Surge Capacity Research Articles

723 Provincial Burn Mass Casualty Incident Planning: Preliminary Results

Abstract Introduction Burn mass casualty incident (BMCI) response planning includes involving relevant stakeholders, assessing regional burn care capacity, and addressing the specialized needs of burn patients. An essential component of these processes is an evaluation of existing resources and plans. In this study, a province with three important elements—a singular health authority to plan for, two burn centres, and updated health technology—was selected for evaluation. Aim What are the current policies, protocols, and practices that address a provincial response to a BMCI? Methods In this ethics approved case study, qualitative description methodology was used for data analysis. Data were gathered from documents outlining the health system response to a mass casualty incident from the health system internal emergency response plans. Health care professionals directly involved in the response were recruited for interviews. Participants were recruited from prehospital emergency management services, hospital emergency departments, inpatient burn units, and a provincial patient transport department. Interviews were conducted online, recorded, and transcribed. Qualitative description was used to code common themes across documents and transcripts. Results Thirteen documents and nine participant interviews were included. Only two documents included burn-specific considerations. Current policies and protocols were limited to all-hazards mass casualty incident planning and did not address specialized needs of burn care. Current plans were based on assumptions that all burn patients would be triaged and transported to burn centres and that surge capacity would be adequate to accommodate for increased demands. Prehospital participants (n=3) felt that existing plans would adequately manage a BMCI. Six participants stated the current plans were not sufficient to manage a BMCI. A comprehensive description of the complex health system response to a potential BMCI was obtained. Some major deficiencies identified included a lack of strategies to bolster burn care staffing capacity such as just-in-time training resources for non-burn trained staff or utilization of outpatient burn clinic staff. Considerations for increased operating room and wound care resources were absent. Conclusions Current provincial all hazards response plans are not sufficient to support adequate response to a BMCI and need to be amended to address the specialized needs of burn patients. Strategies for expanding capacity such as care of burn patients at non burn facilities and utilization of outpatient clinics must be integrated into future plans. Applicability of Research to Practice The provincial health authority needs to support BMCI response planning efforts to better address this unique hazard prior to an incident occurring for best patient outcomes.

Readiness of health facilities to manage individuals infected with COVID-19, Uganda, June 2021

BackgroundThe COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19.MethodsReferral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery points. We used an observational checklist to evaluate capacity in infection prevention, medicines, personal protective equipment (PPE), and CTU surge capacity. We used the “ReadyScore” criteria to classify readiness levels as > 80% (‘ready’), 40–80% (‘work to do’), and < 40% (‘not ready’) and tailored the assessments to the health facility level. Scores for the lower-level health facilities were weighted to approximate representativeness for their health facility type in Uganda.ResultsThe median (interquartile range (IQR)) readiness scores were: 39% (IQR: 30, 51%) for all health facilities, 63% (IQR: 56, 75%) for referral hospitals, and 32% (IQR: 24, 37%) for lower-level facilities. Of 17 referral facilities, two (12%) were ‘ready’ and 15 (88%) were in the “work to do” category. Fourteen (82%) had an inadequate supply of medicines, 12 (71%) lacked adequate supply of oxygen, and 11 (65%) lacked space to expand their CTU. Fifty-five (77%) lower-level health facilities were “not ready,” and 16 (23%) were in the “work to do” category. Seventy (99%) lower-level health facilities lacked medicines, 65 (92%) lacked PPE, and 53 (73%) lacked an emergency plan for COVID-19.ConclusionFew health facilities were ready to manage the second wave of COVID-19 in Uganda during June 2021. Significant gaps existed for essential medicines, PPE, oxygen, and space to expand CTUs. The Uganda Ministry of Health utilized our findings to set up additional COVID-19 wards in hospitals and deliver medicines and PPE to referral hospitals. Adequate readiness for future waves of COVID-19 requires additional support and action in Uganda.

