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Hospital Surge Capacity during Expo 2015 in Milano, Italy

Published online by Cambridge University Press:  29 August 2018

Roberto Faccincani ,
Francesco Della Corte ,
Giovanni Sesana ,
Riccardo Stucchi ,
Eric Weinstein ,
Itamar Ashkenazi  and
Pierluigi Ingrassia
Roberto Faccincani*
Affiliation:
Emergency Department Ospedale San Raffaele, Milano, Italy
Francesco Della Corte
Affiliation:
CRIMEDIM, Eastern Piedmont University, Novara, Italy
Giovanni Sesana
Affiliation:
ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Riccardo Stucchi
Affiliation:
ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Eric Weinstein
Affiliation:
Emergency Department Lexington Medical Center, W. Columbia, South Carolina USA
Itamar Ashkenazi
Affiliation:
Hillel Yaffe Medical Center, Hadera, Israel
Pierluigi Ingrassia
Affiliation:
CRIMEDIM, Eastern Piedmont University, Novara, Italy
*
Correspondence: Roberto Faccincani, MD, MScDM San Raffaele Hospital Milano, Italy E-mail: faccincani.roberto@hsr.it
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Abstract

Introduction

Hospital Acute Care Surge Capacity (HACSC), Hospital Acute Care Surge Threshold (HACST), and Total Hospital Capacity (THC) are scales that were developed to quantify surge capacity in the event of a multiple-casualty incident (MCI). These scales take into consideration the need for adequate care for both critical (T1) and moderate (T2) trauma patients. The objective of this study was to verify the validity of these scales in nine hospitals of the Milano (Italy) metropolitan area that prepared for a possible MCI during EXPO 2015.

Methods

Both HACSC and HACST were computed for individual hospitals. These were compared to surge capacities declared by individual hospitals during EXPO 2015, and also to surge capacity evaluated during a simulation organized on August 23, 2016.

Results

Both HACSC and HACST were smaller compared to capacities measured and reported by the hospitals, as well as those found during the simulation. This resulted in significant differences in THC when this was computed from the different methods of calculation.

Conclusions:

Surge capacity is dependent on the method of measurement. Each method has its inherent deficiencies. Until more reliable methodologies are developed, there is a benefit to analyze surge capacity using several methods rather than just one. Emergency committee members should be aware of the importance of critical resources when looking to the hospital capacity to respond to an MCI, and to the possibility to effectively increase it with a good preparedness plan. Since hospital capacity during real events is not static but dynamic, largely depending on occupation of the available resources, it is important that the regional command center and the hospitals receiving casualties constantly communicate on specific agreed upon critical resources, in order for the regional command center to timely evaluate the overall regional capacity and guarantee the appropriate distribution of the patients.

FaccincaniR, Della CorteF, SesanaG, StucchiR, WeinsteinE, AshkenaziI, IngrassiaP. Hospital Surge Capacity during Expo 2015 in Milano, Italy. Prehosp Disaster Med. 2018;33(5):459–465.

Keywords

disaster managementdisaster metricshospital preparednessmultiple-casualty incidentsurge capacity

Information

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 5 , October 2018 , pp. 459 - 465
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: none

