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Regional variation in critical care evacuation needs for children after a mass casualty incident.
Disaster Med Public Health Prep. 2012 Jun; 6(2):146-9.DM

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.

Authors+Show Affiliations

Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York 13210, USA. kanterr@upstate.edu

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22700023

Citation

Kanter, Robert K.. "Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident." Disaster Medicine and Public Health Preparedness, vol. 6, no. 2, 2012, pp. 146-9.
Kanter RK. Regional variation in critical care evacuation needs for children after a mass casualty incident. Disaster Med Public Health Prep. 2012;6(2):146-9.
Kanter, R. K. (2012). Regional variation in critical care evacuation needs for children after a mass casualty incident. Disaster Medicine and Public Health Preparedness, 6(2), 146-9. https://doi.org/10.1001/dmp.2012.30
Kanter RK. Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident. Disaster Med Public Health Prep. 2012;6(2):146-9. PubMed PMID: 22700023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional variation in critical care evacuation needs for children after a mass casualty incident. A1 - Kanter,Robert K, PY - 2012/6/16/entrez PY - 2012/6/16/pubmed PY - 2012/10/24/medline SP - 146 EP - 9 JF - Disaster medicine and public health preparedness JO - Disaster Med Public Health Prep VL - 6 IS - 2 N2 - 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. SN - 1938-744X UR - https://www.unboundmedicine.com/medline/citation/22700023/Regional_variation_in_critical_care_evacuation_needs_for_children_after_a_mass_casualty_incident_ L2 - https://www.cambridge.org/core/product/identifier/6/2/146/type/journal_article DB - PRIME DP - Unbound Medicine ER -