Lessons learned from implementing a surge capacity support program for COVID-19 contact management in Ontario

SettingIn Ontario, local public health units (PHUs) are responsible for leading case investigations, contact tracing, and follow-up. The workforce capacity and operational requirements needed to maintain this public health strategy during the COVID-19 pandemic were unprecedented.InterventionPublic Health Ontario’s Contact Tracing Initiative (CTI) was established to provide a centralized workforce. This program was unique in leveraging existing human resources from federal and provincial government agencies and its targeted focus on initial and follow-up phone calls to high-risk close contacts of COVID-19 cases. By setting criteria for submissions to the program, standardizing scripts, and simplifying the data management process, the CTI was able to support a high volume of calls.OutcomesDuring its 23 months of operation, the CTI was used by 33 of the 34 PHUs and supported over a million calls to high-risk close contacts. This initiative was able to meet its objectives while adapting to the changing dynamics of the pandemic and the implementation of a new COVID-19 provincial information system. Core strengths of the CTI were timeliness, volume, and efficient use of resources. The CTI was found to be useful for school exposures, providing support when public health measures were lifted, and in supporting PHU’s reallocation of resources during the vaccine roll-out.ImplicationsWhen considering future use of this model, it is important to take note of the program strengths and limitations to ensure alignment with future needs for surge capacity support. Lessons learned from this initiative could provide practice-relevant knowledge for surge capacity planning.

The Impact of Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland

Introduction:In a disaster, the number of victims and severity of injuries may overwhelm the treatment capacity of the local hospital. Surge capacity is the hospital’s ability to receive and treat an increased number of patients. This study aimed to explore if a past disaster or mass casualty incident (MCI) affects local hospital surge capacity preparedness.Method:The current hospital preparedness plans (HPPs) of University and central hospitals receiving surgical emergency patients in Finland were collected (n=28). The HPPs were read and analyzed using the World Health Organization (WHO) hospital emergency checklist tool with eight key components and 67 action items. The scores of key components were compared by percentage of the maximum score. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not. The effective level was considered as 70% of total points.Results:The overall median score of all key components was 76% (range 24%). The highest score was in command and control (median 93%, range 29%) and the lowest in post-disaster preparedness (median 50%, range 90%). The median surge capacity score was 65% (range 39%). There has been 12 disasters or MCIs during the past 25 years in Finland, all anthropogenic. There was no statistical difference between the surge capacity score of the hospitals with a history of a disaster or MCI compared to those without (65% for both, p=0.735).Conclusion:In Finland, the overall hospital preparedness level is effective with command and control being the best covered area. Surge capacity preparedness was below the effective level and it was not affected by a past disaster or MCI. Present-day challenges with the lack of resources in the health care system, more attention should be drawn to the surge capacity aspect in hospital preparedness plans.

The Surge Capacity Applied to Migration Crises: "The Need for a Conceptual Framework for Emergency Medical Teams”

Introduction:Migration and forced displacement are reshaping the globe today. More people are being displaced by conflicts and natural disasters than ever before, and climate change is playing a pivotal role as a contributing factor for migration and conflict.While there is a growing literature regarding provision of care for migrants in hosting countries there is no evidence on the use of the surge capacity model to support preparedness, readiness, and response to migration crisis by local health services, or medical teams.Method:A scoping review with a narrative summary relevant to disaster medicine, looking at two major migration routes (Central/Eastern Mediterranean and South/Central America) was performed to determine if the surge capacity model has been applied by medical teams responding to migration crises, and how this has affected the adaptation of health services.Results:Preliminary analysis demonstrates variations on the use of the term “surge capacity”, and the imperative need to better define its application when preparing to or responding to any type of disaster, here specifically migration crisis. Thus far, there is no evidence on the use of the surge capacity model for the conformation of national/international medical teams when responding to this type of crises, and its relation to the adaptation of health services. This is particularly relevant, as the surge capacity model can support building and/or strengthening the capacity and capability of national and international medical teams.Conclusion:There is an imperative need to design a conceptual framework based on the surge capacity model for the conformation of fit-for-purpose medical teams, that ensures preparedness, readiness, and appropriate response to migration crises guaranteeing adaptation of health services depending on context needs, and that defines skills and competencies of the responders. Additionally, this provides a conducive platform for operational research activities to foster evidence coming from the field.

