Background: Hurricanes cause significant disruption in the delivery of healthcare to patients with acute and chronic medical conditions. There have been several single-center and single-storm studies looking at the effect on a single disease process. We sought to evaluate the effect of multiple storms on the emergency department (ED) to determine if there is an environmental threshold at which a storm affects care in the ED.
Methods: A retrospective chart review of adult patients seen across nine community and one academic ED between 2/22/2008 and 1/1/2018 was performed. During this time period, 7 hurricanes occurred in the region. We reviewed the 14 days before and after each of these storms. For each day, hourly ED volume, and total ED volume was evaluated. Our storm variables were obtained from the National Weather Service.
Results: There were a total of 7 hurricanes that met inclusion criteria. The categories of storms ranged from tropical storm (TS) to Category 2. For our storms: the wind ranged from 9.6mph to 32.6mph, the precipitation ranged from .16inches to 8.28 inches, and the fasted wind gust range was 21.9mph- 72mph. Analysis of variance (ANOVA) revealed there was not a significant difference in total daily ED volume by day across all storms, F(28, 174) = 1.52, p = .06. Although non-significant across the two weeks before and after the hurricane, the mean ED volume on the day of the hurricane was 1193.71 (SD = 190.74), as compared to the mean ED volume pre-storm (1341.44) and post-storm (1345.51). Five of the seven storms showed drops in ED volume on the day before and the day of the storm which returned to pre-storm volumes by day two post-storm.
Conclusion: While the TS and hurricanes did not significantly alter the ED volume, there were clinically relevant drops in the ED immediately before the storm and the day the storm made landfall in the region. Our study was limited by not having hurricanes greater than category 2 in our dataset. Further research is required with high category storms to assess the environmental effect on the ED. We are continuing to examine patient-level data to determine if certain subsets of patients and/or diagnoses may be disproportionately affected by such environmental changes.