Rush University Medical Center, 1653WCongress Pkwy, 177 Murdock Bldg, Chicago, IL 60612, USA.
Disaster Med Public Health Prep. 2011 Jun;5(2):117-24. doi: 10.1001/dmp.2010.19. Epub 2010 Sep 28.
Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion.
A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes.
Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity.
Defining and quantitatively benchmarking the different components of hospital surge capacity is vital to hospital preparedness in MCE. Prospective studies of our mathematical model are needed to verify its applicability, generalizability, and validity.
在多人伤亡事件（MCE）中，医院的扩充能力是医院医疗应对的核心，也是受影响社区整体医疗能力的一个组成部分。然而，迄今为止，对于医院扩充能力的定义或量化，尚未达成共识。本研究的首要目标是定量基准化与创伤相关 MCE 中危重伤和中度伤患者救治相关的医院扩充能力的各个组成部分。第二个目标是说明这些定量参数在当地、区域、国家和国际灾害规划中的应用；在院前医疗服务将患者分配到各个医院的过程中的应用；以及在救护车分流的决策过程中的应用。
本研究采用两步法方法。首先，进行了广泛的文献检索，然后进行了数学建模。将创伤扩充能力的定量研究作为我们模型的框架。出于简化目的，在建模过程中使用了北大西洋公约组织分诊类别（T1-T4）。
医院急性救治扩充能力（HACSC）被定义为在招募所有可能的额外医疗资源后，医院每小时能够充分救治的最大数量的危急（T1）和中度（T2）伤员。将 HACSC 建模为急诊室床位数（#EDB）除以急诊室时间（EDT）；HACSC = #EDB/EDT。在创伤相关 MCE 中，定量基准的 EDT 为 2.5（小时）。由于大多数危重伤和中度伤患者在需要入院治疗的 6 小时内到达医院（根据定义），因此医院床位扩充能力必须与 6 小时内的 HACSC 相匹配，以确保协调的护理，并且数学基准是员工医院床位容量的 18%。
定义和定量基准化医院扩充能力的不同组成部分对 MCE 中的医院准备工作至关重要。需要对我们的数学模型进行前瞻性研究，以验证其适用性、可推广性和有效性。
