Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-06T00:57:52.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents

Published online by Cambridge University Press:  12 May 2021

Paolo Trucco ,
Claudio Nocetti ,
Riccardo Sannicandro ,
Michele Carlucci ,
Eric S. Weinstein Open the ORCID record for Eric S. Weinstein [Opens in a new window]  and
Roberto Faccincani Open the ORCID record for Roberto Faccincani [Opens in a new window]
Paolo Trucco
Affiliation:
School of Management, Politecnico di Milano, Milano, Lombardia, Italy
Claudio Nocetti
Affiliation:
School of Management, Politecnico di Milano, Milano, Lombardia, Italy
Riccardo Sannicandro
Affiliation:
Emergency Department, Ospedale San Raffaele, Milano, Lombardia, Italy
Michele Carlucci
Affiliation:
Pronto Soccorso e Chirurgia Generale e delle Urgenze, Ospedale San Raffaele, Milano, Lombardia, Italy
Eric S. Weinstein
Affiliation:
CRIMEDIM, Research Center in Emergency and Disaster Medicine, Novara, Novara, Italy
Roberto Faccincani*
Affiliation:
Emergency Department, Ospedale San Raffaele, Milano, Lombardia, Italy
*
Corresponding author: Roberto Faccincani, Email: faccincani.roberto@hsr.it.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a mass casualty incident (MCI).

Methods:

A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.

Results:

In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.

Conclusions:

The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.

