Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T02:24:59.506Z Has data issue: false hasContentIssue false
  • English
  • Français

Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident

Published online by Cambridge University Press:  08 April 2013

Robert K. Kanter
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To determine the ability of five New York statewide regions to accommodate 30 children needing critical care after a hypothetical mass casualty incident (MCI) and the duration to complete an evacuation to facilities in other regions if the surge exceeded local capacity.

Methods: A quantitative model evaluated pediatric intensive care unit (PICU) vacancies for MCI patients, based on data on existing resources, historical average occupancy, and evidence on early discharges and transfers in a public health emergency. Evacuation of patients exceeding local capacity to the nearest PICU center with vacancies was modeled in discrete event chronological simulations for three scenarios in each region: pediatric critical care transport teams were considered to originate from other PICU hospitals statewide, using (1) ground ambulances or (2) helicopters, and (3) noncritical care teams were considered to originate from the local MCI region using ground ambulances. Chronology of key events was modeled.

Results: Across five regions, the number of children needing evacuation would vary from 0 to 23. The New York City (NYC) metropolitan area could accommodate all patients. The region closest to NYC could evacuate all excess patients to PICU hospitals in NYC within 12 hours using statewide critical care teams traveling by ground ambulance. Helicopters and local noncritical care teams would not shorten the evacuation. For other statewide regions, evacuation of excess patients by statewide critical care teams traveling by ground ambulance would require up to nearly 26 hours. Helicopter transport would reduce evacuation time by 40%-44%, while local noncritical care teams traveling by ground would reduce evacuation time by 16%-34%.

Conclusions: The present study provides a quantitative, evidence-based approach to estimate regional pediatric critical care evacuation needs after an MCI. Large metropolitan areas with many PICU beds would be better able to accommodate patients in a local MCI, and would serve as a crucial resource if an MCI occurred in a smaller community. Regions near a metropolitan area could be rapidly served by critical care transport teams traveling by ground ambulance. Regions distant from a metropolitan area might benefit from helicopter transport. Using local noncritical care transport teams would involve shorter delays and less expert care during evacuation.

(Disaster Med Public Health Preparedness. 2012;6:146–149)

Keywords

pediatric intensive careinterhospital transportregional resourcesdiscrete event simulationquantitative modelchildren's healthevacuationmass casualty incidentsNew Yorksurge capacityintensive care units, pediatrichospitals
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 6 , Issue 2 , June 2012 , pp. 146 - 149
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Kanter, RK, Moran, JR.Hospital emergency surge capacity: an empiric New York statewide study. Ann Emerg Med. 2007;50 (3):314–319.Google Scholar
2.Mahoney, EJ, Harrington, DT, Biffl, WL, Metzger, J, Oka, T, Cioffi, WG.Lessons learned from a nightclub fire: institutional disaster preparedness. J Trauma. 2005;58 (3):487–491.Google Scholar
3.Agency for Healthcare Research and Quality. Hospital Surge Model.2010. http://archive.ahrq.gov/prep/hospsurgemodel/. Accessed May 16, 2012.Google Scholar
4.Devereaux, A, Christian, MD, Dichter, JR, et alTask Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL. Chest. 2008;133:1S–66S.CrossRefGoogle ScholarPubMed
5.Kanter, RK, Cooper, A.Mass critical care: pediatric considerations in extending and rationing care in public health emergencies. Disaster Med Public Health Prep. 2009;3(suppl 2)S166–S171.Google Scholar
6.New York State Office of Emergency Management. New York State Emergency Management Office Regions.2006. http://www.semo.state.ny.us/about/regionalMap.cfm. Accessed August 10, 2010.Google Scholar
7.New York State Department of Health. New York State Hospital Profile. http://hospitals.nyhealth.gov/. Accessed July 10, 2010.Google Scholar
8.American Medical Association. Graduate Medical Education, 2010. http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml. Accessed August 10, 2010.Google Scholar
9.Randolph, AG, Gonzales, CA, Cortellini, L, Yeh, TS.Growth of pediatric intensive care units in the United States from 1995 to 2001. J Pediatr. 2004;144 (6):792–798.Google Scholar
10.Agency for Healthcare Research and Quality. Mass Evacuation Transportation Model. Rockville, Maryland: Agency for Healthcare Research and Quality; 2008. http://archive.ahrq.gov/prep/massevac/. Accessed May 16, 2012.Google Scholar
11.Google. Google Maps. http://maps.google.com/maps. Accessed December 28, 2010.Google Scholar
12.Distefano, SM, Graf, JM, Lowry, AW, Sitler, GC.Getting kids from the Big Easy hospitals to our place (not easy): preparing, improvising, and caring for children during mass transport after a disaster. Pediatrics. 2006;117 (5, pt 3):S421–S427.Google Scholar
13.Travelmath. Flight distance calculator. http://www.travelmath.com/flight-distance/. Accessed December 28, 2010.Google Scholar
14.US Census Bureau. County population estimates. July 1, 2009. http://www.census.gov/popest/data/datasets.html. Accessed May 16, 2012.Google Scholar
15.Kanter, RK.The 2011 Tuscaloosa tornado: integration of pediatric disaster services into regional systems of care. J Pediatr.2012. Epub ahead of print.Google Scholar