Effect of hospital staff surge capacity on preparedness for a conventional mass casualty event.
OBJECTIVE
To assess current medical staffing levels within the Hospital Referral System in the City of Cape Town Metropolitan Municipality, South Africa, and analyze the surge capacity needs to prepare for the potential of a conventional mass casualty incident during a planned mass gathering.


METHODS
Query of all available medical databases of both state employees and private medical personnel within the greater Cape Town area to determine current staffing levels and distribution of personnel across public and private domains. Analysis of the adequacy of available staff to manage a mass casualty incident.


RESULTS
There are 594 advanced pre-hospital personnel in Cape Town (17/100,000 population) and 142 basic pre-hospital personnel (4.6/100,000). The total number of hospital and clinic-based medical practitioners is 3097 (88.6/100,000), consisting of 1914 general physicians; 54.7/100,000 and 1183 specialist physicians; 33.8/100,000. Vacancy rates for all medical practitioners range from 23.5% to 25.5%. This includes: nursing post vacancies (26%), basic emergency care practitioners (39.3%), advanced emergency care personnel (66.8%), pharmacy assistants (42.6%), and pharmacists (33.1%).


CONCLUSIONS
There are sufficient numbers and types of personnel to provide the expected ordinary healthcare needs at mass gathering sites in Cape Town; however, qualified staff are likely insufficient to manage a concurrent mass casualty event. Considering that adequate correctly skilled and trained staff form the backbone of disaster surge capacity, it appears that Cape Town is currently under resourced to manage a mass casualty event. With the increasing size and frequency of mass gathering events worldwide, adequate disaster surge capacity is an issue of global relevance.
Welzel
Tyson B
TB
University of Cape Town, Division of Emergency Medicine, Cape Town, South Africa.
Koenig
Kristi L
KL
Bey
Tareg
T
Visser
Errol
E
Health Aff (Millwood). 2004 May-Jun;23(3):69-77
15160804
Acad Emerg Med. 2006 Nov;13(11):1179-82
16968687
Acad Emerg Med. 2006 Nov;13(11):1130-4
17015414
Prehosp Disaster Med. 2001 Jul-Sep;16(3):150-8
11875799
BMJ. 1995 May 20;310(6990):1307-11
7773047
Crit Care Med. 2005 Jan;33(1 Suppl):S107-12
15640672
S Afr Med J. 2007 Dec;97(12):1276-80
18264609
J Emerg Med. 2009 Jan;36(1):43-9
18514469
CMAJ. 2004 Mar 2;170(5):793-8
14993174
JAMA. 2007 Oct 10;298(14):1623-5
17925507
N Engl J Med. 2006 Jan 26;354(4):366-78
16436768
Acad Emerg Med. 2006 Nov;13(11):1098-102
17085738
Prehosp Disaster Med. 1997 Jan-Mar;12(1):68-72
10166378
J Urban Health. 2005 Sep;82(3):378-88
16000654