Keywords

mass casualty (MCI)resource allocation strategiesresiliencesimulationcase study
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 3 , June 2022 , pp. 1105 - 1115
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arboleda, CA, Abraham, DM, Luitz, R. Simulation as a tool to assess the vulnerability of the operation of a health care facility. J Perform Construct Facil. 2007;21(4).CrossRefGoogle Scholar
Guinet, A, Faccincani, R. 2015 Hospital’s vulnerability assessment. International Conference on Industrial Engineering and Systems Management (IESM), Seville, Spain, 2015. pp. 249-254. doi: 10.1109/IESM.2015.7380166 CrossRefGoogle Scholar
Homeland Security Act. Pub.L. 107-296, 116 Stat. 2135, enacted November 25, 2002. Assessed July 30, 2020.Google Scholar
EUR-Lex. Council Directive 2008/114/EC of 8 December 2008 on the identification and designation of European critical infrastructures and the assessment of the need to improve their protection. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2008.345.01.0075.01.ENG. Assessed July 7, 2020.Google Scholar
Holling, CS. 1973 Resilience and stability of ecological systems. Annu Rev Ecol Syst. 1973;4(1):1–2.CrossRefGoogle Scholar
Therrien, MC, Normandin, JM, Denis, JL. Bridging complexity theory and resilience to develop surge capacity in health systems. J Health Organ Manag. 2017;31(1):96–109.CrossRefGoogle ScholarPubMed
McDaniels, T, Chang, S, Cole, D, et al. Bridging complexity theory and resilience to develop surge capacity in health systems and adaptation. Glob Environ Change. 2008;18(2):310–318.CrossRefGoogle Scholar
Cimellaro, G, Malavisi, M, Mahin, S. Factor analysis to evaluate hospital resilience. ASCE-ASME Journal of Risk and Uncertainty in Engineering Systems, Part A: Civil Engineering. 2018;4(1).Google Scholar
Hollnagel, E, Pariès, J, Wreathall, J, et al. Resilience Engineering in Practice: A Guidebook. Farnham: Asgate Publishing; pp. 300–309.Google Scholar
Shabanikiya, H, Jafari, M, Gorgi, HA, et al. Developing a practical toolkit for evaluating hospital preparedness for surge capacity in disasters. Int J Disaster Risk Reduct. 2019;34:423–428.Google Scholar
Lapčević, Z, Mandić-Rajčević, S, Lepić, M, et al. Evaluating a primary healthcare centre’s preparedness for disasters using the hospital safety index: lessons learned from the 2014 floods in Obrenovac, Serbia. In Int J Disaster Risk Reduct. 2019;34:436–442.CrossRefGoogle Scholar
Al Thobaity, A, Alamri, S, Plummer, V, et al. Exploring the necessary disaster plan components in Saudi Arabian hospitals. Int J Disaster Risk Reduct. 2019;41:101316.Google Scholar
Pantzartzis, E, Price, A, Edum Fotwe, F. Roadmap layers and processes: resilient and sustainable care facilities. Eng Constr Architect Manag. 2019;26(9):1986–2007.CrossRefGoogle Scholar
Janius, R, Abdan, K, Zulkaflli, ZA. Development of a disaster action plan for hospitals in Malaysia pertaining to critical engineering infrastructure risk analysis. Int J Disaster Risk Reduct. 2017;21:168–175.Google Scholar
Low, SP, Gao, S, Wong, GQE. Resilience of hospital facilities in Singapore’s healthcare industry: a pilot study. Int J Disaster Resil Built Environ. 2017;8(5):537–554.Google Scholar
Labarda, C, Labarda, M, Lamberte, E. Hospital resilience in the aftermath of Typhoon Haiyan in the Philippines. Disaster Prev Manag. 2017;26(4):424–436.CrossRefGoogle Scholar
Achour, N, Price, ADF. Resilience strategies of healthcare facilities: present and future. Int J Disaster Resil Built Environ. 2014;1(3):264–276.Google Scholar
Mallak, LA. Measuring resilience in health care provider organizations. Health Manpow Manage. 1998:24(4):148–152.CrossRefGoogle ScholarPubMed
Carthey, J, de Leval, MR, Reason, J.T. Institutional resilience in healthcare systems. Qual Health Care. 2001;10(1):29–32. doi: org/10.1136/qhc.10.1.29 CrossRefGoogle ScholarPubMed
Institutional UNISDR. Hospitals safe from disasters. 2008. United Nations Office for Disaster Risk Reduction, Geneva. https://www.unisdr.org/2009/campaign/pdf/wdrc-2008-2009-information-kit.pdf. Assessed August 30, 2020.Google Scholar
Mostafa, MM, Sheall, R, Morris, M, et al. Strategic preparation for crisis management in hospitals: empirical evidence from Egypt. Disaster Prev Manag. 2004;13(5)399–408.CrossRefGoogle Scholar
