Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T10:04:35.736Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital Surge Capacity during Expo 2015 in Milano, Italy

Published online by Cambridge University Press:  29 August 2018

Roberto Faccincani ,
Francesco Della Corte ,
Giovanni Sesana ,
Riccardo Stucchi ,
Eric Weinstein ,
Itamar Ashkenazi  and
Pierluigi Ingrassia
Roberto Faccincani*
Affiliation:
Emergency Department Ospedale San Raffaele, Milano, Italy
Francesco Della Corte
Affiliation:
CRIMEDIM, Eastern Piedmont University, Novara, Italy
Giovanni Sesana
Affiliation:
ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Riccardo Stucchi
Affiliation:
ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
Eric Weinstein
Affiliation:
Emergency Department Lexington Medical Center, W. Columbia, South Carolina USA
Itamar Ashkenazi
Affiliation:
Hillel Yaffe Medical Center, Hadera, Israel
Pierluigi Ingrassia
Affiliation:
CRIMEDIM, Eastern Piedmont University, Novara, Italy
*
Correspondence: Roberto Faccincani, MD, MScDM San Raffaele Hospital Milano, Italy E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Hospital 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.

Keywords

disaster managementdisaster metricshospital preparednessmultiple-casualty incidentsurge capacity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 5 , October 2018 , pp. 459 - 465
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47(1):34-49.Google Scholar
2. Handler, JA, Gillam, M, Kirsch, TD, et al. Metrics in the science of surge. Acad Emerg Med. 2006;13(11):1173-1178.Google Scholar
3. American College of Emergency Physicians. Health care system surge capacity recognition, preparedness, and response. Ann Emerg Med. 2005;45(2):239.Google Scholar
4. Carmona, RH. The science of surge: an all-hazard approach is critical to improving public health preparedness. Acad Emerg Med. 2006;13(11):1097.Google Scholar
5. Barbisch, DF, Koenig, KL. Understanding surge capacity: essential elements. Acad Emerg Med. 2006;13(11):1098-1102.Google Scholar
6. Burkle, FM Jr. Population-based triage management in response to surge capacity requirements during a large-scale bio-event disaster. Acad Emerg Med. 2006;13(11):1118-1129.Google Scholar
7. Estacio, PL. Surge capacity for health care systems: early detection, methodologies, and process. Acad Emerg Med. 2006;13(11):1135-1137.Google Scholar
8. Wise, RA. The creation of emergency health care standards for catastrophic events. Acad Emerg Med. 2006;13(11):1150-1152.Google Scholar
9. Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13(11):1157-1159.Google Scholar
10. McManus, J, Huebner, K, Scheulen, J. The science of surge: detection and situational awareness. Acad Emerg Med. 2006;13(11):1179-1182.Google Scholar
11. Stratton, SJ, Tyler, RD. Characteristics of medical surge capacity demand for sudden-impact disasters. Acad Emerg Med. 2006;13(11):1193-1197.Google Scholar
12. Bonnett, CJ, Peery, BN, Cantrill, SV, et al. Surge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25(3):297-306.Google Scholar
13. Hick, JL, Barbera, JA, Kelen, GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009; 3(2 Suppl):S59-S67.Google Scholar
14. De Boer, J. Order in chaos: modelling medical management in disasters. Eur J Emerg Med. 1999; 6(2):141-148.Google Scholar
15. Koenig, KL, Kelen, G. Proceedings of the Consensus Conference “The Science of Surge,” May 17, 2006; San Francisco, California USA. Acad Emerg Med. 2006;13(11):1087-1088.Google Scholar
16. Hirshberg, A, Holcomb, JB, Mattox, KL. Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med. 2001;37(6):647-652.Google Scholar
17. Levi, L, Michaelson, M, Admi, H, et al. National strategy for mass-casualty situations and its effects on the hospital. Prehosp Disaster Med. 2002;17(1):12-16.Google Scholar
18. 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):220-234.Google Scholar
19. Kelen, GD, Kraus, CK, McCarthy, ML, et al. Inpatient disposition classification for the creation of hospital surge capacity: a multiphase study. Lancet. 2006;368(9551):1984-1990.Google Scholar
20. Hick, JL, Koenig, KL, Barbisch, D, et al. Surge capacity concepts for health care facilities: the CO-S-TR model for initial incident assessment. Disaster Med Public Health Prep. 2008; 2(Suppl 1):S51-S57.Google Scholar
21. Rivara, FP, Nathens, AB, Jurkovich, GJ, et al. Do trauma centers have the capacity to respond to disasters? J Trauma. 2006;61(4):949-953.Google Scholar
22. Hirshberg, A, Scott, BG, Granchi, T, et al. How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma. 2005; 58(4):686-693, discussion 694-695.Google Scholar
23. Eastman, AL, Rinnert, KJ, Nemeth, IR, et al. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. J Trauma. 2007;63(2):253-257.Google Scholar
24. Bayram, JD, Zuabi, S, Subbarao Italo. Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple-casualty events. Disaster Med Public Health Prep. 2011;5(2):117-124.Google Scholar
25. Bayram, JD, Zuabi, S. Disaster metrics: quantification of acute medical disasters in trauma-related multiple-casualty events through modeling of the acute medical severity index. Prehosp Disaster Med. 2012;27(2):130-135.Google Scholar
26. Lennquist, S. Medical Response to Major Incidents and Disasters. A Practical Guide for All Medical Staff. Berlin, Germany: Springer; 2012.Google Scholar
27. Mock, C, Lormand, JD, Goosen, J, Joshipura, M, Peden, M. Guidelines for Essential Trauma Care. Geneva, Switzerland: World Health Organization; 2004.Google Scholar
28. World Health Organization. Guidelines for Trauma Quality Improvement Programmes. Geneva, Switzerland: World Health Organization; 2009.Google Scholar
29. National Institute for Health and Care Excellence. Major Trauma. NICE Guidelines. London, United Kingdom: NICE; 2016.Google Scholar
30. American College of Surgeons. Resources for Optimal Care of the Injured Patient. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar
31. American College of Surgeons. Statement on Principles. Chicago, Illinois USA: American College of Surgeons; April 2016.Google Scholar
32. US Department of Health and Human Services. Medical Surge Capacity and Capability: A Management System for Integrating Medical and Health Resources During Large-Scale Emergencies. Second Edition. Washington, DC USA: US Department of Health and Human Services; September 2007.Google Scholar
33. Terndrup, TE, Leaming, JM, Adams, RJ, et al. Hospital-based coalition to improve regional surge capacity. West J Emerg Med. 2012;13(5):445-452.Google Scholar