Appendix F: Resource Requirements Models
Models that estimate resource requirements can complement
resource availability systems (Appendix E) by estimating the "gaps" (i.e.,
the difference between what's required and what's available) and therefore the
resource levels that neighboring jurisdictions or the Federal government could
potentially be asked to fill. These models can be used as part of a planning
process to determine shortfalls and thus help drive investment decisions. In
addition, the models could be used during an incident to estimate resource
shortfalls at that moment.
This section briefly describes two AHRQ-funded resource
requirements models related to mass casualty or evacuation incidents—the
Surge Model and the Mass Evacuation Transportation Model. The latter model was
developed under the same contract as the recommendations for the National
System; separate reports to the Agency for Healthcare Research and Quality (AHRQ) include the model description and user manual
for the Transportation Model.
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AHRQ Hospital Surge Model
The AHRQ Hospital
Surge Model, developed by Abt Associates, Weill Cornell Medical College, and Gryphon Scientific, estimates the hospital resources needed, by day, to treat
casualties arising from various weapons of mass destruction attacks. The Hospital Surge Model
includes ten different scenarios:
- Biological (anthrax, smallpox,
and pandemic flu).
- Chemical (chlorine, sulfur
mustard, or sarin).
- Nuclear (1 KT or 10 KT
explosion).
- Radiological (dispersion device
or point source).
When the
Hospital Surge Model is run, the user selects one of the above scenarios and
specifies the number of casualties that their hospital(s) will need to treat.
Casualties are treated, as necessary, in the emergency department (ED), in the
intensive care unit (ICU), or on a general medical/surgical bed ward. Hospitals
are assumed to have unlimited capacity and provide a standard level of care to
all casualties-that is, the Hospital Surge Model assumes that care is not
degraded by the surge in patients or by resource constraints. Eventually,
casualties in the model are either discharged or die in the hospital(s). While
patients are in the hospital(s), the Hospital Surge Model estimates the amount
of resources (e.g., personnel, equipment, supplies) they require.
For the selected scenario, the
Hospital Surge Model estimates:
- The number of casualties in the
hospital(s) by hospital unit (ED, ICU, or floor) and day.
- The cumulative number of dead
or discharged casualties by day.
- The required hospital resources
(personnel, equipment, and supplies) to treat casualties by hospital unit
and day.
Information about the Hospital Surge Model is available at
http://www.ahrq.gov/prep/hospsurgemodel/description/descriptionsum.htm.
The Surge Model incorporates the AHRQ Bioterrorism and Epidemic Outbreak Response Model (BERM) Model, which
estimates the number of staff needed to operate a mass prophylaxis center.85 Researchers from
Weill Medical College of Cornell University developed the BERM. Based on the
number of people to be prophylaxed, the length of the campaign, characteristics
of the prophylaxis clinic patient flow, speed of patient processing, and the
bioterrorism release scenario, BERM calculates the number of staff required to
prophylax the population in a given timeframe and the type of staff required to
complete the campaign in the given timeframe. The BERM model is available at http://www.ahrq.gov/research/biomodel.htm
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Mass Evacuation Transportation
Model
As noted at the beginning of this report, one of the two
objectives of Abt Associates' contract with AHRQ was to build a Web-based Mass
Evacuation Transportation Planning Model for use before a mass casualty/evacuation incident to estimate the transportation resources needed to evacuate
patients and evacuees from health care facilities and other locations.
The transportation model calculates the time necessary for
evacuation of patients from designated evacuating locations to receiving
facilities. It allows a user to designate patient types, prioritize patients,
and consider evacuation of any number of facilities with the available
vehicles. Furthermore, the model will show bottlenecks and overtaxed resources
so that planners can prioritize resources. The model inputs include:
- Evacuation Resources: The fleet of vehicles
available in an emergency is a key input of the model. The user must
identify how many ALS and BLS ambulances, wheelchair vans, and buses are
available for use in an emergency, and how many patients each vehicle may
carry. It is assumed that patients are ready for pickup by the emergency
vehicles and only require a minimum loading time before transport.
- Facilities: Users can input any number of
facilities into the model. Facilities can be divided into types such as
nursing homes and hospitals, if patients from one type of facility should
not be transported to another type of facility. With information on the
location of the facility, its capacity, its surge capacity percentage
(percent over 100% capacity that a hospital could accept patients in an
emergency), and its patient mix, the model will calculate the best
distribution of patients to facilities in order to minimize travel time.
- Patient mix: Each facility (or facility type) may
have a different patient mix. Specifically, the model needs to know what
proportion of patients will need to be evacuated with ALS, BLS, wheelchair
vans, or buses. Patients are thus grouped by acuity rather than the
specific diagnosis, and can be prioritized to ensure that the most
severely ill patients travel the least amount of distance.
- Additional inputs: Several additional features
include: accounting for traffic by adding time to the expected travel
times, changing the loading or unloading time for each vehicle,
designating overflow capacity outside the city for patients which cannot
be accommodated.
The primary output of the
model is the number of hours necessary to transport patients from evacuating
facilities to receiving facilities. In addition to the total hours for
evacuation, the model shows the number of hours and the number of trips made by
vehicle type, showing which are most in demand. This will help planners
anticipate resource needs.
The Mass Evacuation Transportation
Model is available at http://www.ahrq.gov/prep/massevac/.
85. http://www.ahrq.gov/research/biomodel.htm
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AHRQ Publication No. AHRQ-09-0039-EF
Current as of February 2009
Internet Citation:
Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System. AHRQ Publication No. AHRQ-09-0039-EF, February 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/prep/natlsystem/
540 Gaither Road Rockville, MD 20850