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Hospital Surge Model Version 1.3: User Manual

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.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Step 1: Select a Scenario

After you direct your Web browser to and select the "Start" button, the Scenario Selection screen is displayed.

  • Select one of the scenarios, and click Next to specify additional options for the scenario (described in Step 2).
  • Select Help to display the User Manual (note: you may need to disable your pop-up blocker to view the User Manual).

Scenario Selection Screen

Screen shot of the various scenario options on the Hospital Surge Model Web site that the user can select using radio buttons.

Version 1.3 of the AHRQ Hospital Surge Model includes 13 scenarios.


  1. The covert release of aerosol Bacillus anthracis through a city.
  2. The covert release of smallpox virus in a large indoor theater.
  3. A pandemic flu outbreak that spreads across the country.1
  4. The covert release of airborne Yersinia pestis, producing rapidly progressing cases of pneumonic plague.

These four scenarios include both communicable and noncommunicable diseases; diseases that are treatable and not treatable with antibiotics; and indoor and outdoor attacks. The flu scenario incorporates hospital resource utilization and patient outcomes similar to those documented during the 2009 influenza A (H1N1) pandemic.


  1. The overt explosion of a liquid chlorine tank in a densely populated suburb.
  2. The overt release of the blister agent sulfur mustard at a large outdoor event.
  3. The semi-covert release of the nerve agent sarin in a crowded arena.

These three scenarios include both indoor and outdoor scenarios, as well as attacks with toxic industrial chemicals, blister agents, and nerve agents.


  1. The overt detonation of 1KT of nuclear material (improvised nuclear device) in a city center.
  2. The overt detonation of 10KT of nuclear material (improvised nuclear device) in a city center.
  3. The overt release of cesium-137 dust (commonly referred to as a "dirty bomb" or radiological dispersal device) in a city center.
  4. The covert placement of a cesium-137 point source in a public place.

These four scenarios include threats posed by radionuclides, which can be dispersed in an extremely violent reaction (nuclear), more gently (radiological dispersal device), or not at all (radioactive point source).


  1. The contamination of several ingredients of a popular food product with botulinum toxin. This product is then processed at the factory and distributed nationwide.


  1. Terrorists place small-scale improvised explosive devices in several subway stations during rush hour.


1. The Surge Model project team acknowledges the assistance of the Models of Infectious Disease Agent Study (MIDAS) group in the development of this scenario. For more information about MIDAS, go to

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