Citation

Miller G, Randolph S, Gower D. Int. J. Disaster Med. 2004; 2(1-2): 24-32.

Affiliation

Altarum Institute; US Army Medical Department Board

Copyright

(Copyright © 2004, Informa - Taylor and Francis Group)

DOI

10.1080/15031430410024363

PMID

unavailable

Abstract

Objectives: This paper demonstrates the applicability of discrete event simulation to planning the response of a rural acute health-care delivery system to a bioterrorist attack. Simulation results are used to develop observations and recommendations for planning for bioterrorism events in rural settings.

Methods: The analysis employed two discrete event simulation models, one representing the spread of disease following an attack with a contagious agent (pneumonic plague) and the other representing the care that victims would receive from the acute health-care delivery system and the resultant stress the attack would put on the health-care infrastructure.

Results: In the scenario simulated in this study, early detection of the attack and subsequent aggressive response by the public health system were projected to reduce the total number of victims in this rural setting from 82 to 27 and to reduce deaths from 43 to 7 when compared with a less timely and less effective response.  Early detection also created more favorable lead-times for acquiring necessary equipment that would be in short supply. For example, in all cases simulated, additional ventilators were needed 5 days after the attack. This allowed 2 days for acquiring ventilators with the most optimistic time to detect, but no time under a less optimistic assumption. IN all cases, the need for INtensive CAre Unit beds greatly exceeded the available supply. However, this shortfall could be alleviated if some regular medical / surgical (M/S) beds could be temporarily staffed and equipped for near-ICU use, as the demand for M/S beds peaked later in the crisis than for ICU beds.

Conclusion: Rural health-care delivery systems can minimize mortality and cope with the surge in demand associated with a bioterrorist attack through high public health preparedness, plans for efficient access to needed resources, and creative use of scarce resources. The study illustrates the value of mathematical modelling as an aid in planning for such an attack.