Levi L, Bregman D, Geva H, Revah M
Trauma Research Unit, Rambam Medical Center, Haifa, Israel.
Prehosp Disaster Med. 1997 Oct-Dec;12(4):300-4.
The raw number of hospital trauma beds and occupancy has been used to assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.
Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of "standard wartime casualties." Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A "what-if" module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of "standard casualties." Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.
Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected. The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.
The use of simulation techniques might be useful method to assess the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.
医院创伤病床的原始数量和占用情况已被用于评估医院在战时和灾难情况下的手术能力。本研究的目的是检验并提供一个更好的工具，以确定医院在这些情况下能够有效接收和治疗的伤亡人数。
将模拟软件应用于各种战时场景。它评估了在“标准战时伤亡”负荷下手术室功能的计算机模拟的有用性。对类似医院的功能进行比较，以确定优化护理的可能方法。使用“假设分析”模块来确定在给定医疗系统的已知资源内接收大量伤亡人员的最佳方式。每家医院都在不同的“标准伤亡”负荷下进行测试。手术平均等待时间被用作随着患者负荷增加护理标准持续下降的指标。
确定了不同的、独特的优化等待时间的策略模式。并非所有创伤中心都通过在分诊前或分诊后将轻伤患者分流来缩短等待时间。对隔日轮班的反应出人意料。与功能性手术室匹配患者的时间过程比医院预设的可用床位数更能表明医院接收需要手术的伤亡人员的能力。
使用模拟技术可能是评估全国手术能力的有用方法。这是一个复杂的困境，即使结合以前的分诊经验，也无法通过简单猜测来预测。分析国家层面的薄弱点和瓶颈可能有助于制定准备预案。