Nemeth, C, Cook, R. Healthcare IT as a source of resilience. Paper presented at 2007 IEEE International Conference on Systems, Man and Cybernetics. Montreal, Quebec. 2007. pp. 3408-3412. https://www.researchgate.net/publication/220753648_Healthcare_IT_as_a_source_of_resilience. Accessed on July 30, 2020.Google Scholar
Myrtle, RC, Masri, SF, Nigbor, RL, et al. Classification and prioritization of essential systems in hospitals under extreme events. Earthq Spectra. 2005;21(3):779–802.CrossRefGoogle Scholar
Mehani, Y, Benouar, D, Bechtoula, H, et al. Vulnerability evaluation of the strategic buildings in Algiers (Algeria): a methodology. Nat Hazards (Dordr). 2011;59(1):529–551.CrossRefGoogle Scholar
Wilkinson, SM, Alarcon, JE, Mulyani, R, et al. Observations of damage to buildings from MW 7.6 Padang earthquake of 30 September 2009. Nat Hazards (Dordr). 2012;63:521–547.CrossRefGoogle Scholar
Achour, M, Miyajima, M, Pascale, F, et al. Hospital resilience to natural hazards: classification and performance of utilities. Disaster Manage Prev. 2014;23(1):40–52.Google Scholar
Senpinar-Brunner, N, Eckert, T, Wyss, K. Acceptance of public health measures by air travelers, Switzerland. Emerg Infect Dis. 2009;15(5)831–832.CrossRefGoogle ScholarPubMed
Loosemore, M, Carthey, J, Chandra, V, et al. Climate change risks and opportunities in hospital adaptation. Int J Disaster Resil Built Environ. 2011;2(3);210–221.CrossRefGoogle Scholar
Vanvactor, JD. Cognizant healthcare logistics management: ensuring resilience during crisis. Int J Disaster Resil Built Environ. 2011;2(3):245–255.CrossRefGoogle Scholar
Manley, W, Homer, J, Hoard, ML, et al. A dynamic model to support surge capacity planning in a rural hospital. Paper presented at 23rd Int. Conf. of the System Dynamics Society, Massachusetts, Institute of Technology (MIT), Boston, July 17-21, 2005. https://www.systemdynamics.org/hospital-surge-capacity-planning. Accessed July 30, 2020.Google Scholar
Runkle, JD, Brock-Martin, A, Karmaus, W, et al. Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery. Am J Public Health. 2012;102(12):e24-e32.CrossRefGoogle ScholarPubMed
Faccincani, R, Pascucci, F, Lennquist, S. How to surge to face SARS-CoV-2 outbreak. Lessons learned from Lombardy, Italy. Disaster Med Public Health Prep. 2020;14(5):e39–e41. doi: 10.1017/dmp.2020.64 CrossRefGoogle ScholarPubMed
Weinstein, E, Ragazzoni, L, Burkle, F, et al. Delayed primary and specialty care: the coronavirus disease–2019 pandemic second wave. Disaster Med Public Health Prep. 2020;14(3):e19–e21. doi: 10.1017/dmp.2020.148 CrossRefGoogle ScholarPubMed
Kurihara, H, Bisagni, P, Faccincani, R, et al. COVID-19 outbreak in Northern Italy: viewpoint of the Milan area surgical community. J Trauma Acute Care Surg. 2020;88(6):719–724.CrossRefGoogle ScholarPubMed
Coimbra, R, Edwards, S, Kurihara, H, et al. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur J Trauma Emerg Surg. 2020;46(3):505–510.CrossRefGoogle ScholarPubMed
FEMA. National Disaster Recovery Framework. 2016. https://www.fema.gov/sites/default/files/2020-06/national_disaster_recovery_framework_2nd.pdf. Accessed March 18, 2021.Google Scholar
ISO 22301:2019. Security and resilience — Business continuity management systems — Requirements. International Standard Organisation. https://www.iso.org/standard/75106.html Google Scholar
Devlen, A. How to build a comprehensive business continuity programme for a healthcare organization. J Bus Contin Emer Plan. 2009;4(1)47–61.Google Scholar
Zhong, S, Clark, M, Hou, XY, et al. Development of hospital disaster resilience: Conceptual framework and potential measurement. Emerg Med J. 2014;31(11):930–938.CrossRefGoogle ScholarPubMed
Bruneau, M, Chang, SE, Eguchi, RT, et al. A framework to quantitatively assess and enhance the seismic resilience of communities. Earthq Spectra. 2003;19:733–752.Google Scholar
Bruneau, M, Reinhorn, A. Exploring the concept of seismic resilience for acute care facilities. Earthq Spectra. 2007;23:41–62.CrossRefGoogle Scholar
