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Managing a Medical Surge

  • Randy D. KearnsEmail author
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

This chapter briefly discusses the background of surge capacity and explores where the science is today. There are three key principles that are the focus of this chapter; rapidly triage and moving patients to where they can best be managed for their specific injuries, moving equipment and personnel to where a large group (or groups) of patients are located, and allocating resources to include leveraging existing personnel, space, and equipment for maximum utilization.

Do not confuse capacity and capability. The ability to manage one patient with a critical injury is not, by extension, an indication that the same team of personnel can also manage large numbers of patients with similar critical injuries. Space, equipment, or personnel may suggest that more significant numbers of patients can be managed but without adequate expertise, and by extension capacity, the capability to effectively manage a surge of patients may be problematic.

There are two categories of surge events that any jurisdiction or facility may confront. They include the “no notice” (also referred to as “time-zero”) mass casualty incident (MCI) and the more gradual surge associated with scenarios such as a pandemic event. A “no notice” MCI event includes examples such as a traffic collision involving a bus, train derailment, or a residential building collapse. Although more gradual in onset than the “no notice” event, surge capacity is also needed during disasters that extend over time and include infectious disease outbreaks. The sudden and immediate demand for medical services by a group of patients is not a new phenomenon. Nevertheless, management of these events has evolved through modeling and real-world events driving process improvement.

Keywords

Conventional surge capacity Contingency surge capacity Crisis surge capacity Force multiplier  Immediate bed availability Just-in-time training Mass casualty incident Surge equilibrium 

