title: Does number of beds reflect the surgical capability of hospitals in wartime and disaster? The use of a simulation technique at a national level.
abstract: BACKGROUND
  The raw number of hospital trauma beds and occupancy has been used to assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.
  
  
  METHODS
  Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of "standard wartime casualties." Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A "what-if" module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of "standard casualties." Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.
  
  
  RESULTS
  Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected. The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.
  
  
  CONCLUSIONS
  The use of simulation techniques might be useful method to assess the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.
authors.affiliation: Trauma Research Unit, Rambam Medical Center, Haifa, Israel. llevi@rambam.health.gov.il
authors.forename: L
authors.initials: L
authors.lastname: Levi
authors.forename: D
authors.initials: D
authors.lastname: Bregman
authors.forename: H
authors.initials: H
authors.lastname: Geva
authors.forename: M
authors.initials: M
authors.lastname: Revah
mesh_terms: D003198:Computer Simulation; D004189:Disaster Planning; D013502:General Surgery / Q000458:organization & administration*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D007557:Israel; D008887:Military Medicine; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D014857:Warfare; D014947:Wounds and Injuries / Q000601:surgery*