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Does Number of Beds Reflect the Surgical Capability of Hospitals in Wartime and Disaster? The Use of a Simulation Technique at a National Level

Published online by Cambridge University Press:  28 June 2012

Lion Levi ,
David Bregman ,
Hana Geva  and
Moshe Revah
Lion Levi*
Affiliation:
The Trauma Research Unit, Rambam Medical Center, Haifa, Israel
David Bregman
Affiliation:
The School of Business Administration, The College of Management, Tel-Aviv, Israel
Hana Geva
Affiliation:
The Trauma Research Unit, Rambam Medical Center, Haifa, Israel
Moshe Revah
Affiliation:
The Trauma Research Unit, Rambam Medical Center, Haifa, Israel
*
The Trauma Research Center, Rambam Medical Center, PO Box 7091, Haifa, Israel 31070, E-mail: llevi@rambam.health.gov.il
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Abstract

Introduction:

The raw number of hospital trauma beds and occupancy has been used assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.

Methods:

Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of “standard wartime casualties.” Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A “what-if” module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of “standard casualties.” Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.

Results:

Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.

Recommendations:

The use of simulation techniques might be useful method to asses the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.

Keywords

computerized simulation techniquedisaster hospital planningsurgical capabilitywartime casualties
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 12 , Issue 4 , December 1997 , pp. 67 - 71
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1997

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