Emergency Nurse Roles, Challenges, and Preparedness in Hospitals in the Context of Armed Conflict

Introduction:Emergency nurses’ views on their roles, challenges, and preparedness in the context of armed conflict are necessary to capture in-depth insights into healthcare needs. They can identify the required education and training for emergency nurses and provide evidence of the situations of care in the context of armed conflicts. Unfortunately, the evidence about these factors in the context of armed conflict is scant.Method:A semi-structured interview with 23 participants was conducted using qualitative content analysis. The study was conducted in Saudi border hospitals that are shared with Yemen. The COREQ guideline for reporting qualitative research was followed.Results:The emergency nurses’ roles in hospitals in the context of armed conflict discussed clinical nurses’ and head nurses’ roles. The main challenges that emergency nurses faced include poor orientation, access blocks, and communication barriers. Various perspectives about the preparation, including education, training, and strategies for preparing emergency nurses, were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profile, triage of mass causality, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.Conclusion:This study provided an estimate of the scope of ED nurses' roles, and how they were prepared across a range of hospitals in the armed conflict areas and therefore a snapshot of their experiences significant to be an informative resource for these settings. This study has provided essential implications for preparedness and planning. Given the large number of preparational courses being undertaken by ED nurses in these settings, the choice of the required education and training must be planned accordingly considering the clinical profile of patients in armed conflict areas, trauma care, triage of mass causality, surge capacity, safety and security, communication, policies, and law.

Thai Hospitals’ Evacuation Preparedness: A Survey Among 42 Hospitals According to the Flexible Surge Capacity Concept.

Introduction:Hospitals are subject to internal and external threats which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures’ flaws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept.Method:The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations’ responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments.Results:The findings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations.Conclusion:Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the flexible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.

Teaching Senior Medical Students Mass Casualty Incident Management by 3D Tabletop Exercise without Lecture: Increase Students' Knowledge and Motivation

Introduction:Mass casualty incident (MCI) management was usually taught by lectures and then tested by exercises. However, the lecture may not be interesting and tabletop exercise (TTx) may not adequately engage participants, especially senior medical students. To solve these two problems, we think that a TTx using 3D models can be a good teaching method of MCI management for medical students.Method:A TTx of MCI in the emergency room (ER) was designed for senior medical students based on five core capabilities of MCI management: incident management system, event recognition and initiation of response, patient triage, surge capacity and capability, and recovery and demobilization. 3D models containing miniatures of the ER, hospital staff, patients, and other personnel were used in the TTx. No lecture was conducted before or during the exercise. Students needed to discuss how to respond to events in the incident and show their responses using the 3D models, and the instructor facilitated the discussion and gave feedback right after the students’ decision.Knowledge of each core capability was tested by four multiple-choice questions. The interest in learning disaster medicine and willingness to participate in MCI management were evaluated by questionnaire, along with quantitative feedback to the exercise. The same test and questionnaire were conducted before and after the TTx.Results:From September 2018 to May 2022, 326 students completed both pre- and post-exercise evaluations. The test scores of all five core capabilities, levels of interest, and willingness increased significantly after the exercise. Students thought the exercise was interesting and a good learning tool. Most students wanted to be notified of further training.Conclusion:A tabletop exercise using 3D models is an effective way to teach senior medical students MCI management and disaster medicine while increasing their interest in learning and willingness to participate.

Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience

Introduction:Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).Method:This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.Results:The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.Conclusion:This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.

Applying a “Whole-of-Health-System” Approach in Mass Casualty Management

Introduction:In 2019, the World Health Organization published the Health Emergency and Disaster Risk Management (H-EDRM) framework, detailing how all actors in the health system can contribute to reducing negative health outcomes of emergencies and disasters, including mass casualty incidents (MCI). The H-EDRM framework’s whole-of-health-system approach stresses the need for each level of healthcare systems to be involved in all phases of the disaster cycle, particularly preparedness and response. This approach highlights the critical role that lower levels of care, including primary healthcare, can play during MCI, demonstrating the need to integrate these into countries’ disaster plans. Nevertheless, countries’ disaster management plans have historically focused on hospitals and few recommendations exist for how to practically proceed with such an integration. This study explores what has been published on the topic of reverse triage (RT), namely the process used by healthcare workers (HCWs) to determine which patients can safely be discharged to lower levels of care, resulting in increased surge capacity at hospitals. The objective of this work is to collect evidence around existing criteria, tools or referral pathways used by HCWs during MCI, ultimately integrating lower levels of care in MCI management.Method:A systematic literature review was performed and a total of 12 studies were analyzed.Results:Literature focusing on RT towards lower levels of care during MCI is scant and limited to few case studies. There is no standardized tool or guidelines for how to perform RT and existing referral pathways are described in only isolated case studies.Conclusion:Published evidence on RT criteria is limited. The results of the current review can serve as groundwork upon which to design further research studies. It can be used to help devise strategies and policies for the integration of lower levels of care during MCI.