References

  1. 1.
    Simpson AT. Transporting Lazarus: physicians, the state, and the creation of the modern paramedic and ambulance, 1955-73. J Hist Med Allied Sci. 2013;68(2):163–97.CrossRefGoogle Scholar
  2. 2.
    Murray CJ, Lopez AD, Chin B, Feehan D, Hill KH. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis. Lancet. 2006;368(9554):2211–8.CrossRefGoogle Scholar
  3. 3.
    Stern AM, Cetron MS, Markel H. The 1918-1919 influenza pandemic in the United States: lessons learned and challenges exposed. Public Health Rep. 2010;125(Suppl 3):6–8.CrossRefGoogle Scholar
  4. 4.
    Dodge AH. The 1962 civil defense emergency hospital program. N Y State J Med. 1963;63:3144–6.PubMedGoogle Scholar
  5. 5.
    National Academy of Sciences (US) and National Research Council (US) Committee on Trauma, National Academy of Sciences (US) and National Research Council (US) Committee on Shock. Accidental death and disability: the neglected disease of modern society. Washington, DC: National Academies Press (US); 1966.  https://doi.org/10.17226/9978. https://www.ncbi.nlm.nih.gov/books/NBK222962/.
  6. 6.
    Peleg K, Michaelson M, Shapira SC, Aharonson-Daniel L. Principles of emergency management in disasters. Adv Ren Replace Ther. 2003;10(2):117–21.CrossRefGoogle Scholar
  7. 7.
    Rasmussen TE, Baer DG, Goolsby C. The giving back: battlefield lesson to national preparedness. J Trauma Acute Care Surg. 2016;80(1):166–7.CrossRefGoogle Scholar
  8. 8.
    Alcock J, Delieu J. Planning for pandemic influenza. Nursing Standard (Royal College of Nursing (Great Britain): 1987). 2007;22(3):35–9.CrossRefGoogle Scholar
  9. 9.
    Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(2 Suppl):S59–67.CrossRefGoogle Scholar
  10. 10.
    White DB. Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009;150(2):132.CrossRefGoogle Scholar
  11. 11.
    Rubinson L, Hick JL, Curtis JR, et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):32S–50S.CrossRefGoogle Scholar
  12. 12.
    Cusack L, Gebbie K. Call for national dialogue: adapting standards of care in extreme events. We are not ready. Collegian. 2017;24(1):93–100.CrossRefGoogle Scholar
  13. 13.
    Leider JP, DeBruin D, Reynolds N, Koch A, Seaberg J. Ethical guidance for disaster response, specifically around crisis standards of care: a systematic review. Am J Public Health. 2017;107(9):e1–9.CrossRefGoogle Scholar
  14. 14.
    Hick JL, Hanfling D, Cantrill SV. Allocating scarce resources in disasters: emergency department principles. Ann Emerg Med. 2012;59(3):177–87.CrossRefGoogle Scholar
  15. 15.
    Healthcare Preparedness Capabilties, National Guidance for Healthcare System Preparedness. In: Response OotASfPa, editor. http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf. US DHHS ASPR; 2012. p. 72.
  16. 16.
    Kearns RD, Stringer L, Craig J, et al. Relying on the National Mobile Disaster Hospital as a business continuity strategy in the aftermath of a tornado: the Louisville experience. J Bus Contin Emer Plan. 2017;10(3):230–48.PubMedGoogle Scholar
  17. 17.
    Blackwell T, Bosse M. Use of an innovative design mobile hospital in the medical response to Hurricane Katrina. Ann Emerg Med. 2007;49(5):580–8.CrossRefGoogle Scholar
  18. 18.
    Adini B, Israeli A, Bodas M, Peleg K. Increasing perceived emergency preparedness by participatory policy-making (think-tanks). Disaster Med Public Health Prep. 2018;1–6.Google Scholar
  19. 19.
    VandenBerg SL, Davidson SB. Preparation for mass casualty incidents. Crit Care Nurs Clin North Am. 2015;27(2):157–66.CrossRefGoogle Scholar
  20. 20.
    Kearns RD, Cairns BA, Cairns CB. Surge capacity and capability. A review of the history and where the science is today regarding surge capacity during a mass casualty disaster. Front Public Health. 2014;2:29.CrossRefGoogle Scholar
  21. 21.
    Hashikawa M, Gold KJ. Disaster preparedness in primary care: ready or not? Disaster Med Public Health Prep. 2018;12(5):644–8.CrossRefGoogle Scholar
  22. 22.
    Ortu G, Mounier-Jack S, Coker R. Pandemic influenza preparedness in Africa is a profound challenge for an already distressed region: analysis of national preparedness plans. Health Policy Plan. 2008;23(3):161–9.CrossRefGoogle Scholar
  23. 23.
    Hodge JG Jr, Gostin LO, Parmet WE, Nuzzo JB, Phelan A. Federal powers to control communicable conditions: call for reforms to assure national preparedness and promote global security. Health Secur. 2017;15(1):123–6.CrossRefGoogle Scholar
  24. 24.
    Eastman AL, Fabbri W, Brinsfield K, Jacobs L. Improving national preparedness for intentional mass casualty events: a seamless system of evidence-based care. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S77–80.CrossRefGoogle Scholar
  25. 25.
    Cordova-Villalobos JA, Macias AE, Hernandez-Avila M, et al. The 2009 pandemic in Mexico: experience and lessons regarding national preparedness policies for seasonal and epidemic influenza. Gac Med Mex. 2017;153(1):102–10.PubMedGoogle Scholar
  26. 26.
    Hall TN, McDonald A, Peleg K. Identifying factors that may influence decision-making related to the distribution of patients during a mass casualty incident. Disaster Med Public Health Prep. 2018;12(1):101–8.CrossRefGoogle Scholar
  27. 27.
    Adini B, Bodas M, Nilsson H, Peleg K. Policies for managing emergency medical services in mass casualty incidents. Injury. 2017;48(9):1878–83.CrossRefGoogle Scholar
  28. 28.
    Hick JL, Einav S, Hanfling D, et al. Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4 Suppl):e1S–e16S.CrossRefGoogle Scholar
  29. 29.
