1. Addressing Surge Capacity in a Mass Casualty Event Nathaniel Hupert, M.D., M.P.H. Assistant Professor of Public Health and Medicine Weill Medical College Cornell University New York City

2. Why Model Surge? We already know the U.S. health care system has very little surge capacity. What is the benefit of creating computer models of it? Two possible answers: 1. Reassess common assumptions about the determinants of capacity 2. Quantitative casualty estimates for varied planning efforts (e.g, ranging from different service lines in a single hospital to emergency planning functions in a region)

3. Determinants of Surge Capacity Surge arrivals Hospital or network capacity Medical supplies Out-of- region facility SNFHome Staff Event Beds Pre-hospital management Surge Discharge* Treated Died *Note: I am indebted to Sam Benson, EMT-P, New York City Office of Emergency Management for the notion of “surge discharge”

4. Delay in Reaction None (Hours) Long (Days) Shorter (1-2 Days)Longer 4+ Days Time needed to protect community Protection Less More Modeling Pre-hospital Capacity SAFE

5. Modeled Outcomes of Pre-hospital Anthrax Prophylaxis Percentage of exposed individuals don’t get sick because they receive antibiotics in time Increasing Hospital Surge

6. If 100,000 people were exposed to anthrax and your prophylaxis campaign… Could cover all in 2 days after a 1 day delay  ~1,000 sick

7. Could cover all in 2 days after a 2 day delay  ~4,000 sick If 100,000 people were exposed to anthrax and your prophylaxis campaign…

8. Modeling Improves Community-wide Surge Capacity Planning by Linking Pre-hospital and Hospital-based Care Planning One exposure scenario… …can lead to different total and daily casualty loads depending on pre-hospital preparedness and response…...with different implications for hospital surge arrivals… …yielding different patient outcomes.  

9. “Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness” www.ahcpr.gov/research/cbmprophyl/cbmpro.htm