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Abstract
IntroductionHospital Acute Care Surge Capacity (HACSC), Hospital Acute Care Surge Threshold (HACST), and Total Hospital Capacity (THC) are scales that were developed to quantify surge capacity in the event of a multiple-casualty incident (MCI). These scales take into consideration the need for adequate care for both critical (T1) and moderate (T2) trauma patients. The objective of this study was to verify the validity of these scales in nine hospitals of the Milano (Italy) metropolitan area that prepared for a possible MCI during EXPO 2015. METHODS Both HACSC and HACST were computed for individual hospitals. These were compared to surge capacities declared by individual hospitals during EXPO 2015, and also to surge capacity evaluated during a simulation organized on August 23, 2016. RESULTS Both HACSC and HACST were smaller compared to capacities measured and reported by the hospitals, as well as those found during the simulation. This resulted in significant differences in THC when this was computed from the different methods of calculation. CONCLUSIONS Surge capacity is dependent on the method of measurement. Each method has its inherent deficiencies. Until more reliable methodologies are developed, there is a benefit to analyze surge capacity using several methods rather than just one. Emergency committee members should be aware of the importance of critical resources when looking to the hospital capacity to respond to an MCI, and to the possibility to effectively increase it with a good preparedness plan. Since hospital capacity during real events is not static but dynamic, largely depending on occupation of the available resources, it is important that the regional command center and the hospitals receiving casualties constantly communicate on specific agreed upon critical resources, in order for the regional command center to timely evaluate the overall regional capacity and guarantee the appropriate distribution of the patients. FaccincaniR, Della CorteF, SesanaG, StucchiR, WeinsteinE, AshkenaziI, IngrassiaP. Hospital surge capacity during Expo 2015 in Milano, Italy. Prehosp Disaster Med. 2018;33(5):459-465.
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Bayram JD, Sauer LM, Catlett C, Levin S, Cole G, Kirsch TD, Toerper M, Kelen G. Critical resources for hospital surge capacity: an expert consensus panel. PLOS CURRENTS 2013; 5. [PMID: 24162793 PMCID: PMC3805833 DOI: 10.1371/currents.dis.67c1afe8d78ac2ab0ea52319eb119688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Hospital surge capacity (HSC) is dependent on the ability to increase or conserve resources. The hospital surge model put forth by the Agency for Healthcare Research and Quality (AHRQ) estimates the resources needed by hospitals to treat casualties resulting from 13 national planning scenarios. However, emergency planners need to know which hospital resource are most critical in order to develop a more accurate plan for HSC in the event of a disaster.
Objective: To identify critical hospital resources required in four specific catastrophic scenarios; namely, pandemic influenza, radiation, explosive, and nerve gas.
Methods: We convened an expert consensus panel comprised of 23 participants representing health providers (i.e., nurses and physicians), administrators, emergency planners, and specialists. Four disaster scenarios were examined by the panel. Participants were divided into 4 groups of five or six members, each of which were assigned two of four scenarios. They were asked to consider 132 hospital patient care resources- extracted from the AHRQ's hospital surge model- in order to identify the ones that would be critical in their opinion to patient care. The definition for a critical hospital resource was the following: absence of the resource is likely to have a major impact on patient outcomes, i.e., high likelihood of untoward event, possibly death. For items with any disagreement in ranking, we conducted a facilitated discussion (modified Delphi technique) until consensus was reached, which was defined as more than 50% agreement. Intraclass Correlation Coefficients (ICC) were calculated for each scenario, and across all scenarios as a measure of participant agreement on critical resources. For the critical resources common to all scenarios, Kruskal-Wallis test was performed to measure the distribution of scores across all scenarios.
Results: Of the 132 hospital resources, 25 were considered critical for all four scenarios by more than 50% of the participants. The number of hospital resources considered to be critical by consensus varied from one scenario to another; 58 for the pandemic influenza scenario, 51 for radiation exposure, 41 for explosives, and 35 for nerve gas scenario. Intravenous crystalloid solution was the only resource ranked by all participants as critical across all scenarios. The agreement in ranking was strong in nerve agent and pandemic influenza (ICC= 0.7 in both), and moderate in explosives (ICC= 0.6) and radiation (ICC= 0.5).
Conclusion: In four disaster scenarios, namely, radiation, pandemic influenza, explosives, and nerve gas scenarios; supply of as few as 25 common resources may be considered critical to hospital surge capacity. The absence of any these resources may compromise patient care. More studies are needed to identify critical hospital resources in other disaster scenarios.
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Affiliation(s)
- Jamil D Bayram
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lauren M Sauer
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christina Catlett
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
| | - Scott Levin
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gai Cole
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
| | - Thomas D Kirsch
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew Toerper
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabor Kelen
- Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA
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Bonham AJ, Paden NG, Ricci F, Plaxco KW. Detection of IP-10 protein marker in undiluted blood serum via an electrochemical E-DNA scaffold sensor. Analyst 2013; 138:5580-3. [PMID: 23905162 PMCID: PMC3956051 DOI: 10.1039/c3an01079a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We describe an electrochemical analog of fluorescence polarization that supports the quantitative measurement of a specific protein, the chemokine IP-10, directly in undiluted blood serum. The sensor is label-free, wash-free, and electronic, suggesting it could support point-of-care detection of diagnostic proteins in largely unprocessed clinical samples.
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Affiliation(s)
- Andrew J. Bonham
- Department of Chemistry, Metropolitan State University of Denver, Denver, CO 80217, USA. Fax: 01 303 556 5399; Tel: 01 303 556 3929;
| | - Nicole G. Paden
- Department of Chemistry & Biochemistry, University of California, Santa Barbara, CA 93117, USA. Fax: 01 805 893 4120; Tel: 01 805 893 5558;
| | - Francesco Ricci
- University of Rome Tor Vergata, Rome, Italy. Tel: 39 06 72594422;
| | - Kevin W. Plaxco
- Department of Chemistry & Biochemistry, University of California, Santa Barbara, CA 93117, USA. Fax: 01 805 893 4120; Tel: 01 805 893 5558;
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Watson SK, Rudge JW, Coker R. Health systems' "surge capacity": state of the art and priorities for future research. Milbank Q 2013; 91:78-122. [PMID: 23488712 PMCID: PMC3607127 DOI: 10.1111/milq.12003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
CONTEXT Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice. METHODS A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health. FINDINGS The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings. CONCLUSIONS The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.
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Affiliation(s)
- Samantha K Watson
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Bethesda hospitals' emergency preparedness partnership: a model for transinstitutional collaboration of emergency responses. Disaster Med Public Health Prep 2010; 3:168-73. [PMID: 19834325 DOI: 10.1097/dmp.0b013e3181aa2719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The events of September 11, 2001 identified a need for health care institutions to develop flexible, creative, and adaptive response mechanisms in the event of a local, regional, or national disaster. The 3 major health care institutions in Bethesda, MD-the National Naval Medical Center (NNMC), the Suburban Hospital Healthcare System (SHHS), and the National Institutes of Health Clinical Center (NIHCC)-have created a preparedness partnership that outstrips what any of the institutions could provide independently by pooling complementary resources. The creation of the partnership initially was driven by geographic proximity and by remarkably complementary resources. This article describes the creation of the partnership, the drivers and obstacles to creation, and the functioning and initial accomplishments of the partnership. The article argues that similar proximity and resource relationships exist among institutions at academic centers throughout the United States and suggests that this partnership may serve as a template for other similarly situated institutions.
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