Utilizing AEMS (Assess-EOP-Map-Simulate) Algorithm to Assess and Spatially Link Prehospital Emergency Medical Services Resources in Road-Traffic Mass Casualty Incidents in Kumasi, Ghana

Introduction:Due to the high number of road traffic accidents with acute injuries and fatalities–particularly in Mass Casualty Incidents (MCI) in low-resource urban sub-Saharan African cities–research was undertaken to create an evidence-based algorithm that could be used to assess and geospatially link EMS needs in Kumasi, Ghana, to trauma resources. Our examination showed that non-MCI fatalities was approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.Therefore, several studies (funded through Fulbright-Fogarty and Fulbright Specialist programs), supported the development of the A-E-M-S (Assess-EOP-Map-Simulate) Medical Mass Casualty Algorithm that began networking accident ‘hotspots’ to existing trauma-level capabilities and surge capacity competencies in eight specified Kumasi hospitals. This low-cost response model promises to be an innovative alternative to long-term infrastructure development and high-priced resource distributions. Use of GIS and UAV drones allowed response systems to geospatially locate, classify, shift, and/or augment resources as needed in conjunction with hotspots.Method:Sample sizes were averaged at 295 for all patients' ages, with only a sample size of 292 for adults at 95% confidence intervals, and a standard deviation of 0.5. A total of 300 road-traffic accident victims were collected at KATH A&amp;E in February-May, 2017, utilizing handheld devices by four researchers 24/7 daily.Results:Our examination showed that non-MCI fatalities were approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.Conclusion:To date–and in partnership with Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Ghana Medical Council, Health Services, National Disaster Management Organization, and others–over 306 Ghanaian healthcare providers from 80 different facilities have been trained in the AEMS program.

One Month in One Hundred Degrees: Caring for High-Risk Populations During Extreme Weather Events

Introduction:In August 2021, Hurricane Ida struck Louisiana as a near-category five storm, bringing massive devastation to the region’s healthcare infrastructure. In its aftermath, extreme heat coincided with record COVID-19 hospitalizations in the state, leaving minimal healthcare surge capacity remaining and medically vulnerable populations unprotected. Meanwhile, sparse pre-storm evacuations exposed prominent gaps in existing medical response plans designed to serve high-risk groups. Subsequently, Louisiana rapidly established a 250-bed alternative care site (ACS) within hard-hit New Orleans. This presentation highlights key considerations in the operation of the site and discusses which patient populations are most in need of medical support following tropical weather events.Method:The findings of this discussion are the result of after-action reviews, brief literature reviews, and the experiences of responders during Hurricane Ida. The presentation also draws on retrospective patient chart reviews from Louisiana’s prior alternative care sites.Results:Following Hurricane Ida, a post-storm alternative care site was rapidly established in New Orleans in partnership with a US Disaster Medical Assistance Team (DMAT). Operationalized in less than 72-hours, this site provided inpatient care to displaced persons with major chronic medical needs (e.g. home ventilators, hemodialysis, respiratory therapies), significant mobility impairment, wound care, and psychiatric illnesses. Incorporating Louisiana’s experience with a COVID-19 alternative care site, this facility far-exceeded the typical scope of medical shelters, simultaneously lessening medical surge on already-overburdened hospitals and meeting post-storm needs in the region.Conclusion:Following extreme weather events in metropolitan areas, traumatic injuries and acute illness comprise a small proportion of the medical needs after the event. Accordingly, disaster medical responses must prepare to treat large numbers of chronic illness exacerbations that result from a loss of access to primary care, home health support, and auxiliary services. This approach efficiently leverages resources into lifesaving interventions and protects healthcare systems during times of high stress.

Community-Based Response to Pandemic: Case Study of Home Isolation Center using Flexible Surge Capacity

Introduction:The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.Method:This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.Results:The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.Conclusion:The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.

Measuring surge capacity: preparing for the unexpected.

Measuring surge capacity: preparing for the unexpected.

Experience of Florence University Hospital: the Disaster Emergency Plan in a third level hospital

Objective. The study aims to explain how to prepare a disaster manual, describes it and shows how it is applied it in a tertiary care hospital when emergency occur. Methods. We based the article on the principles of disaster medicine, on recent literature and on the experiences gained during the pandemic COVID emergency. Results. Recent terrorist attacks have highlighted the importance of a contingency plan to effectively and efficiently manage a large influx of wounded. Careggi Hospital’s PEMAF (emergency plans for a massive influx of injured) is a comprehensive and well-coordinated response to a disaster situation. The hospital’s specialized disaster response team, surge capacity plan, and patient tracking system provide the necessary resources to provide immediate and efficient care to patients in the event of a disaster. Conclusions. Disaster medicine protocols play a critical role in preparing healthcare professionals to respond to large-scale disasters, including terrorist attacks. By following established protocols and principles of disaster medicine, healthcare professionals can provide effective care to those affected by disasters and help to mitigate the impact of future disasters.

