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Hospital Surge Model Version 1.3: Description

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness (PHEP) program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Chapter 7. 1 KT and 10 KT Nuclear Device (continued)

Resources Consumed Per Patient Per Day, continued

Resource Units Category Subcategory Lambdaa Fallout-Mild Fallout-Severe
ED ICU Floor ED ICU Floor
Med/Surg bed One Bed Capacity Floor 1 0.083 0 0 0.083 0 0
ICU bed One Bed Capacity ICU 1 0 1 0 0 1 0
Burn bed One Bed Capacity Burn 1 0 0 0 0 0 0
Operating room One OR Suite Capacity OR 1 0 0 0 0 0 0
Airborne isolation room One Bed Capacity Isolation 0.9 0 0 0 0 0 0
Intensivists (CCM) FTE Staff CCM 0.7 0.083 0.083 0 0.083 0.083 0
Critical care nurses (CCN) FTE Staff CCN 1 0.083 0.33 0 0.083 0.33 0
Surgeons FTE Staff Surgeon 0.3 0 0.042 0 0 0.042 0
Non-intensivists (MD) FTE Staff MD 0.9 0.167 0 0.042 0.167 0 0.042
Non-critical care nurses (RN/LPN) FTE Staff RN 1 0.042 0 0.146 0.042 0 0.146
Respiratory therapists (RT) FTE Staff RT 0.7 0.083 0.083 0 0.083 0.083 0
Radiology machines Machine Time Lab/Radiology Radiology 0.3 0.021 0.021 0 0.021 0.021 0
Radiologic technicians FTE Staff Rad Tech 0.3 0.021 0.021 0 0.021 0.021 0
Pharmacists (PharmD/RPh) FTE Staff Pharmacist 0.7 0.021 0.042 0.042 0.021 0.042 0.042
Mechanical ventilator Machine Time Capacity Ventilator 0.9 0 0 0 0 0 0
Ventilator equipment One Ventilator Equipment Vent Tubing 0.9 0 0 0 0 0 0
Oxygen (O2) 24h O2 for Vent Supplies Oxygen 0.9 0 1 0 0 1 0
Oxygenation monitoring equipment Machine Time Equipment O2 Monitoring 0.9 0.083 1 0 0.083 1 0
Surgical supplies Trauma Set Supplies Surgical 0.3 0 0 0 0 0 0
Radiology supplies Radiographic Film Supplies Radiological 0.3 1 1 0 1 1 0
Ciprofloxacin or doxycycline 400mg/100mg bid Pharmacy Antibiotics 1 0 0 0 0 0 0
Rifampin or other 2nd line agent 600mg po bid Pharmacy Antibiotics 1 0 0 0 0 0 0
Antibiotics for secondary pneumonia Assorted Pharmacy Antibiotics 1 0 1 0 0 1 0
Surgical Infection prophylaxis/treatment Assorted Pharmacy Antibiotics 1 0 0 0 0 0 0
Neutropenia prophylaxis/treatment Assorted Pharmacy Antibiotics 1 0 0 0 1 1 1
Antibiotics intravenous infusion set One IV Piggyback Supplies IV set 1 0 0.5 0 1 0.5 0
Hemodynamic medications Assorted Pharmacy Hemodynamic 0.7 0 1 0 0 1 0
Intravenous fluids 24h LR or equiv. Pharmacy IVF 0.7 1 1 1 1 1 1
Intravenous infusions set One IV Set Supplies IV Set 0.7 1 1 1 1 1 1
Laboratory machines Machine Time Lab/Radiology Laboratory 0.7 0.083 0.166 0.083 0.083 0.166 0.083
Laboratory supplies CBC/CMP Reag. Supplies Laboratory 0.7 3 6 3 3 6 3
Temperature monitoring equipment Machine Time Equipment Temperature 1 0.083 1 0 0.083 1 0
Thromboembolism prophylaxis Enoxaparin 40mg sc qd Pharmacy DVT Prophylaxis 1 0 1 0 0 1 0
Urine output monitoring equipment Catheter and Bag Equipment U/O 1 0 1 0 0 1 0

