# Presentation: 070495

## Addressing Surge Capacity in a Mass Casualty Event

**Nathaniel Hupert, M.D., M.P.H.**
**Assistant Professor of Public **
**Health and Medicine**
**Weill Medical College **
**Cornell University**
**New York City**

## Why Model Surge?

- We already know the U.S. health care system has very little surge capacity.
- 	What is the benefit of creating computer models of it?

- Two possible answers:
- Reassess common assumptions about the determinants of capacity
- Quantitative casualty estimates for varied planning efforts (e.g, ranging from different service lines in a single hospital to emergency planning functions in a region)

**Notes:**
Q1: Dr. Hupert, I understand that the U.S. health care system has very little surge capacity.  In response, ARK has sponsored the development of a variety of models and guides that address hospital preparedness, one of which is your “Community-Based Mass Prophylaxis Planning Guide for Public Health Preparedness.”  Can you tell us, what are the value and benefits of modeling surge capacity? 

## Determinants of Surge Capacity

- Surge arrivals

- Hospital or network
- capacity

- Medical supplies

- Out-of-region facility

- SNF

- Home

- Staff

- Event

- Beds

- Pre-hospital
- management

- Surge Discharge*

- Treated

- Died

- *Note: 	I am indebted to Sam Benson, EMT-P, New York City Office of Emergency Management for the notion of “surge discharge”

**Notes:**
Q2: When you develop a model for a mass casualty event, what are the things you need to think about? 

## Modeling Pre-hospital Capacity

**Delay in **
**Reaction**

*None (Hours)*

*Long (Days)*

*Shorter (1-2 Days)*

*Longer 4+ Days*

**Time needed to protect community**

**Modeling Pre-hospital Capacity**

**Notes:**
Q3: Using anthrax as an example, what can a model us about how soon patients will seek treatment?

## Modeled Outcomes of Pre-hospital Anthrax Prophylaxis

**Modeled Outcomes of Pre-hospital Anthrax Prophylaxis**

- Percentage of exposed individuals don’t get sick because they receive antibiotics in time

- Increasing Hospital Surge

**Notes:**
Q4: How could we use this model to figure out how many people could be treated outside the hospital? 

## If 100,000 people were exposed to anthrax and your prophylaxis campaign...

- Could cover all in 2 days after a **1 day** delay
- 		 ~1,000 sick

**Notes:**
Q5: Can we also use models to predict when and what resources will be needed in the hospital?

## Could cover all in 2 days after a 2 day delay 
		 ~4,000 sick

- 		 ~4,000 sick

**If 100,000 people were exposed to anthrax and your prophylaxis campaign...**

**Notes:**
Q5 Cont.: Can we also use models to predict when and what resources will be needed in the hospital?

## Modeling Improves Community-wide Surge Capacity Planning by Linking Pre-hospital and Hospital-based Care Planning

- One exposure scenario...

- ...can lead to different total and daily casualty loads depending on pre-hospital preparedness and response...

- ...with different implications for hospital surge arrivals...

- ...yielding different patient outcomes.

- 

- 

**Notes:**
Q6: What are the advantages of being able to model both pre-hospital and hospital-based surge capacity?

## “Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness”

**www.ahcpr.gov/research/cbmprophyl/cbmpro.htm**

**Notes:**
Q8. Where can our audience find out more about your model?