title: A computer simulation of a california casualty collection point used to respond to a major earthquake.
abstract: OBJECTIVE
  Casualty Collection Points (CCPs) are sites predesignated by county officials for the congregation, triage, austere medical treatment, holding, and evacuation of casualties following a major disaster. A CCP (and the simulation) is made up of a series of discrete, interrelated steps that collectively result in medical care being provided to a casualty.
  
  
  METHODS
  A series of computer simulations was run comparing differences in personnel, supplies, and evacuation configuration for a jurisdiction that has plans in place to establish a CCP, and for one that does not. Each simulation was for 650 earthquake-related casualties.
  
  
  RESULTS
  Generally, it was found that: 1) mortality appears to be related directly to performance of triage of casualties and to where they are directed for care. The least injured did not need to be treated at a CCP; 2) survival is related directly to arrival time, mix of medical staff, and the ability to form "care teams" on-site; 3) the sudden, massive arrival of casualties will result in a "snowball" mortality effect if staff numbers are low or do not include the proper mix of training to form care teams well before the peak arrival time of casualties; 4) holding ambulances until they are filled completely before evacuation may increase mortality; 5) during the first four hours, more lives may be saved by using transportation assets to move medical staff and supplies to a CCP, if large numbers of casualties are expected to congregate there. Generally, the local jurisdiction must be prepared to mobilize a significant number of medical staff and supplies to a predesignated CCP within 4-6 hours after an event.
  
  
  CONCLUSIONS
  The simulation produced useful information. In particular, local disaster response planners need to develop rapid response methods to ensure that the best combination of medical staff are available early to care for casualties.
authors.affiliation: Program Research Specialist, Emergency Medical Services Authority, State of California, Health and Welfare Agency, Sacramento, Calif.
authors.forename: G A
authors.initials: GA
authors.lastname: Koehler
authors.forename: D
authors.initials: D
authors.lastname: Foley
authors.forename: M
authors.initials: M
authors.lastname: Jones