How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis

Asher Hirshberg, Bradford G. Scott, Thomas Granchi, Matthew J. Wall, Kenneth L. Mattox, Michael Stein, Anne G. Rizzo, Martin Schreiber, Michel Aboutanos, John B. Holcomb, Arthur Cooper, Donald Trunkey

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Background: The aim of this modeling study was to examine how casualty load affects the level of trauma care in multiple casualty incidents and to define the surge capacity of the hospital trauma assets. Methods: The disaster plan of a U.S. Level I trauma center was translated into a computer model and challenged with simulated casualties based on 223 patients from 22 bombing incidents treated at an Israeli hospital. The model assigns providers and facilities to casualties and computes the level of care for each critical casualty from six variables that reflect the composition of the trauma team and access to facilities. Results: The model predicts a sigmoid-shaped relationship between casualty load and the level of care, with the upper flat portion of the curve corresponding to the surge capacity of the trauma assets of the hospital. This capacity is 4.6 critical patients per hour using immediately available assets. A fully deployed disaster plan shifts the curve to the right, increasing the surge capacity to 7.1. Overtriage rates of 50% and 75% shift the curve to the left, decreasing the surge capacity to 3.8 and 2.7, respectively. Conclusion: This model defines the quantitative relationship between an increasing casualty load and gradual degradation of the level of trauma care in multiple casualty incidents, and defines the surge capacity of the hospital trauma assets as a rate of casualty arrival rather than a number of beds. The study demonstrates the value of dynamic computer modeling as an important tool in disaster planning.

Original languageEnglish (US)
Pages (from-to)686-695
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number4
DOIs
StatePublished - Apr 2005
Externally publishedYes

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Surge Capacity
Wounds and Injuries
Disasters
Disaster Planning
Architectural Accessibility
Trauma Centers
Sigmoid Colon
Critical Care
Computer Simulation

Keywords

  • Mass casualty
  • Terrorism
  • Urban bombing

ASJC Scopus subject areas

  • Surgery

Cite this

How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. / Hirshberg, Asher; Scott, Bradford G.; Granchi, Thomas; Wall, Matthew J.; Mattox, Kenneth L.; Stein, Michael; Rizzo, Anne G.; Schreiber, Martin; Aboutanos, Michel; Holcomb, John B.; Cooper, Arthur; Trunkey, Donald.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 58, No. 4, 04.2005, p. 686-695.

Research output: Contribution to journalArticle

Hirshberg, A, Scott, BG, Granchi, T, Wall, MJ, Mattox, KL, Stein, M, Rizzo, AG, Schreiber, M, Aboutanos, M, Holcomb, JB, Cooper, A & Trunkey, D 2005, 'How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis', Journal of Trauma - Injury, Infection and Critical Care, vol. 58, no. 4, pp. 686-695. https://doi.org/10.1097/01.TA.0000159243.70507.86
Hirshberg, Asher ; Scott, Bradford G. ; Granchi, Thomas ; Wall, Matthew J. ; Mattox, Kenneth L. ; Stein, Michael ; Rizzo, Anne G. ; Schreiber, Martin ; Aboutanos, Michel ; Holcomb, John B. ; Cooper, Arthur ; Trunkey, Donald. / How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 58, No. 4. pp. 686-695.
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