Universal precautions PPE

Glove/gown/mask PPE Universal 1 1 1 1 1 1 1
Chemical PPE Level D PPE Chemical 0.3 0 0 0 0 0 0
Radiological PPE Level D PPE Radiological 0.3 1 1 1 1 1 1
Waste disposal Level D PPE Decon Waste 0.3 1 1 1 1 1 1
Mortuary decontamination materials Level D PPE Mortuary 0.3 0 0 0 0 0 0
Atropine sulfate 2mg Pharmacy Atropine 0.1 0 0 0 0 0 0
Pralidoxime 2g Pharmacy Pralidoxime 0.1 0 0 0 0 0 0
Diazepam 10mg Pharmacy Diazepam 0.1 0 0 0 0 0 0
EEG Machine Time Equipment Chemical 0.1 0 0 0 0 0 0
IV steroids Hydrocortisone 50mg IV q6h Pharmacy Steroids 0.7 0 0 0 0 0 0
DPTA 1g IV Pharmacy DPTA 0.1 1 1 1 1 1 1
Prussian blue 3mg po tid Pharmacy Prussian Blue 1 1 1 1 1 1 1
Growth factors Pegfilgrastim 6mg sc qw Pharmacy Growth factors 1 0 0 0 1 1 1
Stem cell transfusion Unit of Use Heme/Onc Stem Cell Trans 1 0 0 0 0 0 0
Geiger counter Machine Time Equipment Radiation 0.1 0.42 0.21 0.21 0.42 0.21 0.21
Enteral feedings (3/day/patient) Unit of Use Nutrition Enteral 1 0 0.5 0.5 0 0.5 0.5
Oral food (3 meals/day/ patient) Unit of Use Nutrition Oral 1 0 0.5 1 0 0.5 1
Sheet change 1 linen change Housekeeping Laundry 1 1 1 1 1 1 1
Patient infection control FTE Epidemiology Infection Control 0.5 0.021 0.042 0.042 0.021 0.042 0.042
Engineering FTE Engineering Facility 0.7 0.042 0.083 0.042 0.042 0.083 0.042
Janitorial/Housekeeping FTE Housekeeping Janitorial 1 0.125 0.125 0.083 0.125 0.125 0.083
Nutrition FTE Nutrition Counseling 0.5 0 0.083 0.083 0 0.083 0.083
Psychological support FTE Ancillary Psychologist 0.5 0 0 0.042 0 0 0.042
Mortuary FTE Mortuary Morgue 0.1 0 0.042 0.042 0.042 0.042 0.042

a Lambda captures the resource requirement decay rate for a resource. Lambda = 1 implies no decay; the patient requires a constant amount of the resource while s/he is hospitalized. Lambda <1 implies that less of the resource is required each day the patient is hospitalized. Go to section 2.2 for details.

7.7 References

a. Trauma

1. Arnold JL, Halpern P, Tsai MC, et al. Mass casualty terrorist bombings: a comparison of outcomes by bombing type. Ann Emerg Med 2004;43(2):263-73.

2. 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):220-34.

3. Blocker V, Blocker TG Jr. The Texas City disaster, a survey of 3,000 casualties. Am J Surgery 1949;78(5):756-71.

4. Connelly LG, Bair AE. Discrete event simulation of emergency department activity: a platform for system-level operations research. Acad Emerg Med 2004;11(11):1177-85.

5. Cook L. The World Trade Center attack. The paramedic response: an insider's view. Crit Care 2001;5(6):301-3.

6. Cowell A. London officials report details of attack and recovery snags. The New York Times: The New York Times Company; 2005.

7. Cushman JG, Pachter HL, Beaton HL. Two New York City hospitals' surgical response to the September 11, 2001, terrorist attack in New York City. J Trauma 2003;54(1):147-54; discussion 154-5.

