home they still would need some kind of care. The panel also placed patients into one of five categories, from minimum risk to very high risk, in which case patients could only be cared for in a critical care facility. An "ethical framework" also was mentioned as needing to be created through the process. Interestingly, a follow-up study is being planned and will score 4,000 real patients to help determine whether the system would work in actual disaster conditions ("Planning for surge"). Stay tuned[horizontal ellipsis]


Home health, hospice, and community-based care programs are involved in emergency management. We care for patients where they live, not where they "visit" or "are admitted," such as at the hospital. With this in mind, patients and families look to home healthcare and hospices to help them prepare and plan for such hard-to-imagine events. In this issue, Kevin Ross and Caryn Bing, authors of "Emergency Management: Expanding the Disaster Plan," bring home the human and operational stories of lessons learned after Hurricanes Katrina and Rita. These unwanted visitors wreaked havoc on their multiple branches in Florida, Alabama, Mississippi, Louisiana, and Texas. We can all learn something from their harrowing story. Josephine Sienkiewicz and colleagues write about a collaborative project in New Jersey entitled "A Patient Classification System for Emergency Events in Home Care."


Home care is continuing to grow, and the latest statistics confirm that home care may be the fastest-growing segment of healthcare. At the recent National Private Duty Association ( meeting held in Orlando, FL, topics included "Crisis Management and Communications," "Dementia: What It Is, What It Is Not, and What to Do," "Geriatric Case Management," and "Recruitment and Retention." From my perspective, home care is not "one" entity; it is an all-encompassing entity that includes all the services, payers, clinicians, and models that can be imagined and operationalized. Home care includes pediatrics, 24-hour skilled and personal care services, and many other approaches, which are as individualized as the patients and families who seek these specialized services.


Home Healthcare Nurse also welcomes a new Editorial Board Member, Jeanne M. Ryan, MA, OTR, CHCE, who is the Executive Director at the Visiting Nurse Association and Hospice of the Cooley Dickinson Hospital in North Hampton, MA. Welcome, Jeanne!!


We continually strive to make Home Healthcare Nurse reflect all of home care. There are many exciting things going on all across the country and beyond. We want to hear about your successes and lessons learned. If you wish to contribute, please review the author guidelines at and then e-mail the Editor at We cannot wait to read your manuscript!!


Tina M. Marrelli, MSN, MA, RN




Johns Hopkins News. (2007). Planning for surge of disaster victims? Discharge the healthiest from every hospital. Baltimore, MD: Johns Hopkins University. [Context Link]