Use of computerized simulation models can help communities plan an effective response in the event of a bioterrorist attack, according to George Miller, Ph.D., of the Altarum Institute in Ann Arbor, MI. A recent study conducted by Dr. Miller and his colleagues demonstrated the applicability of discrete event simulation to planning the response of a rural health care delivery system to a bioterrorist attack. The researchers used two discrete event simulation models, one representing the spread of disease following an attack with a contagious agent (pneumonic plague) and the other representing the care that victims would receive from the health care delivery system and the resultant stress the attack would put on the system.
In the simulated scenario, early detection of the attack and subsequent aggressive response by the public health system were projected to reduce the total number of victims in this rural setting from 82 to 27 and reduce the number of deaths from 43 to 7 when compared with a less timely and less effective response. Early detection also created more favorable lead times for acquiring necessary equipment that would be in short supply. For example, in all cases simulated, additional ventilators were needed 5 days after the attack. Early detection allowed 2 days for acquiring ventilators, but there was no acquisition time with later detection.
In all cases, the immediate need for intensive care unit (ICU) beds greatly exceeded the available supply. However, this shortfall could be alleviated if some medical/surgical (M/S) beds could be temporarily staffed and equipped for near-ICU use, as the demand for M/S beds peaked later in the crisis, suggest the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS13683).
More details are in "Simulating the response of a rural acute health-care delivery system to a bioterrorist attack," by Dr. Miller, Stephen Randolph, M.B.A., and Dan Gower, Ph.D., in the International Journal of Disaster Medicine 2, pp. 24-32, 2004.
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