Kajihara, C, Munechika, M, Kaneko, M, et al. A matrix of the functions and organizations that ensure continued healthcare services in a disaster. Qual Innovation Prosperity. 2016;20(2):145–156.Google Scholar
Labaka, L, Hernantes, J, Sarriegi, JM. A holistic framework for building critical infrastructure resilience. technological forecasting and social change. Technol Forecast Soc Chang. 2016;103:21–33.CrossRefGoogle Scholar
SICUT. Indicazioni per un Piano di risposta ospedaliera ad una Maxi-emergenza di carattere traumatico (in Italian), Società Italiana di Chirurgia d’Urgenza e del Trauma. 2017. http://www.sicut.net/wp-content/uploads/2017/06/PEMAF-SICUT.pdf. Accessed March 7, 2021.Google Scholar
Lennquist, S. Major incidents: definitions and demands on the health-care system. Medical Response to Major Incidents and Disasters. Berlin Heidelberg: Springer Verlag; 2012:1-7.CrossRefGoogle Scholar
Gazzetta Ufficiale. Regione Lombardia. https://www.gazzettaufficiale.it/eli/id/1997/11/29/097R0637/s3. Assessed November 10, 2020.Google Scholar
Guinet, A, Faccincani, R. Hospital’s vulnerability assessment. 2015 International Conference on Industrial Engineering and Systems Management (IESM), Seville, Spain, 2015, pp. 249-254, doi: 10.1109/IESM.2015.7380166 CrossRefGoogle Scholar
Faccincani, R, Della Corte, F, Sesana, G, et al. Hospital surge capacity during Expo 2015 in Milano, Italy. Prehosp Disaster Med. 2015;33(5):459–465.CrossRefGoogle Scholar
MRMI Italia. Terrorist attacks on hospitals: risk and emergency assessment, tools, and systems. https://www.mrmi-italia.org/threats-project. Assessed November 10, 2020.Google Scholar
Hick, JL, Einav, S, Hanfling, D, et al. Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4 Suppl):e1S–e16S. doi: 10.1378/chest.14-0733 CrossRefGoogle ScholarPubMed
Zhang, X. Application of discrete event simulation in health care: a systematic review. BMC Health Serv Res. 2018;18:687. doi: 10.1186/s12913-018-3456-4 CrossRefGoogle ScholarPubMed
Samuel, C, Gonapa, K, Chaudhar, PK, et al. Supply chain dynamics in healthcare services. Int J Health Care Qual Assur. 2010;23(7):631–642. doi: 10.1108/09526861011071562 CrossRefGoogle ScholarPubMed
Hirsch, G. Modeling the consequences of major incidents for health care systems. 2004; Proceedings of the 22nd International Conference of the System Dynamics Society, Oxford, England.Google Scholar
Wang, Y, Luangkesorn, K, Shuman, L. Modeling emergency medical response to a mass casualty incident using agent based simulation. Socio-Econ Plan Sci. 2012;46(4):281–290. doi: 10.1016/j.seps.2012.07.002 CrossRefGoogle Scholar
Alsubaie, A, Alutaibi, K, Marti, J. Resources allocation in emergency response using an interdependencies simulation environment. IEEE Canada International Humanitarian Technology Conference. 2015; (IHTC2015). doi: 10.1109/ihtc.2015.7238050 Google Scholar
Lubyansky, A. “A system dynamics model of health care surge capacity.” 23rd Int. Conf. of the System Dynamics Society, System Dynamics Soc., http://www.systemdynamics.org/publications.html Google Scholar
Bayram, J, Zuabi, S. Disaster metrics: Quantification of acute medical disasters in trauma-related multiple casualty events through modeling of the acute medical severity index. Prehospital and Disaster Medicine. 2012;27(2):130–135. doi: 10.1017/s1049023x12000428 CrossRefGoogle ScholarPubMed
Cimellaro, G, Piqué, M. Resilience of a hospital emergency department under seismic event. Adv Struct Eng. 2016;19(5):825–836. doi: 10.1177/1369433216630441 CrossRefGoogle Scholar
Cimellaro, G, Reinhorn, A, Bruneau, M. Framework for analytical quantification of disaster resilience. Eng Struct. 2010;32(11):3639–3649. doi: 10.1016/j.engstruct.2010.08.008 CrossRefGoogle Scholar
Saaty, TL. The Analytic Hierarchy Process. New York: McGraw-Hill; 1980.Google Scholar
Faccincani, R, Stucchi, R, Carlucci, M, et al. Evaluation of interaction between Emergency Medical System and hospital network during the January 2018 train derailment in Milano. Disaster Med Public Health Prep. 2021:1–6. doi: 10.1017/dmp.2020.410 Google ScholarPubMed
Lim, HW, Li, Z, Fang, D. Impact of management, leadership, and group integration on the hospital response readiness for earthquakes. Int J Disaster Risk Reduct. 2020;48:101586.CrossRefGoogle Scholar