Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-18T23:33:59.079Z Has data issue: false hasContentIssue false
  • English
  • Français

Disaster Metrics: Quantitative Benchmarking of Hospital Surge Capacity in Trauma-Related Multiple Casualty Events

Published online by Cambridge University Press:  08 April 2013

Jamil D. Bayram ,
Shawki Zuabi  and
Italo Subbarao
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion.

Methods: A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes.

Results: Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity.

Conclusions: Defining and quantitatively benchmarking the different components of hospital surge capacity is vital to hospital preparedness in MCE. Prospective studies of our mathematical model are needed to verify its applicability, generalizability, and validity.

(Disaster Med Public Health Preparedness. 2011;5:117–124)

Keywords

traumabenchmarkingmodels, statisticalhospitalssurge capacitymass casualty incidentsdisaster responsehealth care evaluation mechanismsemergency service, hospitaltime factorshospital bed capacityIllinoisChicagodisaster planninghospital surge capacitymultiple casualtydisaster managementhospital preparednessdisaster modelingdisaster metrics
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 5 , Issue 2 , June 2011 , pp. 117 - 124
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2011

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

REFERENCES

1.Auf der Heide, E.The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47 (1):34–49.Google Scholar
2.Handler, JA, Gillam, M, Kirsch, TD, Feied, CF.Metrics in the science of surge. Acad Emerg Med. 2006;13 (11):1173–1178.Google Scholar
3.American College of Emergency Physicians. Health care system surge capacity recognition, preparedness, and response. Ann Emerg Med. 2005;45 (2):23915671992.CrossRefGoogle Scholar
4.Carmona, RH.The science of surge: an all-hazard approach is critical to improving public health preparedness. Acad Emerg Med. 2006;13 (11):109716968686.Google Scholar
5.Barbisch, DF, Koenig, KL.Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13 (11):1098–1102.CrossRefGoogle ScholarPubMed
6.Burkle, FM JrPopulation-based triage management in response to surge-capacity requirements during a large-scale bioevent disaster. Acad Emerg Med. 2006;13 (11):1118–1129.Google ScholarPubMed
7.Estacio, PL.Surge capacity for health care systems: early detection, methodologies, and process. Acad Emerg Med. 2006;13 (11):1135–1137.Google Scholar
8.Wise, RA.The creation of emergency health care standards for catastrophic events. Acad Emerg Med. 2006;13 (11):1150–1152.Google Scholar
9.Kaji, A, Koenig, KL, Bey, T.Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13 (11):1157–1159.Google Scholar
10. McManus, J, Huebner, K, Scheulen, J.The science of surge: detection and situational awareness. Acad Emerg Med. 2006;13 (11):1179–1182.CrossRefGoogle ScholarPubMed
11.Stratton, SJ, Tyler, RD.Characteristics of medical surge capacity demand for sudden-impact disasters. Acad Emerg Med. 2006;13 (11):1193–1197.Google Scholar
12.Bonnett, CJ, Peery, BN, Cantrill, SV.Surge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25 (3):297–306.Google Scholar
13.Hirshberg, A, Holcomb, JB, Mattox, KL.Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001;37 (6):647–652.Google Scholar
14.Levi, L, Michaelson, M, Admi, H, Bregman, D, Bar-Nahor, R.National strategy for mass casualty situations and its effects on the hospital. Prehosp Disaster Med. 2002;17 (1):12–16.Google Scholar
15.Arnold, JL, Tsai, MC, Halpern, P, Smithline, H, Stok, E, Ersoy, G.Mass-casualty, terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I). Prehosp Disaster Med. 2003;18 (3):220–234.Google Scholar
16.Hick, JL, Hanfling, D, Burstein, JL.Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44 (3):253–261.CrossRefGoogle ScholarPubMed
17.Hanfling, D.Equipment, supplies, and pharmaceuticals: how much might it cost to achieve basic surge capacity? Acad Emerg Med. 2006;13 (11):1232–1237.Google Scholar
18.Burt, CW, McCaig, LF.Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003-04. Adv Data. 2006;27 (376):1–23.Google Scholar
19.Kelen, GD, Kraus, CK, McCarthy, ML.Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368 (9551):1984–1990.Google Scholar
