title: Surgical resource utilization in urban terrorist bombing: a computer simulation.
abstract: BACKGROUND
  The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident.
  
  
  METHODS
  A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel.
  
  
  RESULTS
  The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients.
  
  
  CONCLUSIONS
  Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.
authors.affiliation: Department of Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Hirshberg
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: R
authors.initials: R
authors.lastname: Walden
mesh_terms: D003198:Computer Simulation; D004189:Disaster Planning; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D013502:General Surgery / Q000458:organization & administration*; D006742:Hospital Bed Capacity; D006801:Humans; D007557:Israel; D008962:Models, Theoretical; D010561:Personnel Staffing and Scheduling; D011859:Radiography; D014218:Triage / Q000458:organization & administration; D014504:Urban Health; D014754:Violence; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000601:surgery