1. Modeling the Consequences of Major Incidents for Health Care Systems
Gary B. Hirsch
22nd International Conference of the System Dynamics Society
Oxford
July 27, 2004

2. Background and Purpose
Part of larger effort involving 3 national labs in the US
Model health care at metropolitan, regional, and national levels and in the context of 13 other infrastructures
Help officials and their communities
understand impact of different types of incidents on the health care system and its capacity to care for patients
assess different strategies for dealing with incidents and scale needed to respond effectively
determine capacity of backup resources and stockpiles for supporting local health care systems
develop shared understanding among different levels of government, various services, and areas that depend on each other for mutual aid

3. Threats to Health Care Systems
Direct Attack
Infrastructure Failure
Overwhelming Demand
Combined Threats
Different profiles with regard to impact over time, extent of health care demand, reduction in health system capacity

4. Emphases Suggested by the Literature
“All hazards” approach--planning for a wide range of contingencies
Continuation of “normal” health services while responding to major incidents
Plan for entire health system, not just hospitals
Capacity to deal with entire (exposed) population, not just the severely injured
Modeling that had been done was mostly special purpose--e.g., bio-terror attacks

5. System Overview

6. Population Flows as a Result of an Incident

7. Health Care System Detail: Hospital Inpatients

8. Events That Can Be Simulated
Infrastructure Failures
Limited Duration Events
Natural Disasters
Explosions, Fires
Spread of a Pathogen, with or without contagion
Combined Events

9. Infrastructure Failure
Emergency Patients Awaiting Admission to the Hospital
Emergency Patients Awaiting Admission
Chronic Patients Requiring Admission

10. Infrastructure Failure (Cont’d)
Fully Functional Population
Cumulative Deaths

11. Infrastructure Failure (Cont’d)
Emergency Patients Awaiting Admission
(with 200 bed self-contained field hospital
in blue)

12. Limited Duration 2000 Casualty Event--Sensitivity Test with More Severe Casualties
Emergency Patients Awaiting Admission
Inpatient Length of Stay (Hours)

13. Contagious Disease--with and without Large Scale Prophylaxis
Cumulative Deaths
Fully Functional Population

14. Contagious Disease--with and without Large Scale Prophylaxis (cont’d)
Emergency Patients
Awaiting Admission
Staffed Beds Available

15. Further Development Improve Data, Based on Case Studies If Possible
Expand to Assure Model Covers a Wide Range of Scenarios
Link to Other Infrastructure Models
Apply to Real-World Communities
Create Management Simulator and Use as Basis for Workshops Bringing Together Multiple Jurisdictions and Disciplines