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The objective of this study was to determine how easy or
difficult it would be to quantify the population of individuals who depend on
medical assistance and who, if their services and/or support were disrupted
during an mass casualty event (MCE), would potentially seek those services in their local hospital emergency
department. The investigators began by exploring a variety of databases
containing information on the medical needs of these individuals, but found
that no one data source could provide the level of detail they were seeking.
Information was available, but no corresponding information, such as caregiver
availability, presence of a medical condition, or the level of disability, was
provided. Furthermore, there is considerable overlap of information in these
databases, making any combination of groups prone to overestimation.
The investigators attempted an alternative approach to developing
population estimates, "from the ground up," which involved contacting local agencies
in one city that have regular interactions with at-risk individuals and
soliciting their estimates. Identifying the agencies and the most appropriate contact
within the agency, as well as overcoming their hesitation to provide
information, was quite labor intensive, and the investigators were not confident
that the estimates they were able to derive are accurate.
Although neither approach yielded reliable estimates of the
at-risk population, further exploration of these databases has the potential to
provide the level of detail needed. The searches in this study were limited to
only those databases that are publically available (i.e., that did not require
a data user agreement (DUA) or submission of a proposal and fee). Data on medical/clinical needs (e.g.,
IVs, enteral nutrition, complex wound care, insulin injections, urinary
catheters/colostomies, ventilators, VADs, and hospice care) are the areas in
which data are most lacking. This type of information could, however, readily
be obtained from Medicare and Medicaid claims. Although each has its
limitations (Medicare covers only the elderly and disabled; Medicaid covers
only the poor and each State's eligibility and benefits vary), the population
covered by these public payers is substantial.
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