Kanter Robert K, Moran John R
Department of Pediatrics, State University of New York-Upstate Medical University, Syracuse, NY 13210, USA.
Ann Emerg Med. 2007 Sep;50(3):314-9. doi: 10.1016/j.annemergmed.2006.10.019. Epub 2006 Dec 18.
National policy for emergency preparedness calls for hospitals to accommodate surges of 500 new patients per million population in a disaster, but published studies have not evaluated the ability of existing resources to meet these goals. We describe typical statewide and regional hospital occupancy and patterns of variation in occupancy and estimate the ability of hospitals to accommodate new inpatients.
Daily hospital occupancy for each hospital was calculated according to admission date and length of stay for each patient during the study period. Occupancy was expressed as the count of occupied beds. Peak hospital capacity was defined as the 95th percentile highest occupancy at each facility. Data obtained from the New York Statewide Planning and Research Cooperative System were analyzed for 1996 to 2002. Patients were classified as children (0 to 14 years, excluding newborns) or adults. Vacant hospital beds per million age-specific population were determined as the difference between peak capacity and average occupancy.
In New York State, 242 hospitals cared for a peak capacity of 2,707 children and 46,613 adults. Occupancy averaged 60% of the peak for children and 82% for adults, allowing an average statewide capacity for a surge of 268 new pediatric and 555 adult patients for each million age-specific population. After the September 11, 2001, attacks, in the New York City region, a discretionary modification of admissions and discharges resulted in an 11% reduction from the expected occupancy for children and adults.
Typically, there are not enough vacant hospital beds available to serve 500 children per million population. Modified standards of hospital care to expand capacity may be necessary to serve children in a mass-casualty event.
国家应急准备政策要求医院在灾难期间能够接纳每百万人口新增500名患者，但已发表的研究尚未评估现有资源实现这些目标的能力。我们描述了典型的全州和地区医院床位占用情况及占用模式的变化，并估计了医院接纳新住院患者的能力。
根据研究期间每位患者的入院日期和住院时间计算每家医院的每日床位占用情况。床位占用情况以占用床位数量表示。每家医院的最高床位容量定义为各机构占用率最高的第95百分位数。对1996年至2002年从纽约州全州规划与研究合作系统获得的数据进行分析。患者分为儿童（0至14岁，不包括新生儿）或成人。每百万特定年龄段人口的空置医院床位数量通过最高床位容量与平均占用率之间的差值确定。
在纽约州，242家医院的最高床位容量为2707名儿童和46613名成人。儿童床位占用率平均为最高床位容量的60%，成人则为82%，这使得全州平均每百万特定年龄段人口有能力接纳268名新增儿科患者和555名新增成人患者。2001年9月11日袭击事件后，在纽约市地区，通过酌情调整入院和出院安排，儿童和成人的预期床位占用率降低了11%。
通常情况下，没有足够的空置医院床位来为每百万人口中的500名儿童提供服务。在大规模伤亡事件中，可能需要修改医院护理标准以扩大容量来服务儿童。
