Simulation model of delivering health care to the wounded in a special purpose medical unit at elimination of medical and sanitary consequences of emergency situations

Abstract

Relevance. The scientific research conducted in the field of medical support at elimination of medical and sanitary consequences of the emergency situations (ES) is inseparably linked with process of modeling of complex systems. Modeling is a study of objects, processes and the phenomena for definition (specification) of the studied characteristics of the surveyed system or specification (improvement) of the offered new elements of this system. Simulation modeling is one option to study medical support system experimentally. Intention. Simulation modeling is necessary for developing respective models of special purpose medical group functioning, describing the main components of health care delivery to the wounded at ES taking into account their medical and evacuation characteristics. Methodology. For experiments, discrete and event simulation models were used which represented the system under study, its states changing with specific events in discrete time points. During research, the behavior of separate elements of the modelled system (a special purpose medical group) is described via Python programming algorithms and using the SimPy library. The following data were used as model parameters: victim in-flow structure with time-frames of various medical procedures and manipulations / surgeries as well as time-frames of non-transportability of victims with various lesions. For model simplification, in-flows of victims with penetrating and non-penetrating wounds of various severity were simulated. For modeling, averaged in-flow structures by severity grade in various ESs were used: 29.1 % – mild, 27.2 % – moderate, 42.1 % – severe and 1.6 % – extremely severe. Time-frames of medical manipulations and procedures, time-frames of nontransportability were described as random variables with triangular distribution (Simpson); its parameters were estimated by military-medical experts (surgeons, therapists). A simple Poisson process with various parameters was used for modeling the victim in-flow. During modeling, group work was assessed with victim in-flow of 40, 60, 80, 100 persons a day. Results and Discussion. Results of modeling indicated some potential bottlenecks of a special purpose medical group, i.e. surgical unit and intensive care unit. It was shown, for example, increased number of surgical teams can enlarge considerably the capacity of a special purpose surgical unit and medical group in general, but at the same time will demand augmentation of capacity of the intensive care unit due to increased flow of the postoperative wounded. Possible effects of such advanced technologies as Celox GauzeR bandage and maintaining wounds with low pressure bandages were studied (vacuum assistant closure – VAC, negative pressure wound therapy – NPWT). Preliminary conclusions were made on appreciable effectiveness of the specified technologies in work of a special purpose medical group. Conclusion. Simulation modeling is one of the most popular types of mathematical modeling and is used for research of complex systems. Therefore, it can be successfully used when modeling work of a special purpose medical group at elimination of medical and sanitary consequences of ESs. The developed simulation model helps analyze the changing workload of the group with various in-flows of wounded as a result of natural, technogenic and social ESs.