Addressing Surge Capacity in a Mass Casualty Event

1
Addressing Surge Capacity in a Mass Casualty Event

• Nathaniel Hupert, M.D., M.P.H.
• Assistant Professor of Public
• Health and Medicine
• Weill Medical College
• Cornell University
• New York City

2
Why Model Surge?

• We already know the U.S. health care system has
  very little surge capacity.
• What is the benefit of creating computer models
  of it?

• Two possible answers
• Reassess common assumptions about the
  determinants of capacity
• Quantitative casualty estimates for varied
  planning efforts (e.g, ranging from different
  service lines in a single hospital to emergency
  planning functions in a region)

3
Determinants of Surge Capacity
Event
Staff
Medical supplies
Pre-hospital management
Beds
Treated
Hospital or network capacity
Surge arrivals
Died
Surge Discharge
SNF
Home
Out-of-region facility
Note I am indebted to Sam Benson, EMT-P, New
York City Office of Emergency Management for the
notion of surge discharge
4
Modeling Pre-hospital Capacity
Long (Days)
Delay in Reaction
None (Hours)
Shorter (1-2 Days)
Longer 4 Days
Time needed to protect community
5
Modeled Outcomes of Pre-hospital Anthrax
Prophylaxis
Percentage of exposed individuals dont get sick
because they receive antibiotics in time
Increasing Hospital Surge
6
If 100,000 people were exposed to anthrax and
your prophylaxis campaign

• Could cover all in 2 days after a 1 day delay
• ? 1,000 sick

7
If 100,000 people were exposed to anthrax and
your prophylaxis campaign

• Could cover all in 2 days after a 2 day delay
• ? 4,000 sick

8
Modeling Improves Community-wide Surge Capacity
Planning by Linking Pre-hospital and
Hospital-based Care Planning
One exposure scenario
?
?
can lead to different total and daily casualty
loads depending on pre-hospital preparedness and
response
yielding different patient outcomes.
...with different implications for hospital surge
arrivals
9
Community-Based Mass Prophylaxis A Planning
Guide for Public Health Preparedness
www.ahcpr.gov/research/cbmprophyl/cbmpro.htm