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Surge Capacity and Health System Preparedness

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Slide Presentation by Nathaniel Hupert, M.D.


On October 26, 2004, Dr. Hupert made a presentation in a Web conference entitled Addressing Surge Capacity in a Mass Casualty Event.

This is the text version of Dr. Hupert's slide presentation. Select to access the PowerPoint® Slides (140 KB).


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

Slide 1

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:
    1. Reassess common assumptions about the determinants of capacity.
    2. 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).

Slide 2

Determinants of Surge Capacity

This slide contains several text boxes. At the top left-hand corner are two text boxes in large parentheses. The top box is labeled "event" followed by an arrow pointing down to another text box labeled "pre-hospital management." This is connected via an arrow pointing down and to the right to another text box located in the left center of the slide that is labeled "surge arrivals." From the right hand side of the surge arrivals text box another arrow points to the right to a large oval, labeled "hospital or network capacity," which is located in the center of the slide. Above the oval are three text boxes labeled "staff," "medical supplies," and "beds." Arrows lead from the staff and medial supplies text boxes to "beds," followed by another arrow that curves from left to right from "hospital or network capacity" through "beds" and returns to "hospital or network capacity." A second arrow extends from "staff" and "medical supplies" text boxes to "hospital or network capacity."

Below the oval "labeled hospital or network capacity" are three individual arrows that lead to three text boxes labeled from right to left "SNF," "out-of-region facility," and "home." Superimposed over the arrows is a text box in the shape of a banner labeled "surge discharge." To the right of the oval labeled "hospital or network capacity" are two arrows, each leading to their own text box on the right. The text boxes are labeled "treated" and "died."

A footnote to surge discharge says Note: I am indebted to Sam Benson, EMT-P, New York City, Office of Emergency Management for the notion of "surge discharge."

Slide 3

Modeling Pre-hospital Capacity

This slide contains a graphic. The y-axis is labeled "delay to reaction" with "none (hours)" at the bottom of the axis and "long (days)" at the top. On the right hand side of the chart, an arrow runs from the bottom to the top along the length of the y-axis.

The x-axis is labeled "time needed to protect community" with "shorter (1 to 2 days)" at the far left and "longer (4 plus days) at the far right of the axis. An arrow also runs along the length of the x-axis pointing from left to right.

Inside the graph there is a small right triangle, which is bounded by the x and y axes. The triangle is striped and contains the text "safe." An arrow, labeled, "protection," runs from the center of the triangle's hypotenuse to the top right-hand corner of the graph. "Less" is listed at the top of the protection line and "more" is positioned along the bottom of the line closest to the safe triangle.

Slide 4

Modeled Outcomes of Pre-hospital Anthrax Prophylaxis

A shaded box, located at the top center of the slide, contains the text "percentage of exposed individuals don't get sick because they receive antibiotics in time." Below the text box is a chart with an x-axis labeled "delay in response time" by "Immediate, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days." The y-axis is labeled "Time to Community Antibiotic Coverage" and ascends in increments of "1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days." There is an arrow above the chart pointing from left to right, which ends at a text box labeled "increasing hospital surge." Another arrow located along the right side of the graph points up toward the same text box.

Running from bottom to top under immediate delay in response time, the values are 100 percent, 100 percent, 99 percent, 98 percent, 96 percent, 94 percent, and 91 percent. From bottom to top under 1 day of delay in response time, the values are 100 percent, 99 percent, 97 percent, 95 percent, 92 percent, 90 percent and 91 percent. From bottom to top under 2 days of delay in response time, the values are 98 percent, 96 percent, 93 percent, 91 percent, 88 percent, 84 percent, and 81 percent. From bottom to top under 3 days of delay in response time, the values are 94 percent, 91 percent, 88 percent, 85 percent, 82 percent, 78 percent and 75 percent. From bottom to top under 4 days of delay in response time, the values are 89 percent, 85 percent, 82 percent, 79 percent, 75 percent, 72 percent, and 69 percent. From bottom to top under 5 days the values are 82 percent, 79 percent, 75 percent, 72 percent, 69 percent, 65 percent, and 62 percent. From bottom to top under 6 days of delay in response time, the values are 75 percent, 72 percent, 68 percent, 65 percent, 62 percent, 59 percent, and 56 percent. From bottom to top under 7 days of delay in response time, the values are 68 percent, 65 percent, 62 percent, 59 percent, 56 percent, 53 percent, and 50 percent.

The values appearing above the immediate column are shaded in black from 1 day through 5 days. Days 6 and 7 values are shaded in gray. The values appearing above the 1-day column are shaded black from 1 day to 4 days. Days 5 and 6 are shaded in gray and 7 days has no shading. The values appearing above the 2 days column are shaded in black from 1 day to 2 days, days 3 and 4 are shaded in gray, and days 5, 6, and 7 are not shaded. The values appearing in the 3 days column are shaded in gray from 1 to 2 days and days 3 through 7 are not shaded. All other columns (days 4, 5, 6, and 7) are not shaded.

Slide 5

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

Could cover all in 2 days after a 1 day delay is greater than or equal to 1,000 sick This slide contains a bar graph titled "Number of exposed people developing sickness, by day." The y-axis is labeled "number hospitalized" and marked in increments of "0, 500, 1000, 1500, 2000, 2500." The y-axis is labeled "days after exposure" and is marked in increments of "0, 1, 2, 3, 4." The shaded bar at day 0 on the x-axis rises just above 0 on the y-axis. The day 1 bar rises to approximately 600 hospitalizations and day 2 is approximately at 800 hospitalizations. No hospitalizations are indicated on days 3 and 4.

Slide 6

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

Could cover all in 2 days after a 2 day delay is equal to or greater than 4,000 sick This slide contains a bar graph titled "Number of exposed people developing sickness, by day." The y-axis is labeled "number hospitalized" and marked in increments of "0, 500, 1000, 1500, 2000, 2500." The x-axis is labeled "days after exposure" and is marked in increments of "0, 1, 2, 3, 4." The shaded bar at day 0 on the x-axis rises just above 0 on the y-axis. The day 1 bar rises to approximately 8600 hospitalizations, day 2 is approximately 2100 hospitalizations, and day 3 is approximately 1300 hospitalizations. No hospitalizations are indicated for day 4.

Slide 7

Modeling Improves Community-wide Surge Capacity Planning by Linking Pre-hospital and Hospital-based Care Planning

This slide contains three sections. The section on the left contains the text "one exposure scenario" above a graphic of an explosion. Below the graphic is the text "...can lead to different total and daily casualty loads depending on pre-hospital preparedness and response..." This section of text and graphic has five arrows all pointing right to the middle section of the slide which contains a graphic of a medical cross encompassed by an arrow forming a circle. Below this graphic is the text "...with different implications for hospital surge arrivals..." To the right of the cross/circle are two arrows; the top angling up and the bottom arrow angling down. To the right of the top arrow is a check mark and to the right of the bottom arrow is an X. The text below the two arrows is "...yielding different patient outcomes."

Slide 8

"Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness"

http://www.ahrq.gov/research/cbmprophyl/cbmpro.htm

Current as of December 2004

Internet Citation:

Addressing Surge Capacity in a Mass Casualty Event. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/btsurgemass/huperttxt.htm

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