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Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents

Published online by Cambridge University Press:  12 May 2021

Paolo Trucco
School of Management, Politecnico di Milano, Milano, Lombardia, Italy
Claudio Nocetti
School of Management, Politecnico di Milano, Milano, Lombardia, Italy
Riccardo Sannicandro
Emergency Department, Ospedale San Raffaele, Milano, Lombardia, Italy
Michele Carlucci
Pronto Soccorso e Chirurgia Generale e delle Urgenze, Ospedale San Raffaele, Milano, Lombardia, Italy
Eric S. Weinstein
CRIMEDIM, Research Center in Emergency and Disaster Medicine, Novara, Novara, Italy
Roberto Faccincani*
Emergency Department, Ospedale San Raffaele, Milano, Lombardia, Italy
Corresponding author: Roberto Faccincani, Email:



Hospitals are expected to operate at a high-performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet, and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. More resilient resource allocation strategies, ie, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a mass casualty incident (MCI).


A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.


In the daytime scenario, during the recovery phase of the emergency, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards, returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.


The present study offers a robust approach, effective strategies, and new insights to design more resilient plans to cope with MCIs. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities, such as operational coordination mechanisms, among multiple hospitals in the same geographic area.

Original Research
© Society for Disaster Medicine and Public Health, Inc. 2021

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