Barthel Erik R, Pierce James R, Goodhue Catherine J, Ford Henri R, Grikscheit Tracy C, Upperman Jeffrey S
Children's Hospital Los Angeles, Division of Pediatric Surgery, Los Angeles, CA 90027, USA.
Theor Biol Med Model. 2011 Oct 12;8:38. doi: 10.1186/1742-4682-8-38.
The concept of disaster surge has arisen in recent years to describe the phenomenon of severely increased demands on healthcare systems resulting from catastrophic mass casualty events (MCEs) such as natural disasters and terrorist attacks. The major challenge in dealing with a disaster surge is the efficient triage and utilization of the healthcare resources appropriate to the magnitude and character of the affected population in terms of its demographics and the types of injuries that have been sustained.
In this paper a deterministic population kinetics model is used to predict the effect of the availability of a pediatric trauma center (PTC) upon the response to an arbitrary disaster surge as a function of the rates of pediatric patients' admission to adult and pediatric centers and the corresponding discharge rates of these centers. We find that adding a hypothetical pediatric trauma center to the response documented in an historical example (the Israeli Defense Forces field hospital that responded to the Haiti earthquake of 2010) would have allowed for a significant increase in the overall rate of admission of the pediatric surge cohort. This would have reduced the time to treatment in this example by approximately half. The time needed to completely treat all children affected by the disaster would have decreased by slightly more than a third, with the caveat that the PTC would have to have been approximately as fast as the adult center in discharging its patients. Lastly, if disaster death rates from other events reported in the literature are included in the model, availability of a PTC would result in a relative mortality risk reduction of 37%.
Our model provides a mathematical justification for aggressive inclusion of PTCs in planning for disasters by public health agencies.
近年来出现了灾难激增的概念，用于描述由自然灾害和恐怖袭击等灾难性大规模伤亡事件（MCE）导致的对医疗系统需求急剧增加的现象。应对灾难激增的主要挑战在于根据受影响人群的人口统计学特征和所遭受伤害的类型，对与受灾规模和特征相适应的医疗资源进行有效分诊和利用。
本文使用确定性群体动力学模型来预测儿科创伤中心（PTC）的可用性对任意灾难激增应对措施的影响，该影响是儿科患者进入成人和儿科中心的入院率以及这些中心相应出院率的函数。我们发现，在一个历史实例（2010年应对海地地震的以色列国防军野战医院）记录的应对措施中增加一个假设的儿科创伤中心，将使儿科激增队列的总体入院率显著提高。在这个例子中，这将使治疗时间减少约一半。完全治疗所有受灾儿童所需的时间将减少略超过三分之一，但前提是PTC在出院患者方面必须与成人中心速度大致相同。最后，如果将文献中报道的其他事件的灾难死亡率纳入模型，PTC的可用性将导致相对死亡风险降低37%。
我们的模型为公共卫生机构在灾难规划中积极纳入PTC提供了数学依据。