References

1. Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47(1):34-49.10.1016/j.annemergmed.2005.05.009CrossRefGoogle ScholarPubMed
2. Handler, JA, Gillam, M, Kirsch, TD, et al. Metrics in the science of surge. Acad Emerg Med. 2006;13(11):1173-1178.10.1197/j.aem.2006.07.006CrossRefGoogle ScholarPubMed
3. American College of Emergency Physicians. Health care system surge capacity recognition, preparedness, and response. Ann Emerg Med. 2005;45(2):239.10.1016/j.annemergmed.2004.10.015CrossRefGoogle 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):1097.Google ScholarPubMed
5. Barbisch, DF, Koenig, KL. Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13(11):1098-1102.10.1197/j.aem.2006.06.041CrossRefGoogle ScholarPubMed
6. Burkle, FM Jr. Population-based triage management in response to surge capacity requirements during a large-scale bio-event disaster. Acad Emerg Med. 2006;13(11):1118-1129.Google Scholar
7. Estacio, PL. Surge capacity for health care systems: early detection, methodologies, and process. Acad Emerg Med. 2006;13(11):1135-1137.10.1197/j.aem.2006.07.018CrossRefGoogle ScholarPubMed
8. Wise, RA. The creation of emergency health care standards for catastrophic events. Acad Emerg Med. 2006;13(11):1150-1152.10.1197/j.aem.2006.06.034CrossRefGoogle ScholarPubMed
9. Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13(11):1157-1159.10.1197/j.aem.2006.06.032CrossRefGoogle ScholarPubMed
10. McManus, J, Huebner, K, Scheulen, J. The science of surge: detection and situational awareness. Acad Emerg Med. 2006;13(11):1179-1182.10.1197/j.aem.2006.06.038CrossRefGoogle 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 ScholarPubMed
12. Bonnett, CJ, Peery, BN, Cantrill, SV, et al. Surge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25(3):297-306.10.1016/j.ajem.2006.08.011CrossRefGoogle ScholarPubMed
13. Hick, JL, Barbera, JA, Kelen, GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009; 3(2 Suppl):S59-S67.10.1097/DMP.0b013e31819f1ae2CrossRefGoogle ScholarPubMed
14. De Boer, J. Order in chaos: modelling medical management in disasters. Eur J Emerg Med. 1999; 6(2):141-148.10.1097/00063110-199906000-00011CrossRefGoogle ScholarPubMed
15. 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(11):1087-1088.10.1197/j.aem.2006.07.008CrossRefGoogle Scholar
16. Hirshberg, A, Holcomb, JB, Mattox, KL. Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001;37(6):647-652.10.1067/mem.2001.115650CrossRefGoogle ScholarPubMed
17. Levi, L, Michaelson, M, Admi, H, et al. National strategy for mass-casualty situations and its effects on the hospital. Prehosp Disaster Med. 2002;17(1):12-16.10.1017/S1049023X00000054CrossRefGoogle ScholarPubMed
18. Arnold, JL, Tsai, MC, Halpern, P, et al. Mass-casualty terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I). Prehosp Disaster Med. 2003;18(3):220-234.10.1017/S1049023X00001096CrossRefGoogle ScholarPubMed
19. Kelen, GD, Kraus, CK, McCarthy, ML, et al. Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368(9551):1984-1990.10.1016/S0140-6736(06)69808-5CrossRefGoogle ScholarPubMed
20. Hick, JL, Koenig, KL, Barbisch, D, et al. 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-S57.10.1097/DMP.0b013e31817fffe8CrossRefGoogle ScholarPubMed
21. Rivara, FP, Nathens, AB, Jurkovich, GJ, et al. Do trauma centers have the capacity to respond to disasters? J Trauma. 2006;61(4):949-953.10.1097/01.ta.0000219936.72483.6aCrossRefGoogle ScholarPubMed
22. Hirshberg, A, Scott, BG, Granchi, T, et al. How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma. 2005; 58(4):686-693, discussion 694-695.10.1097/01.TA.0000159243.70507.86CrossRefGoogle Scholar
23. Eastman, AL, Rinnert, KJ, Nemeth, IR, et al. 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 ScholarPubMed
24. Bayram, JD, Zuabi, S, Subbarao Italo. Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple-casualty events. Disaster Med Public Health Prep. 2011;5(2):117-124.10.1001/dmp.2010.19CrossRefGoogle ScholarPubMed
25. Bayram, JD, Zuabi, S. Disaster metrics: quantification of acute medical disasters in trauma-related multiple-casualty events through modeling of the acute medical severity index. Prehosp Disaster Med. 2012;27(2):130-135.10.1017/S1049023X12000428CrossRefGoogle ScholarPubMed
26. Lennquist, S. Medical Response to Major Incidents and Disasters. A Practical Guide for All Medical Staff. Berlin, Germany: Springer; 2012.10.1007/978-3-642-21895-8CrossRefGoogle Scholar
27. Mock, C, Lormand, JD, Goosen, J, Joshipura, M, Peden, M. Guidelines for Essential Trauma Care. Geneva, Switzerland: World Health Organization; 2004.Google Scholar
28. World Health Organization. Guidelines for Trauma Quality Improvement Programmes. Geneva, Switzerland: World Health Organization; 2009.Google Scholar
29. National Institute for Health and Care Excellence. Major Trauma. NICE Guidelines. London, United Kingdom: NICE; 2016.Google Scholar
30. American College of Surgeons. Resources for Optimal Care of the Injured Patient. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar
31. American College of Surgeons. Statement on Principles. Chicago, Illinois USA: American College of Surgeons; April 2016.Google Scholar
32. US Department of Health and Human Services. Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. Second Edition. Washington, DC USA: US Department of Health and Human Services; September 2007.Google Scholar
33. Terndrup, TE, Leaming, JM, Adams, RJ, et al. Hospital-based coalition to improve regional surge capacity. West J Emerg Med. 2012;13(5):445-452.10.5811/westjem.2011.10.6853CrossRefGoogle ScholarPubMed