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Surge Capacity Assessments and Regionalization Issues

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Slide Presentation by Michael Allswede, D.O.


On June 17, 2003, Michael Allswede, D.O., made a presentation in the Web-assisted Audioconference entitled Surge Capacity Assessments and Regionalization Issues. The User Liaison Program (ULP) of the Agency for Healthcare Research and Quality (AHRQ) developed and sponsored the program.

The is the text version of Dr. Allswede's slide presentation.


Bioterrorism Workbook and Decision Support: The Pittsburgh Matrix

Michael Allswede, D.O.
Section Chief
Special Emergency Medical Response
University of Pittsburgh Medical Center Health System

Slide 1

Pittsburgh Matrix

  • Provides a decision support tool for hospitals and hospital systems preparing for or responding to bioterrorism events.
  • Provides a method of determining value for bioterrorism capability.
  • Guides funding for hospital capability development.

Slide 2

Pittsburgh Matrix: Stratification of Tasks

Slide contains a three by three matrix. The rows, from top to bottom, are labeled: Immediate, Short Term, and Long Term. The columns, from left to right, are labeled: High Priority, Moderate, and Low Priority. In the top most row, from left to right, the entries in each cell are: Anthrax Protocols, Education Programs, and Command Center Development. In the second row, those entries are: Lab Capacity and Quarantine Protocols, Special Lab Capability, and New Research. In the last row, entries are: Improve Mass Decon, Standardization of Training, and Medical School Curriculum.

Slide 3

The Pittsburgh Matrix: Medical Decisionmaking

Slide contains 5x5 matrix [Either 5x6 or 4x5]. The rows are labeled (from top to bottom): Triage of Resources, Augmented Capacity, Surge Capacity, Current Capacity, and the fifth is blank. The columns are labeled (from left to right): Press Release, Release, Symptom Occurrence, Illness Occurrence, and Deaths/Epidemics.

Slide 4

Pathogen Rating

Communicability/Quarantine Needs
0: Non-communicable/No Quarantine -- Example: Bot Toxin
1: Blood and Body Fluid/Universal Precautions -- Example: HIV Virus
2: Close Contact/Universal Precautions -- Example: Ebola Virus
3: Airborne/HEPA Filtration -- Example: Variola Virus

Effectiveness of Medical Treatment
0: Comfort Measures Only Needed -- Example: Salmonella
1: Highly Effective-Survival Probable -- Example: Skin Anthrax
2: Improved Survival-Survival Improved -- Example: Yersinia Pestis
3. Ineffective-Survival Not Improved -- Example: Variola Virus

Availability of Medical Treatment
0: Non-Pharmaceutical Treatment -- Example: Clear Liquid Diet
1: Multiple Available Pharmaceuticals -- Example: Ames Strains
2: Insufficient Local Supply Pharmaceutical -- Example: Bot Antitoxin
3: Obscure or Experimental Pharmaceuticals -- Example: Variola Vaccine

Slide 5

Effects of Preparedness

Slide contains the same matrix as found on Slide 3. Added over this matrix are two arrows. The first arrow is located right above the first row, points toward the left, and is labeled "Better Technology" The other is pointing downward and is placed over the first column, this arrow is labeled, " System Preparedness."

Slide 6

Anthrax Aerosol

Slide contains the same matrix as found on Slide 3. Each cell in this matrix contains a number that represents pathogen scores, as well as a percentage in parentheses that represent estimated mortality rates. These values are as follows: In the top most row, left to right, first entry is blank, 3(7.5%), 4(20%), 5(89%), and 6(99%). The second row from the top: 2(0%), 2 (0%), 3(15%), 4(54%), 5 (95%). The next row down has the values: 2(0%), 2 (0%), 3(15%), 4 (45%), and 5 (90%). The last row, has the following values: 2(0%), 2 (0%), 3(15%), 4 (45%), and 5 (90%).

Slide 7

Variola:

Slide contains the same matrix as found on Slide 3. Each cell in this matrix contains a number that represents pathogen scores, as well as a percentage in parentheses that represent estimated mortality rates. These values are as follows: In the top most row, left to right, first entry is blank, 6(15%), 9(30%), 9(30%), and 9(30%). The second row from the top: 2(1.5%), 5 (10%), 9(30%), 9(30%), 9 (30%). The next row down has the values: 2(15%), 5 (10%), 9(27%), 9 (27%), and 9 (27%). The last row, has the following values: 2(15%), 5 (10%), 9(25%), 9 (25%), and 9 (25%).

Slide 8

Decision Support Tool

  • Each Medical Asset can determine capacity levels based on daily census, surge disaster planning, and community outreach.
  • Timeline will be evident so a given box can be accessed.
  • Each box has Key Decisions and Key Resources enumerated in a logical response hierarchy.

Slide 9

Resource Valuation

  • Key Resources (capabilities) within each matrix box are accounted using UPMC Health System data.
  • Survivorship estimates yield value in dollars/lives saved for each matrix Key Resource.

Slide 10

Pittsburgh Matrix: Work to do

  • Complete methodological workbook for other medical facilities to follow.
  • Estimation of probability of a given attack occurrence.
    • EX: World events change the threshold and likelihood of each given attack.
  • Estimation of detection capability of a given attack.
    • EX: Syndromic detection is better for larger scale events.

Slide 11

For More Information:

AHRQ-sponsored Workbook for Regional Bioterrorism Preparedness
A collaborative effort between Research Triangle Institute, UPMC Health Systems, and Intermountain Health Care

Available: September 30, 2003
Contact: Lucy Savitz at savitz@rti.org

Current as of September 2003


Internet Citation:

Bioterrorism Workbook and Decision Support: The Pittsburgh Matrix. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/surge/allswedetxt.htm


 

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