Hospital Surge Capacity: A Web-Based Simulation Tool for Emergency Planners.

The National Center for the Study of Preparedness and Catastrophic Event Response (PACER) has created a publicly available simulation tool called Surge (accessible at http://www.pacerapps.org) to estimate surge capacity for user-defined hospitals. Based on user input, a Monte Carlo simulation algorithm forecasts available hospital bed capacity over a 7-day period and iteratively assesses the ability to accommodate disaster patients. Currently, the tool can simulate bed capacity for acute mass casualty events (such as explosions) only and does not specifically simulate staff and supply inventory. Strategies to expand hospital capacity, such as (1) opening unlicensed beds, (2) canceling elective admissions, and (3) implementing reverse triage, can be interactively evaluated. In the present application of the tool, various response strategies were systematically investigated for 3 nationally representative hospital settings (large urban, midsize community, small rural). The simulation experiments estimated baseline surge capacity between 7% (large hospitals) and 22% (small hospitals) of staffed beds. Combining all response strategies simulated surge capacity between 30% and 40% of staffed beds. Response strategies were more impactful in the large urban hospital simulation owing to higher baseline occupancy and greater proportion of elective admissions. The publicly available Surge tool enables proactive assessment of hospital surge capacity to support improved decision-making for disaster response. (Disaster Med Public Health Preparedness. 2018;12:513-522).

Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.

BACKGROUND AND OBJECTIVE: Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population. METHODS: Structured literature review of PubMed and clinicaltrials.gov was conducted to identify relevant studies. Inclusion criteria were studies evaluating ED returns by identifying risk factors and interventions in the pediatric population. Emergency department return was defined as returning to the ED within 1 year after initial visit. Abstract and full text articles were reviewed, and data were abstracted by 2 independent authors. RESULTS: A total of 963 articles were screened and yielded 42 potential relevant articles involving pediatric population. After full text review, a total of 12 articles were included in the final analysis (6 on risk factors and 6 on interventions). Risk factors for pediatric ED return included behavioral/psychiatric problems, younger age, acuity of illness, medical history of asthma, and social factors. Interventions included computer-generated instructions, postdischarge telephone coaching, ED-made appointments, case management, and home environment intervention. Emergency department-made appointments and postdischarge telephone coaching plus monetary incentive improved outpatient follow-up rate but not ED return. Home environment assessment coupled with case management reduced ED returns specifically among asthma patients. CONCLUSIONS: Several patient and visit characteristics can help predict children at risk for ED return. Although some interventions are successful at improving postdischarge follow-up, most did not reduce ED returns.

Fellowships in international emergency medicine in the USA: a comparative survey of program directors' and fellows' perspectives on the curriculum.

OBJECTIVE: Experts have proposed core curriculum components for international emergency medicine (IEM) fellowships. This study examined perceptions of program directors (PDs) and fellows on whether IEM fellowships cover these components, whether their perspectives differ and the barriers preventing fellowships from covering them. METHODS: From 1 November 2011 to 30 November 2011, a survey was administered to PDs, current fellows and recent graduates of the 34 US IEM fellowships. Respondents quantified their fellowship experience in six proposed core curriculum areas: emergency medicine (EM) systems development, EM education, humanitarian assistance, public health, emergency medical services and disaster medicine. Analysis was performed regarding what per cent of programmes fulfil the six curriculum areas. A paired t test determined the difference between PDs' and fellows' responses. Agreement between PDs and fellows within the same programme was determined using a κ statistic. RESULTS: Only 1/18 (6%) (according to fellows) to 2/24 (8%) (according to PDs) of programmes expose fellows to all six components. PDs consistently reported higher exposure than fellows. The difference in mean score between PDs and fellows was statistically significant (p<0.05) in three of the 6 (50%) core curriculum elements: humanitarian aid, public health and disaster medicine. Per cent agreement between PDs and fellows within each programmes ranged from poor to fair. CONCLUSIONS: While IEM fellowships have varying structure, this study highlights the importance of further discussion between PDs and fellows regarding delineation and objectives of core curriculum components. Transparent curricula and open communication between PDs and fellows may reduce differences in reported experiences.

Prehospital emergency medical services in Lebanon: overview and prospects.

Prehospital emergency medical services in Lebanon are based on volunteer systems with multiple agencies. In this article, a brief history of the development of prehospital care in Lebanon is presented with a description of existing services. Also explored are the different aspects of prehospital care in Lebanon, including funding, public access and dispatch, equipment and supplies, provider training and certification, medical direction, and associated hospital-based emergency care.

Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS).

BACKGROUND: Complex Humanitarian Emergencies (CHE) result in rapid degradation of population health and quickly overwhelm indigenous health resources. Numerous governmental, non-governmental, national and international organizations and agencies are involved in the assessment of post-CHE affected populations. To date, there is no entirely quantitative assessment tool conceptualized to measure the public health impact of CHE. METHODS: Essential public health parameters in CHE were identified based on the Sphere Project "Minimum Standards", and scoring rubrics were proposed based on the prevailing evidence when applicable. RESULTS: 12 quantitative parameters were identified, representing the four categories of "Minimum Standards for Disaster Response" according to the Sphere Project; health, shelter, food and nutrition, in addition to water and sanitation. The cumulative tool constitutes a quantitative scale, referred to as the Public Health Impact Severity Scale (PHISS), and the score on this scale ranges from a minimum of 0 to a maximum of 100. CONCLUSION: Quantitative measurement of the public health impact of CHE is germane to accurate assessment, in order to identify the scale and scope of the critical response required for the relief efforts of the affected populations. PHISS is a new conceptual metric tool, proposed to add an objective quantitative dimension to the post-CHE assessment arsenal. PHISS has not yet been validated, and studies are needed with prospective data collection to test its validity, feasibility and reliability. CITATION: Bayram JD, Kysia R, Kirsch TD. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS). PLOS Currents Disasters. 2012 Aug 21. doi: 10.1371/4f7b4bab0d1a3.

Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple casualty events.

OBJECTIVES: Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion. METHODS: A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes. RESULTS: Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity. CONCLUSIONS: Defining and quantitatively benchmarking the different components of hospital surge capacity is vital to hospital preparedness in MCE. Prospective studies of our mathematical model are needed to verify its applicability, generalizability, and validity.

Emergency medicine in Lebanon: overview and prospect.

Emergency Medicine, established in the United States as a specialty in 1979 and in Canada in 1980, is drawing interest among countries throughout Europe, Asia, and the Middle East. Lebanon, located on the eastern coast of the Mediterranean Sea, like many other developing countries, struggles to advance its medical system. One of the main hurdles is the continuing violence and political turmoil. Attempts at health care system recovery have been met with a number of deep-seated structural problems. Data and references regarding emergency health care are rare. This article presents an overview of the current status of Emergency Medicine in Lebanon as well as ongoing related activities over the past decade and the plans for future development.