Care trajectories for patients utilizing electronic visits for COVID-like symptoms in a large healthcare delivery system: May 2020–December 2021

Background There is limited information about how on-line screening tools developed by integrated systems facilitated management of COVID-like illness patients. Methods Using the Kaiser Permanente Northwest (KPNW) Electronic Health Record, we identified adult plan members who accessed online COVID-19 screening e-visits and enumerated their subsequent medical encounters, tests for SARS-CoV-2, and test outcomes. Results Between May 2020 and December 2021, members completed 55,139 e-visits, with disproportionate representation among females (65% vs. 53% in the overall membership) and members aged <45 years (61% vs. 39%). Thirty percent of patients (16,953) were managed entirely through e-visits and 70% received subsequent in-person care. The percent of SARS-CoV-2 positive individuals was highest among the 1055 individuals triaged to inpatient care (17.9%), compared to 9.5% among those escalated to additional ambulatory care. Conclusions The e-visit on-line screening tool helped KPNW assist thousands of patients with COVID-19 symptoms, avoid unnecessary in-person patient encounters, and preserved KPNW infection control and pandemic surge capacity.

Birth of an International Journal Dedicated to Health Systems Resilience

Health systems, small or large, are essential to ensure the well-being of communities. However, health systems worldwide are struggling with their challenges in delivering services to communities. On top of that, when disasters, conflicts, crises, and pandemics occur, the communities will depend more on the health systems. If the health systems are functional despite the adversities, they can reduce deaths, injuries, diseases, and human suffering in the aftermath of such events. However, such adversities do not spare health systems. On the contrary, they will pose an additional burden for emergency health systems, calling for augmentation of surge capacity. All building blocks of health systems could be affected by shocks and stressors; the COVID-19 pandemic has been the perfect and the most recent example. The lessons learned by health systems, irrespective of their size, complexity, and geographic distribution during the pandemic, call for better understanding and operationalizing of health systems resilience, at all levels, from the global, national, sub-national, and institutional levels. Resilient health systems have some common positive characteristics: they can prepare, respond and recover from shocks and stressors, capitalizing on resources within; they can cope; they can bounce back. However, more academic and practice-based research is needed to expand our understanding of health systems resilience and ways and means of enhancing it. We must learn to look at health systems through a lens of resilience, going beyond the traditional health emergency preparedness and response activities, which are often fragmented and compartmentalized. Each disaster, conflict, crisis, and pandemic can teach us many great lessons on making our health systems more resilient. However, organizational learning will happen only if the health systems are humble, open, and ready to learn, not only from successes but also from failures. The International Journal of Health Systems Resilience (INJHSR) creates a platform for our resilience practitioners to learn from each other. INJHSR promotes sharing of experiences, lessons learned, and best practices on health systems resilience. In addition, INJHSR fosters innovation in the field of health systems resilience. At INJHSR, we celebrate innovations that were successful and scaled up and those that did not do so well because such honest learnings are critical in addressing future challenges. Further, INJHSR will provide opportunities for resilience practitioners to collaborate on promoting health systems resilience. International Journal of Health Systems Resilience is our journal. It is our platform to make our health systems resilient.

Scaling Surgical Resources: A Capacity Analysis of C-arm Machines in Haiti Following the 2021 Earthquake