20.Joint Commission on Accreditation of Healthcare Organizations. Preparing for a mass casualty event. Jt Comm Perspect. 2001;21 (12):10–11.Google Scholar
21.Voelker, R.Mobile hospital raises questions about hospital surge capacity. JAMA. 2006;295 (13):1499–1503.CrossRefGoogle ScholarPubMed
22.Hick, JL, Koenig, KL, Barbisch, D, Bey, TA.Surge capacity concepts for health care facilities: the CO-S-TR model for initial incident assessment. Disaster Med Public Health Prep. 2008;2(Suppl 1)S51–S57.Google Scholar
23.Koenig, KL, Kelen, G.Proceedings of the Consensus Conference “The Science of Surge,” May 17, 2006, San Francisco, California, USA. Acad Emerg Med. 2006;13:1087–1088.CrossRefGoogle Scholar
24.Hick, JL, Barbera, JA, Kelen, GD.Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3 2(Suppl)S59–S67.Google Scholar
25.De Boer, J.Order in chaos: modelling medical management in disasters. Eur J Emerg Med. 1999;6 (2):141–148.Google Scholar
26.Rivara, FP, Nathens, AB, Jurkovich, GJ, Maier, RV.Do trauma centers have the capacity to respond to disasters? J Trauma. 2006;61 (4):949–953.Google Scholar
27.Hirshberg, A, Scott, BG, Granchi, T, Wall, MJ Jr, Mattox, KL, Stein, M.How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma. 2005;58 (4):686–693, discussion 694-695.Google Scholar
28.Eastman, AL, Rinnert, KJ, Nemeth, IR, Fowler, RL, Minei, JP.Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma. 2007;63 (2):253–257.Google Scholar
29. McCarthy, ML, Aronsky, D, Kelen, GD.The measurement of daily surge and its relevance to disaster preparedness. Acad Emerg Med. 2006;13 (11):1138–1141.Google Scholar
30.Greenberg, MI, Hendrickson, RGCIMERC; Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Report of the CIMERC/Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Acad Emerg Med. 2003;10 (7):783–788.Google Scholar
31.Halpern, P, Tsai, MC, Arnold, JL, Stok, E, Ersoy, G.Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II). Prehosp Disaster Med. 2003;18 (3):235–241.Google Scholar
32.Levi, L, Bregman, D, Geva, H, Revah, M.Does number of beds reflect the surgical capability of hospitals in wartime and disaster? The use of a simulation technique at a national level. Prehosp Disaster Med. 1997;12 (4):300–304.Google Scholar
33.Davis, DP, Poste, JC, Hicks, T, Polk, D, Rymer, TE, Jacoby, I.Hospital bed surge capacity in the event of a mass-casualty incident. Prehosp Disaster Med. 2005;20 (3):169–176.Google Scholar
34.DeLia, D.Annual bed statistics give a misleading picture of hospital surge capacity. Ann Emerg Med. 2006;48 (4):384–388,e2.Google Scholar
35.Einav, S, Aharonson-Daniel, L, Weissman, C, Freund, HR, Peleg, KIsrael Trauma Group. In-hospital resource utilization during multiple casualty incidents. Ann Surg. 2006;243 (4):533–540.Google Scholar
36.Cosgrove, SE, Jenckes, MW, Kohri, DEvaluation of hospital disaster drills: a module-based approach. http://www.ahrq.gov/research/hospdrills/index.html. Published April 2004. Accessed on August 22, 2010.Google Scholar
37.Challen, K, Walter, D.Accelerated discharge of patients in the event of a major incident: observational study of a teaching hospital. BMC Public Health. 2006;6:10816638157.Google Scholar
38.Roccaforte, JD, Cushman, JG.Disaster preparedness, triage, and surge capacity for hospital definitive care areas: optimizing outcomes when demands exceed resources. Anesthesiol Clin. 2007;25 (1):161–177, xi.Google Scholar
39.Kelen, GD, McCarthy, ML.The science of surge. Acad Emerg Med. 2006;13 (11):1089–1094.Google Scholar
40.Phillips, S.Current status of surge research. Acad Emerg Med. 2006;13 (11):1103–1108.CrossRefGoogle ScholarPubMed
41.Asplin, BR, Flottemesch, TJ, Gordon, BD.Developing models for patient flow and daily surge capacity research. Acad Emerg Med. 2006;13 (11):1109–1113.Google Scholar
42.Schultz, CH, Koenig, KL.State of research in high-consequence hospital surge capacity. Acad Emerg Med. 2006;13 (11):1153–1156.Google ScholarPubMed
43.Rothman, RE, Hsu, EB, Kahn, CA, Kelen, GD.Research priorities for surge capacity. Acad Emerg Med. 2006;13 (11):1160–1168.Google Scholar
44.Jenkins, JL, O’Connor, RE, Cone, DC.Differentiating large-scale surge versus daily surge. Acad Emerg Med. 2006;13 (11):1169–1172.Google Scholar
45.Davidson, SJ, Koenig, KL, Cone, DC.Daily patient flow is not surge: “management is prediction.” Acad Emerg Med. 2006;13 (11):1095–1096.Google Scholar