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Strategies to Improve Pediatric Disaster Surge Response: Potential Mortality Reduction and Tradeoffs
Title: Strategies to Improve Pediatric Disaster Surge Response: Potential Mortality Reduction and Tradeoffs
Date: December 2007
Author: R.K. Kanter
Institution: N/A
Bibliographic Entry: Kanter, R.K. “Strategies to Improve Pediatric Disaster Surge Response: Potential Mortality Reduction and Tradeoffs.” Critical Care Medicine 35, no. 12 (2007): 2837-2842.
Electronic Link: http://www.ncbi.nlm.nih.gov/pubmed/17901842
Article is copyrighted; access article via a library portal or journal subscription.
Key Words: disaster surge response, disaster mortality reduction
Summary of Key Points, Issues, Conclusions:
This purpose of this study design was to estimate potential disaster mortality reduction using two surge response strategies. These strategies were: 1.) controlling for the distribution of disaster victims to avoid overcrowding at or near the scene, and 2.) expanding capacity by altering standards of care to only interventions deemed “essential.”
The design used was a quantitative model of hospital mortality. The study setting was New York City’s pediatric intensive care unit and non-intensive care unit pediatric hospital capacity and population. Mortality was calculated for a hypothetical sudden disaster of unspecified mechanisms assuming 500 children per million would need hospitalization. This amount included 30% of severely ill/injured in need of pediatric intensive care. The pre-disaster hospital occupancy was a high of 76%, and triage rules allowed for the accommodation of patients at lower levels of care if capacity was met.
Higher risks of relative mortality were assumed with reduced levels of care. In a non-optimistic baseline scenario, hospitals near the disaster scene were considered to have met 20% of regional capacity and reached a level of overcrowding with 80% surge patients. Overcapacity within hospitals near the scene accounted for most of the 45 deaths, while unused capacity remained at remote facilities. If regional surge distribution were to be controlled to avoid overcrowding near the scene, then mortality would have been reduced by 11%. Limited pediatric intensive care unit capacity would require triage to a non-intensive care unit for many severe patients.
If standards of care were to be altered, quadrupling pediatric intensive care unit and non-intensive care unit capacity, then mortality would fall to 24% below baseline. The two study strategies, when combined, would improve mortality 47% below baseline. If standards of care were altered prematurely, a number of deaths would be preventable.
Additional simulations, varying surge size, patient severity, and pre-disaster occupancy numbers found that mortality tradeoffs generally favored altering care to improve population outcomes within the federal planning targeted range of 500 new patients per million population. The conclusion of the study was that quantitative simulations demonstrate response strategies controlling patient distribution and expansion of capacity through altering standards of care may lower mortality rates in sizable disasters.
Name of Researcher: Alison Stevens
Institution: Integrative Center for Homeland Security, Texas A&M University
Date Posted: April 30, 2008