Allocation of Scarce Resources During Mass Casualty Events - Executive Summary | AHRQ Effective Health Care Program
Limited Evidence on Best Strategies During Mass Casualty Events
Limited evidence exists to help policymakers and health care professionals identify the most effective strategies to allocate scarce resources during mass casualty events, according to a new AHRQ report. A mass casualty event, whether a natural event such as a hurricane, flood or disease outbreak, or man-made such as a bioterrorism attack, can occur suddenly and can severely challenge highly experienced and well-equipped health care providers and systems. Based on an evidence review conducted by researchers at AHRQ’s Southern California RAND Evidence-based Practice Center, no single strategy to allocate resources during mass casualty events was found to be most effective. Led by Justin Timbie, Ph.D., and Art Kellerman, M.D., the researchers also found that commonly used field triage measures do not perform consistently during mass casualty events. They also found evidence suggesting that specific strategies influence the speed and efficiency of biological countermeasure dispensing during a bioterrorism attack or influenza pandemic. For example, delivering medicines to the public via postal carriers reaches more people faster than making them available at a centralized location. Although some promising strategies exist, additional research is needed to identify the optimal methods, techniques, and technologies to employ during mass casualty events. Select to access the report, Allocation of Scarce Resources During Mass Casualty Events.
Executive Summary – Jun. 13, 2012
Allocation of Scarce Resources During Mass Casualty Events
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Table of Contents
- Background
- Objectives
- Analytic Framework
- Methods
- Results
- Discussion
- Future Research
- References
- Full Report
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Background
Most experts define a mass casualty event (MCE) as a natural (e.g., earthquake, pandemic) or manmade (e.g., detonation of a nuclear device, conventional explosive, bioterror attack) incident that suddenly or progressively generates large numbers of injured and/or ill people who require medical and/or mental health care. The magnitude of demand for medical care resources has the potential to vastly outstrip the ability of a health care facility or a local, regional, or national public health and health care delivery system to deliver medical care services consistent with generally established standards of care.An MCE can occur suddenly, as is typical of an earthquake, tornado, or terrorist bombing;1 or it may evolve over hours to days, as is typical of a hurricane, flood, or disease outbreak;2 or would likely happen following a bioterror attack.3 Regardless of its rate of onset, the scope and complexity of an MCE can severely challenge even the most highly experienced and well-equipped health care providers and systems.4
By definition, an MCE generates a level of demand for health care resources that outstrips available supply. Under those circumstances, local and regional health care providers are unable to meet victims’ needs at the level normally expected of a modern health care delivery system. Because such situations are difficult to predict and can occur with little or no warning, health care systems and providers must be prepared to swiftly implement contingency plans to reduce less-urgent demand for health care services; optimize the use of existing resources; and secure additional resources, if possible, from backup sources. If these measures are insufficient to meet demand, providers may be forced to shift from the traditional treatment approach, which strives to deliver optimum care to every patient, to one that seeks to do the most good for the most people with the available resources. This latter concept has come to be known as “crisis standards of care.”
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