8. de Boer J, Debacker M. A more rational approach to medical disaster management applied retrospectively to the Enschede fireworks disaster, 13 May 2000. Eur J Emerg Med 2003;10(2):117-23.

9. de Ceballos JP, Turégano-Fuentes F, Perez-Diaz D, et al. 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):104-11.

10. DePalma RG, Burris DG, Champion HR, et al. Blast injuries. N Engl J Med 2005;352(13):1335-42.

11. England C, Lapworth K, Rahman E, et al. Critical care in the 21st century: preparation, preparation, and preparation. Crit Care 2005;9(1):3-4.

12. Feliciano DV, Anderson GV, Jr., Rozycki GS, et al. Management of casualties from the bombing at the centennial olympics. Am J Surg 1998;176(6):538-43.

13. Frykberg ER. Principles of mass casualty management following terrorist disasters. Ann Surg 2004;239(3):319-21.

14. Garner A, Lee A, Harrison K, et al. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med 2001;38(5):541-8.

15. Gutierrez de Ceballos JP, Turégano Fuentes F, Perez Diaz D, et al. Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 2005;33(1 Suppl):S107-12.

16. Halpern P, Tsai MC, Arnold JL, et al. Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II). Prehospital Disaster Med. 2003;18(3):235-41.

17. Hogan DE, Waeckerle JF, Dire DJ, et al. Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999;34(2):160-7.

18. Huang MS, Yang YF, Lee CH. Evaluation of staff workload during resuscitation of trauma patients. J Trauma 2002;52(3):492-7.

19. Kirschenbaum L, Keene A, O'Neill P, et al. The experience at St. Vincent's Hospital, Manhattan, on September 11, 2001: preparedness, response, and lessons learned. Crit Care Med 2005;33(1 Suppl):S48-52.

20. Kluger Y, Mayo A, Soffer D, et al. Functions and principles in the management of bombing mass casualty incidents: lessons learned at the Tel-Aviv Souraski Medical Center. Eur J Emerg Med 2004;11(6):329-34.

21. Liang NJ, Shih YT, Shih FY, et al. Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan. Ann Emerg Med 2001;38(5):549-55.

22. Lucas CE, Buechter KJ, Coscia RL, et al. Mathematical modeling to define optimum operating room staffing needs for trauma centers. J Am Coll Surg 2001;192(5):559-65.

23. Martinez C, Gonzalez D. The World Trade Center attack. Doctors in the fire and police services. Crit Care 2001;5(6):304-6.

24. Oliviera MD. Modelling demand and supply influences on utilization: a flow demand model to predict hospital utilization at the small area level. Applied Economics 2004;36(20):2237-51.

25. Redhead J, Ward P, Batrick N. The London attacks—response: prehospital and hospital care. N Engl J Med 2005;353(6):546-7.

26. Rodoplu U, Arnold JL, Tokyay R, et al. Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response. Prehosp Disaster Med 2004;19(2):133-45.

27. Rodoplu U, Arnold JL, Tokyay R, et al. Impact of the terrorist bombings of the Neve Shalom and Beth Israel Synagogues on the hospital(s) in Istanbul, Turkey. Acad Emerg Med 2005;12(2):135-41.

28. Rodoplu U, Arnold JL, Yucel T, et al. Impact of the terrorist bombings of the Hong Kong Shanghai Bank Corporation headquarters and the British Consulate on two hospitals in Istanbul, Turkey, in November 2003. J Trauma 2005;59(1):195-201.

29. Thompson D, Brown S, Mallonee S, et al. Fatal and non-fatal injuries among U.S. Air Force personnel resulting from the terrorist bombing of the Khobar Towers. J Trauma 2004;57(2):208-15.

30. von Schreeb J, Kalmykov A, Riddez L, et al. Emergency care following the terrorist attack in Beslan, North Ossetia, Russian Federation, 2004. Int J Disaster Med 2004;2(1&2):41-47.

