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Design of a Model to Predict Surge Capacity Bottlenecks for Burn Mass Casualties at a Large Academic Medical Center

  • Mahshid Abir (a1), Matthew M. Davis (a2), Pratap Sankar (a3), Andrew C. Wong (a4) and Stewart C. Wang (a5)...
Abstract
AbstractObjectives

To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims.

Methods

Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability—number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources—anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability.

Results

Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type AB packed red blood cells (76 h), silver dressing/Acticoat (100 h), bismuth tribromophenate/Xeroform (102 h), and gauze bandage rolls/Kerlix (168 h). The following items do not precipitate a bottleneck: ventilators, topical epinephrine, staplers, foams, antimicrobial non-adherent dressing/Telfa types A, B, or O blood. Nurse, respiratory therapist, and physician staffing does not induce bottlenecks.

Conclusions

This model, and similar models for non-burn-related MCIs, can serve as a real-time estimation and management tool for hospital capacity in the setting of MCIs, and can inform supply decision support for disaster management.

AbirM, DavisMM, SankarP, WongAC, WangSC. Design of a Model to Predict Surge Capacity Bottlenecks for Burn Mass Casualties at a Large Academic Medical Center. Prehosp Disaster Med. 2013;28(1):1-10.

Copyright
Corresponding author
Correspondence: Mahshid Abir, MD, MSc Rand Corporation 1200 South Hayes Street Arlington, VA 22202 USA E-mail mabir@rand.org
References
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1.Institute of Medicine. Hospital-Based Emergency Care: At the Breaking Point. Washington, DC, USA: National Academies Press; 2006.
2.Koenig KL, Kelen GD. Executive Summary: The Science of Surge Conference. Acad Emer Med. 2006;13:1087-1088.
3.Kelen GD, McCarthy ML. The science of surge. Acad Emer Med. 2006;13(11):1089-1094.
4.US Department of Health and Human Services, Agency for Healthcare Research and Quality. Addressing surge capacity in a mass casualty event. http://archive.ahrq.gov/news/ulp/btbriefs/btbrief9.htm. Accessed September 12, 2012.
5.Joint Commission on Accreditation of Healthcare Organizations. Surge Hospitals: Providing Safe Care in Emergencies. Oak Brook Terrace, IL, USA; 2006.
6.Barbisch D. Regional responses to terrorism and other medical disasters: developing sustainable surge capacity. In: Johnson JA, Ludlow GR, Jones WJ (eds). Community Preparedness and Response to Terrorism. Westport, CT: Praeger; 2005.
7. Roberts R. Disaster Surge Tool. http://www.emrocch.org/disastersurge/. Accessed October 30, 2010.
8.US Department of Health and Human Services, Centers for Disease Control and Prevention. FluSurge. http://www.cdc.gov/flu/tools/flusurge/. Accessed October 30, 2010.
9.US Department of Health and Human Services, Agency for Healthcare Research and Quality. Hospital Surge Model. http://archive.ahrq.gov/prep/hospsurgemodel/. Accessed September 12, 2012.
10.ProModel Corporation (2008). Promodel (Version 7.5) [computer software]. Orem, UT. http://www.promodel.com. Accessed October 30, 2010.
11.Welling L, Van Harten SM, Patka P, et al. The café fire on New Year's Eve in Volendam, the Netherlands: description of events. Burns. 2005;31(5):548-555.
12.Mahoney EJ, Harrington DT, Biffl WL, Metzger J, Oka T, Cioffi WG. Lessons learned from a nightclub fire: institutional disaster preparedness. J Trauma. 2005;58(3):487-491.
13.Ma B, Wei W, Xia ZF, et al. Mass chemical burn casualty: emergency management of 118 patients with alkali burn during a Matsa typhoon attack in Shanghai, China in 2005. Burns. 2007;33(5):565-571.
14.US Census Bureau. U.S. Population Projections. http://www.census.gov/population/projections/23PyrmdMI1.pdf. Accessed August 14, 2010.
15.Christie PMJ, Levary RR. The use of simulation in planning the transportation of patients to hospitals following a disaster. J of Medical Systems. 1998;22(5):289-300.
16.de Ceballos JP, Turégano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Martin-Llorente C, Guerrero-Sanz JE. 11 March 2004: the terrorist bomb explosions in Madrid, Spain–an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9(1):104-111.
