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Bioterrorism and Health System Preparedness

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Slide Presentation by Nathaniel Hupert, M.D., M.P.H.

On May 1, 2002, Nathaniel Hupert, M.D., M.P.H., made a presentation in a Web-assisted teleconference at Session 3, which was entitled "Assessing Hospital and Health System Preparedness and Response."

This is the text version of Dr. Hupert's slide presentation. Select to access the slides or to access the streaming video of Bioterrorism and Health System Preparedness.

Assessing Hospital and Health System Preparedness and Response

Nathaniel Hupert, M.D., M.P.H.
Assistant Professor of Public Health and Medicine
Division of Outcomes and Effectiveness Research
Weill Medical College of Cornell

Slide 1

Guiding Questions

  • How can/should we assess hospital capacity for bioterrorism response?
  • What is the role of private hospital networks in bioterrorism response?
  • What is the capacity of existing integrated healthcare delivery systems to provide patient care after a large-scale bioterrorist attack?

Slide 2

Large-Scale Anthrax Attack Scenario

This slide shows a diagram of a the possible scenarios for a large-scale anthrax attack. It assumes that 250,000 are exposed, and 7.75 million are non exposed. The exposed individuals would be the targets for prophylaxis. Individuals who receive no treatment will end up in the hospital and could possibly die without treatment. Some individuals who receive antibiotics distributed in an outpatient setting could still present at the hospital, but others will be fine and will not need to go to the hospital.

Slide 3

Static vs. Dynamic Hospital Capacity

A static estimate of the capacity of hospitals for bioterrorism response takes into account the estimated total casualties requiring hospitalization and the estimated total hospital beds and supplies.

Slide 4

Problem with Static Estimates:

This slide shows a graph of the number of bioterrorism-related anthrax cases, by date of onset and work location—District of Columbia, Florida, New Jersey, and New York City, September 16-October 25, 2001.

The problem with static estimates is knowing at what point in time to measure casualties.

Slide 5

Alternative: Dynamic Capacity Estimates

This slide shows a diagram of dynamic capacity estimates. Between exposure and disease onset it is necessary to measure the daily case onset rate, and between disease onset and hospital bed it is necessary to measure the daily bed capacity.

Slide 6

Hospital Treatment Model


  • Patient load: New York Presbyterian Healthcare System (NYPHS) has 20 percent NY Metro market share.
  • Staffed bed availability.
  • Success of post-exposure prophylaxis.
  • Timing of disease onset.
  • Disease treatment/hospital length of stay (LOS) and mortality.

Information Sources.

  • NYPHS "Surge Capacity" survey.
  • CDC estimates of anthrax case rates.
  • Hospital treatment/LOS/mortality from 2001 attack (e.g. >24 hours sick without treatment = death).

Slide 7

New York Presbyterian Healthcare System Bed Surge Capacity

This slide shows a graph of New York Presbyterian Healthcare System's bed surge capacity. At baseline, NYPHS shows approximately 2000 beds, and the average network bed occupancy at baseline is 74 percent. After 24 hours, the bed capacity has surged to approximately 3500 beds, and after 72 hours its over 4,000.

Slide 8

Hospital Treatment Model (Arena©)

This slide shows a diagram of the hospital treatment model, which displays information on the number of patients send to hospitals, the number of hospital beds available, the number of patients waiting for a bed, and the average waiting time.

Slide 9

Hospital Capacity: Scenario Results

If NYPHS were responsible for 50,000 potential casualties, outpatient prophylaxis would have to reach >90 percent of those exposed to prevent anthrax cases from exceeding available bed supply.

This slide displays a graph that plots the number of patients who require a transfer or die waiting for a bed against the proportion of patients who receive post-exposure prophylaxis. As the proportion increases, the number of patients who require transfer or die decreases.

Slide 10

Outpatient Distribution Model


  • Staffing.
  • Triage protocol.
  • Drug availability.
  • Patient arrival pattern.
  • Patient characteristics.

Basic Template:

  • ~70 staff per shift.
  • ~7 minutes per patient.
  • ~1000 pts/hr.

Slide 11

Outpatient Dynamic Simulation Model

This slide shows an illustration of the outpatient dynamic simulation model. The model looks at the elements of the different phases of a patients hospital experience, including entry, triage, medical evaluation, drug dispensing, transportation, exit.

Slide 12


  • These are the first scalable computer models of civilian medical response to bioterrorism.
  • Our outpatient prophylaxis model was implemented during 2001 NYC anthrax attacks = Next: Improve this model using "live run" data.
  • Our hospital model pinpointed the limits of system capacity in response to a hypothetical bioterrorist mass casualty event.
  • Accuracy of the model depends on the quality of information (e.g., type of agent, natural history of disease, and treatment requirements) used.

Current as of June 2002

Internet Citation

Assessing Hospital and Health System Preparedness and Response. Presentation by Nathaniel Hupert at Web-Assisted Teleconference, "Bioterrorism and Health System Preparedness: Emerging Tools, Methods, and Strategies." Agency for Healthcare Research and Quality, Rockville, MD.

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