    National Academies of Sciences, Engineering, and Medicine. A national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury. Washington, DC: The National Academies Press; 2016.Google Scholar
  30. 30.
    Public Health Emergency. Immediate bed availability. 2014. http://www.phe.gov/Preparedness/planning/sharper/Pages/iba.aspx. Accessed 7 July 2016.
  31. 31.
    Kearns RD, Skarote MB, Peterson J, et al. Deployable, portable, and temporary hospitals; one state’s experiences through the years. Am J Disaster Med. 2014;9(3):195–210.CrossRefGoogle Scholar
  32. 32.
    Kearns RD, Hubble MW, Holmes JH 4th, Cairns BA. Disaster planning: transportation resources and considerations for managing a burn disaster. J Burn Care Res. 2014;35(1):e21–32.CrossRefGoogle Scholar
  33. 33.
    Gerberding JL, Falk H, Arias I, et al. In a moment’s notice: surge capacity for terrorist bombings challenges and proposed solutions. In: Services USDoHaH, editor. 2007. p. 60. http://emergency.cdc.gov/masscasualties/pdf/surgecapacity.pdf.
  34. 34.
    Kelen GD, McCarthy ML. The science of surge. Acad Emerg Med. 2006;13(11):1089–94.CrossRefGoogle Scholar
  35. 35.
    Abramovich MN, Hershey JC, Callies B, Adalja AA, Tosh PK, Toner ES. Hospital influenza pandemic stockpiling needs: a computer simulation. Am J Infect Control. 2017;45(3):272–7.CrossRefGoogle Scholar
  36. 36.
    Posner Z, Admi H, Menashe N. Ten-fold expansion of a burn unit in mass casualty: how to recruit the nursing staff. Disaster Manag Response. 2003;1(4):100–4.CrossRefGoogle Scholar
  37. 37.
    Lennarson P, Boedeker BH, Kuper GM, et al. Utilization of a civilian academic center as a force multiplier in support of NATO special operations medicine—a pilot demonstration. Stud Health Technol Inform. 2012;173:260–2.PubMedGoogle Scholar
  38. 38.
    Bryan J, Miyamoto D, Holman V. Medical civil-military operations: the deployed medical brigade’s role in counterinsurgency operations. US Army Med Dep J. 2008;25–28.Google Scholar
  39. 39.
    Simmons S, Alverson D, Poropatich R, D’Iorio J, DeVany M, Doarn CR. Applying telehealth in natural and anthropogenic disasters. Telemed J E Health. 2008;14(9):968–71.CrossRefGoogle Scholar
  40. 40.
    Franco C, Toner E, Waldhorn R, Inglesby TV, O’Toole T. The national disaster medical system: past, present, and suggestions for the future. Biosecur Bioterror. 2007;5(4):319–25.CrossRefGoogle Scholar
  41. 41.
    Kearns RD, Conlon KM, Valenta AL, Lord GC, Cairns CB, Holmes JH, Johnson DD, Matherly AF, Sawyer D, Skarote MB, Siler SM, Helminiak RC, Cairns BA. Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center. J Burn Care Res. 2014;35(1):e1–e13.  https://doi.org/10.1097/BCR.0b013e31829afe25. PubMed PMID: 23877135.CrossRefGoogle Scholar
  42. 42.
    Franc JM, Ingrassia PL, Verde M, Colombo D, Della Corte F. A simple graphical method for quantification of disaster management surge capacity using computer simulation and process-control tools. Prehosp Disaster Med. 2015;30(1):9–15.CrossRefGoogle Scholar
  43. 43.
    Toerper MF, Kelen GD, Sauer LM, Bayram JD, Catlett C, Levin S. Hospital surge capacity: a web-based simulation tool for emergency planners. Disaster Med Public Health Prep. 2018;12(4):513–22.CrossRefGoogle Scholar
  44. 44.
    Nilsson H, Jonson CO, Vikstrom T, et al. Simulation-assisted burn disaster planning. Burns. 2013;39(6):1122–30.CrossRefGoogle Scholar
  45. 45.
    Abir M, Davis MM, Sankar P, Wong AC, Wang SC. Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center. Prehosp Disaster Med. 2013;28(1):23–32.CrossRefGoogle Scholar
  46. 46.
    Albores P, Shaw D. Government preparedness: using simulation to prepare for a terrorist attack. Comput Oper Res. 2008;35(6):1924–43.CrossRefGoogle Scholar
  47. 47.
    Dallas CE, Bell WC. Prediction modeling to determine the adequacy of medical response to urban nuclear attack. Disaster Med Public Health Prep. 2007;1(2):80–9.CrossRefGoogle Scholar
  48. 48.
    Franc-Law JM, Bullard M, Della Corte F. Simulation of a hospital disaster plan: a virtual, live exercise. Prehosp Disaster Med. 2008;23(4):346–53.CrossRefGoogle Scholar
  49. 49.
    Hirshberg A, Scott BG, Granchi T, Wall MJ, Mattox KL, Stein M. How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma. 2005;58(4):686–95.CrossRefGoogle Scholar
  50. 50.
    Smith SW, Portelli I, Narzisi G, et al. A novel approach to multihazard modeling and simulation. Disaster Med Public Health Prep. 2009;3(2):75–87.CrossRefGoogle Scholar
  51. 51.
    Steward D, Wan TT. The role of simulation and modeling in disaster management. J Med Syst. 2007;31(2):125–30.CrossRefGoogle Scholar
  52. 52.
    Kearns R, Zoller J, Hubble M, Alson R, Cairns B, Holmes J IV. Using Monte Carlo simulation for modeling surge capacity in the ABA southern region. J Burn Care Res. 2012;33(2):1.Google Scholar
  53. 53.
    Kearns RD. Burn surge capacity in the south what is the capacity of burn centers within the american burn association southern region to absorb significant numbers of burn injured patients during a medical disaster? Medical University of South Carolina: ProQuest Dissertations and Theses; 2011.Google Scholar
  54. 54.
    Agency FEMA. Homeland security exercise and evaluation program. 2013. http://www.fema.gov/media-library-data/20130726-1914-25045-8890/hseep_apr13_.pdf. Accessed 6 July 2016.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of New Orleans, College of Business AdministrationNew OrleansUSA
  2. 2.University of North Carolina, School of MedicineChapel HillUSA

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