17.Michigan Department of Community Health, Office of Public Health Preparedness, EMS & Trauma Systems Section, et al. Developmental Template for the Hospital Management of Burn Patients Resulting from a Multi-casualty Incident. January 2010. http://www.michiganburn.org/images/content/MIBurnVer15.pdf. Accessed September 12, 2012.
18.American Burn Association. National Burn Repository 2000-2009. http://www.ameriburn.org/. Accessed March 21, 2010.
19.Cassuto J, Tarnow P. A discotheque fire in Gothenburg 1998. A tragedy among teenagers. Burns. 2003;29(5):405-416.
20.Mackie DP, Koning HM. Fate of mass burn casualties: implications for disaster planning. Burns. 1990;16(3):203-206.
21.American Burn Association. Burn Center Referral Criteria. http://www.ameriburn.org/BurnCenterReferralCriteria.pdf. Accessed October 30, 2010.
22.Hick JL, Hanfling D, Burstein JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44(3):253-261.
23.Rubinson L, Hick JL, Curtis JR, et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity. Chest. 2008;133:32S-50S.
24.Barbisch D, Haik J, Tessone A, Hanfling D. Surge capacity. In: Koenig KL, Schultz CH (eds). Disaster Medicine. New York, NY: Cambridge University Press; 2010:35-50.
25.Tricklebank S. Modern trends in fluid therapy for burns. Burns. 2009;35(6):757-767.
26.US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/data/ad/ad347.pdf. Accessed August 14, 2010.
27.Discovery Health. http://health.howstuffworks.com/human-body/cells-tissues/question593.htm. Accessed August 14, 2010.
28.Huckfeldt RE. Critical care for patients with severe burn injury. In: Clark AD (ed). Burns: The Medical and Forensics Model. Tucson, AZ: Lawyers & Judges Publishing Company, Inc.; 2006:57-78.
29.Barnett DJ, Balicer RD, Thompson CB, et al. Assessment of local public health workers’ willingness to respond to pandemic influenza through the application of the extended parallel process model. PLoS One. 2009;4(7):e6365.
30.Lanzilotti SS, Galanis D, Leoni N, Craig B. Hawaii medical personnel assessment: a longitudinal study of Hawaii doctors and nurses, their knowledge, skill and willingness to treat victims related to weapons of mass destruction and naturally caused casualty incidents. Hawaii Medical Journal. 2002;61(8):162-173.
31.Phillips SJ, Knebel A. Mass Medical Care with Scarce Resources: A Community Planning Guide. Rockville, MD: Agency for Healthcare Research and Quality; 2007.
32.Health Systems Research. Altered Standards of Care in Mass Casualty Events: Bioterrorism and Other Public Health Emergencies. Rockville, MD: Agency for Healthcare Research and Quality. Publication No. 05-0043; 2005.
33.US Department of Homeland Security, Homeland Security Grant Program. Supplemental Resource: MMRS Target Capabilities/Capability Focus Areas and Community Preparedness, February 2008. http://www.fema.gov/pdf/government/grant/hsgp/fy08_hsgp_guide_mmrs.pdf. Accessed November 1, 2010.
34. Barbisch, DF. Developing sustainable surge capacity for a regional health response to terrorism and other medical disasters [video recording]. American Public Health Association: Public Health and Environment, Washington DC, November 6-10, 2004. http://apha.confex.com/apha/132am/techprogram/paper_83055.htm. Accessed November 1, 2010.
35. PR Newswire. California Unveils World's Largest Mobile Civilian Hospital in Preparation for Major California Disaster. http://www.prnewswire.com/cgibin/stories.pl?ACCT=109&STORY=/www/story/08-25-2007/0004651300&EDATE=. Accessed November 1, 2010.
36.Joint Commission on Accreditation of Healthcare Organizations. Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Strategies. Oakbrook, IL; 2003.
37.McCarthy ML, Zeger SL, Ding R, Aronsky D, Hoot NR, Kelen GD. The challenge of predicting demand for emergency department services. Acad Emerg Med. 2008;15(4):337-346.
38.Schweigler LM, Desmond JS, McCarthy ML, Bukowski KJ, Ionides EL, Younger JG. Forecasting models of emergency department crowding. Acad Emerg Med. 2009;16(4):301-308.
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
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