31. Yavuz MS, Asirdizer M, Cetin G, et al. Deaths due to terrorist bombings in Istanbul (Turkey). J Clin Forensic Med 2004;11(6):308-15.

b. Burn

32. Faucher LD. Physical and Chemical Injuries: Burns. In: Rakel RE and Bope ET, eds. Conn's Current Therapy, 2005. Elsevier Health Sciences; 2005.

33. Ho WS, Ying SY. An epidemiological study of 1,063 hospitalized burn patients in a tertiary burns centre in Hong Kong. Burns 2001;27(2):119-23.

34. Ho WS, Ying SY, Burd A. Outcome analysis of 286 severely burned patients: retrospective study. Hong Kong Med J 2002;8(4):235-9.

35. Peck MD, Mantelle L, Ward CG. Comparison of length of hospital stay to mortality rate in a regional burn center. J Burn Care Rehabil 1996;17(1):39-44.

36. Ryan CM, Schoenfeld DA, Thorpe WP, et al. Objective estimates of the probability of death from burn injuries. N Engl J Med 1998;338(6):362-6.

37. Santaniello JM, Luchette FA, Esposito TJ, et al. Ten year experience of burn, trauma, and combined burn/trauma injuries comparing outcomes. J Trauma 2004;57(4):696-700; discussion 700-1.

38. Wong MK, Ngim RC. Burns mortality and hospitalization time—a prospective statistical study of 352 patients in an Asian National Burn Centre. Burns 1995;21(1):39-46.

c. Fallout

39. Barrett JA. SRP meeting on radiological terrorism: prevention and response. J Radiol Prot 2004;24(3):331-2.

40. Chuchalin AG, Maracheva AV, Grobova OM, et al. Lungs exposed to nuclear catastrophe: one-year therapeutic programme in Chernobyl liquidators group. Schweiz Med Wochenschr 1997;127(5):165-9.

41. Elcock D, Klemic GA, Taboas AL. Establishing remediation levels in response to a radiological dispersal event (or "dirty bomb"). Environ Sci Technol 2004;38(9):2505-12.

42. Hundahl SA. Perspective: National Cancer Institute summary report about estimated exposures and thyroid doses received from iodine 131 in fallout after Nevada atmospheric nuclear bomb tests. CA Cancer J Clin 1998;48(5):285-98.

43. Moulder JE. Radiobiology of nuclear terrorism: report on an interagency workshop (Bethesda, MD, December 17-18, 2001). Int J Radiat Oncol Biol Phys 2002;54(2):327-8.

44. Moulder JE. Post-irradiation approaches to treatment of radiation injuries in the context of radiological terrorism and radiation accidents: a review. Int J Radiat Biol 2004;80(1):3-10.

45. Norwood WD. Radiation casualties: emergency plans and medical care. Arch Environ Health 1971;23(2):129-34.

46. Schleipman AR, Gerbaudo VH, Castronovo FP, Jr. Radiation disaster response: preparation and simulation experience at an academic medical center. J Nucl Med Technol 2004;32(1):22-7.

47. Shoikhet YN, Kiselev VI, Zaitsev EV, et al. A registry for exposure and population health in the Altai region affected by fallout from the Semipalatinsk nuclear test site. Radiat Environ Biophys 1999;38(3):207-10.

48. Turai I, Veress K, Günalp B, et al. Medical response to radiation incidents and radionuclear threats. BMJ 2004;328(7439):568-72.

49. Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group. Ann Intern Med 2004;140(12):1037-51.

50. World MJ. Casualties resulting from nuclear explosion: an overview. J R Army Med Corps 2004;150(3 Suppl 1):3-4.

d. General

51. Field Manual 8-9—NATO Handbook on the Medical Aspects of NBC Defensive Operations AMedP-6(B). Part I—Nuclear. Departments of the Army, the Navy, and the Air Force. Washington, DC; 1996.

52. Medical Management of Radiological Casualties Handbook. Military Medical Operations Office, First Edition. Armed Forces Radiobiology Research Institute. Bethesda, Maryland; 1999.

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