Schultz Carl H, Koenig Kristi L
Department of Emergency Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA.
Acad Emerg Med. 2006 Nov;13(11):1153-6. doi: 10.1197/j.aem.2006.06.033. Epub 2006 Aug 31.
High-consequence surge research involves a systems approach that includes elements such as healthcare facilities, out-of-hospital systems, mortuary services, public health, and sheltering. This article focuses on one aspect of this research, hospital surge capacity, and discusses a definition for such capacity, its components, and future considerations. While conceptual definitions of surge capacity exist, evidence-based practical guidelines for hospitals require enhancement. The Health Resources and Services Administration's (HRSA) definition and benchmarks are extrapolated from those of other countries and rely mainly on trauma data. The most significant part of the HRSA target, the need to care for 500 victims stricken with an infectious disease per one million population in 24 hours, was not developed using a biological model. If HRSA's recommendation is applied to a sample metropolitan area such as Orange County, California, this translates to a goal of expanding hospital capacity by 20%-25% in the first 24 hours. Literature supporting this target is largely consensus based or anecdotal. There are no current objective measures defining hospital surge capacity. The literature identifying the components of surge capacity is fairly consistent and lists them as personnel, supplies and equipment, facilities, and a management system. Studies identifying strategies for hospitals to enhance these components and estimates of how long it will take are lacking. One system for augmenting hospital staff, the Emergency System for Advance Registration of Volunteer Health Professionals, is a consensus-derived plan that has never been tested. Future challenges include developing strategies to handle the two different types of high-consequence surge events: 1) a focal, time-limited event (such as an earthquake) where outside resources exist and can be mobilized to assist those in need and 2) a widespread, prolonged event (such as pandemic influenza) where all resources will be in use and rationing or triage is needed.
高影响激增研究采用系统方法，涵盖医疗保健设施、院外系统、太平间服务、公共卫生和避难所等要素。本文聚焦于该研究的一个方面，即医院激增能力，探讨了这种能力的定义、其组成部分以及未来考量。虽然存在激增能力的概念性定义，但医院基于证据的实用指南仍需完善。卫生资源与服务管理局（HRSA）的定义和基准是从其他国家推断而来，主要依赖创伤数据。HRSA目标中最重要的部分，即在24小时内每百万人口需照料500名传染病患者的需求，并非基于生物学模型制定。如果将HRSA的建议应用于加利福尼亚州橙县这样的典型大都市地区，这意味着在前24小时内将医院容量扩大20% - 25%的目标。支持这一目标的文献大多基于共识或轶事。目前尚无定义医院激增能力的客观衡量标准。确定激增能力组成部分的文献相当一致，将其列为人员、物资和设备、设施以及管理系统。缺乏确定医院增强这些组成部分的策略以及所需时间估计的研究。一种增加医院工作人员的系统，即志愿卫生专业人员预先登记应急系统，是一个从未经过测试的基于共识的计划。未来的挑战包括制定策略来应对两种不同类型的高影响激增事件：1）局部、限时事件（如地震），外部资源存在且可被调动以援助有需要的人；2）广泛、长期事件（如大流行性流感），所有资源都将被使用，需要进行配给或分诊。
