Post-earthquake Patient diversion strategies for improving regional emergency healthcare accessibility

Abstract

A surge in medical demand after a large-scale earthquake impedes emergency healthcare accessibility. To reduce an unfavourable long wait for medical services, one solution is to redistribute regional medical demand so that the impact can be absorbed by multiple hospitals together. In this paper, discrete event simulations are conducted to experiment with three different patient diversion strategies with the routine method serving as a benchmark. Different aspects of a hospital, either queues at certain medical stages or the overall hospital performance, are monitored for different strategies. To make simulations approximate to real post-earthquake situations, emergency response measures independently carried out by each hospital to increase capacities, including personnel mobilization and vacant beds release, are also considered. Five districts in Taipei City are chosen as the research area for a case study, in which eight first-aid hospitals are located. Based on an earthquake scenario of Richter magnitude 6.6 that would cause this area an estimate of 2361 casualties, results show that the strategy attending to the overall hospital performance is effective in containing waiting time for every medical service. Its effectiveness remains in the sensitivity analysis where beds are decreased. On the contrary, monitoring states of particular medical stages in each hospital to divert patients risks bottlenecks at hospitalization and is sensitive to changes in resource numbers. Findings of this study provide implications for practices of patient diversion after an earthquake, especially on the role of small hospitals and the way to gauge the suitability of hospitals to receive diverted patients.