BackgroundIn 2021, a 7.2 magnitude earthquake struck Haiti resulting in a surge of orthopaedic trauma requiring immediate surgical treatment. Safe and efficient operative management of orthopaedic trauma injuries requires intraoperative fluoroscopy through C-arm machines. The Haitian Health Network (HHN) received a philanthropic donation of three C-arm machines and considered an analytical tool may guide efficacious placement of those machines. The study objective was to develop and apply a clinical needs and hospital readiness measuring tool relevant to C-arm machines, which may guide decision-makers, such as HHN, in response to an emergency situation with a surge in need for orthopaedic treatment.MethodsAn online survey to assess surgical volume and capacity was created and then completed by a senior surgeon or hospital administrator based at hospitals within the HHN. Multiple-choice and free-text answer data were collected and classified into five categories: staff, space, stuff, systems, and surgical capacity. Each hospital received a final score out of 100, calculated by equal weighting of each category.ResultsTen out of twelve hospitals completed the survey. The average weighted score for the staff category was 10.2 (SD 5.12), the space category was 13.1 (SD 4.09), the stuff category was 15.6 (SD 2.56), the systems category was 12.25 (SD 6.50), and the surgical capacity category was 9.5 (SD 6.47). The average final hospital scores ranged from 29.5 to 83.0.ConclusionThis analysis tool provided data as to the clinical demand and capabilities of hospitals within the HHN to receive a C-arm machine and reaffirmed the critical need for more C-arms in Haiti. This methodology may be utilised by other health systems to provide data to distribute orthopaedic trauma equipment, which would benefit communities during periods of surge capacity, such as natural disasters.

Relationship between intensive care surge capacity and hospital factors: an extensive experience.

As a prolonged surge scenario, the COVID-19 pandemic has offered an unparalleled opportunity to improve hospital surge capacity (SC) understanding and the ability to manage it. In this study, the authors report the experience of a large hospital network and evaluate potential relationships between Intensive Care Units SC (ICU-SC) and some hospital-related variables: bed occupancy, emergency department admissions, ward admission from ED, and elective surgery procedures. Pearson's partial correlation coefficient (r) has been used to define the relationship between SC and the daily values of the above variables, collected through a dedicated digital platform that also ensured a regular quality check of the data. The observation has concerned several levels of analysis, namely two different types of SC calculation (SC base-SCb and SC actual-SCa), hospital category level and multi-hospital level, and two consecutive pandemic waves. Among the 16 hospitals observed, the correlation was shown to be moderate-positive with non-ICU bed occupancy (r/ = 0.62, r/ = 0.54), strong/moderate with ICU bed occupancy (r/ = 0.72, r/ = 0.54), and moderate with ward admissions from ED (r/ = 0.50, r/ = 0.51) On the contrary, the correlation proved to be moderate-negative with ED admissions (r/ = - 0.69, r/ = - 0.62) and low with the number of elective surgery procedures (r/ = - 0.10, r/ = - 0.16). This study identified a positive correlation between SC and three variables monitored: ICU bed occupancy, non-ICU bed occupancy, and ward admissions from ED. On the contrary, the correlation was negative for ED admission and the number of elective surgery procedures. The results have been confirmed across all levels of analysis adopted.

Assessing the surge capacity of hospitals in Ugandan health care systems in managing the COVID-19 pandemic

IntroductionThe increasing cases of COVID-19 poses a threat on the over strained health care systems, especially in developing countries. Health care systems might need a surge to accommodate the ever increasing number of COVID1-19 cases. Hence, we assessed the Ugandan healthcare systems’ capacity to accommodate the surge in the increased caseloads, which might need admission and critical care due to COVID-19.ObjectivesUnderstanding the health systems capacity to accomadate the surge in increase caseload of COVID-19MethodsWe assumed that 2% of the Uganda population get symptomatic infections by COVID-19 based on modelled estimates of Uganda and ascertained the healthcare systems surge capacity for COVID-19 under three transmission curves scenarios; 6, 12 and 18 months. We estimated four measures for hospital surge capacity; ICU bed surge capacity, ICU bed tipping point, hospital bed capacity and hospital bed tipping point. Estimates were made for national level and 132 district local government.ResultsThe capacity of Ugandan health care system to accommodate the increasing numbers of cases due to COVID-19 is hindered by the lack of oxygen. Only 9 in 20 (46%) of hospital beds had oxygen supply. The hospital bed surge capacity varied across districts. Under the 12 months transmission scenario, the proportion of hospital with available beds, that would accommodate COVID-19 cases varied from 4% in Karomoja district, to 84% in Kampala district. The Ugandan healthcare systems faces a critical gap in ICU beds and ventilator capacity. Only 48 out of 132 districts had at least 1 ICU unit. An additional 2,247 bed and 2,756 ventilators (12 months transmission curve) will be needed to accommodate the caseloads due to COVID-19.ConclusionsThe capacity for Ugandan healthcare systems to manage to manage the COVID-19 caseloads is minimal. There need to address the sub-national variations in bed surge capacity, ICU units and ventilators within the Ugandan healthcare system.Disclosure of InterestNone Declared