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Modeling and Simulation of In-Hospital Disaster Medicine in a Mass Casualty Event for the Resilience Evaluation of BCPs

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JOURNAL OF DISASTER RESEARCH 2023年第2期18卷 104-113页

作者： Umemoto, Mizuki Kadono, Shunsuke Kanno, Taro Kajiyama, Kazumi Sharikura, Sachika Ikari, Ryoko Yoneyama, Masashi chuang, sheuwen Univ Tokyo Sch Engn 7-3-1 HongoBunkyo Ku Tokyo 1138656 Japan Kitasato Univ Hosp Dept Nursing 1-15-1 KitasatoMinami Ku Sagamihara Kanagawa 2520375 Japan Kitasato Univ Hosp Emergency & Disaster Med Ctr 1-15-1 KitasatoMinami Ku Sagamihara Kanagawa 2520375 Japan Showa Univ Hosp Nursing Dept 1-5-8 HatanodaiShinagawa Ku Tokyo 1428666 Japan Showa Univ Hosp Emergency Med Ctr 1-5-8 HatanodaiShinagawa Ku Tokyo 1428666 Japan Taipei Med Univ Hosp Taipei Taiwan

In this study, we developed a simulation model of de-tailed in-hospital disaster response to a mass casu-alty incident based on the analysis of related docu-ments and actual in-hospital disaster response train-ing, aiming to assess the hospital's response capac-ity under various disaster situations. This simulation model includes detailed models of patients, floor con-figurations, resources, and response tasks, which con-sider resource requirements for the treatment of dif-ferent patients with various injuries and physical con-ditions. The model covers patients' arrivals to hos-pitalization or discharge. We conducted simulations of the target hospital to test two resource allocation strategies under two patient scenarios. By comparing the results under different resource allocation strate-gies, we found that the X-ray photography examina-tion capacity could become a fundamental bottleneck in responding to mass casualty incidents. Also, we found that the appropriate resource allocations and quick replenishment could alleviate the negative effect of resource shortages and maintain a higher perfor-mance. Furthermore, the results show that the length of stay can be heavily affected by the patients' config-uration. As a result, by monitoring and anticipating the situation, a resilient and responsive resource allo-cation strategy must be prepared to handle such un-certain disaster situations.

关键词： disaster prevention earthquake business continuity planning (BCP) mass casualty incident

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Measurement of resilience potentials in emergency departments: Applications of a tailored resilience assessment grid

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SAFETY SCIENCE 2020年 121卷 385-393页

作者： chuang, sheuwen Ou, Ju-Chi Ma, Hon-Ping Taipei Med Univ Grad Inst Data Sci Taipei Taiwan Taipei Med Univ Hlth Policy & Care Res Ctr Taipei Taiwan Taipei Med Univ Shuang Ho Hosp Dept Emergency Med Taipei Taiwan Taipei Med Univ Grad Inst Injury Prevent & Control Taipei Taiwan Taipei Med Univ Sch Med Dept Emergency Med Taipei Taiwan

A proxy measurement of four resilience potentials (respond, monitor, learn, and anticipate) developed by Hollnagel is called the resilience assessment grid (RAG). This study aimed to attain an enhanced understanding of the resilience performance of emergency departments (EDs) in terms of the four potentials across hospitals through the adoption of a custom-made RAG (ED-RAG). The study setting was four hospitals. The ED-RAG questionnaire was used to interview focus groups at the four EDs from February to June 2015. All interviews were led by the lead researcher and the interview transcripts were evaluated using the ED-RAG four-point scoring scale. Four radar charts of individual resilience potentials and a star chart presenting a system's potential of overall resilience performance for each hospital's ED were generated. The charts provide visualized results that indicate clear directions for making improvement plans toward resilience in EDs. Overall, all EDs exhibited considerable potential to learn compared with the other three potentials at the time of measurement. Common strengths and weaknesses with respect to developing the four potentials were identified. Besides, no association between potential scores and staffing capacity, and no significant differences of resilience performance between hospital types were found. EDs' ability to perform in a resilient manner can be critical under considerable uncertainty and economic pressure. The study revealed essential knowledge about the development of resilience potentials in emergence departments among hospitals. The findings could contribute to the promotion of resilient health care.

关键词： Resilience assessment grid (RAG) Emergency department ED-RAG Resilient health care

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Taiwan's Experience in Disaster Coordination

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NATURAL HAZARDS REVIEW 2021年第1期22卷 04020047-04020047页

作者： chuang, sheuwen Ho, Hui Yan Taipei Med Univ Grad Inst Data Sci Taipei Taiwan Taipei Med Univ Hlth Policy & Care Res Ctr 12F172-1Sec 2 Keelung Rd Taipei 10675 Taiwan Taipei Med Univ Sch Hlth Care Adm Taipei 10675 Taiwan

Taiwan is located on the earthquake-prone circum-Pacific belt and seasonal typhoon impact zone. Given Taiwan's large population and high urban density, disasters can have serious consequences on its economy, environment, and public health. This paper traces the evolution of Taiwan's disaster management system into its current framework under the national Disaster Prevention and Response Act and examines the coordination experiences across different actors in involved in disaster response. Through two case studies, Typhoon Morakot and the Formosa Fun Coast Dust Explosion incident, this paper investigates the coordination that occurred in the various phases of disaster management and indicates coordination successes and failures, as well as factors leading to coordination breakdowns in the response stage of the two cases. These factors include unclear responsibilities for mobilization, lack of real-time information systems sharing across sectors, ineffective communication mechanism, inadequate disaster management structure, and lack of disaster drills/exercises for integrating multiple organizations. Understanding how coordination successes and breakdowns occur will provide useful learning points on which future policy changes and education can improve.

关键词： Disaster management Coordination Taiwan Disaster preparedness Response

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Coping With a Mass Casualty: Insights into a Hospital's Emergency Response and Adaptations After the Formosa Fun Coast Dust Explosion

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DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 2020年第4期14卷 467-476页

作者： chuang, sheuwen Woods, David D. Ting, Hsien-Wei Cook, Richard I. Hsu, Jiin-Chyr Taipei Med Univ Hlth Policy & Care Res Ctr Grad Inst Data Sci Taipei Taiwan Ohio State Univ Dept Integrated Syst Engn Columbus OH 43210 USA Taipei Hosp Minist Hlth & Welf Dept Neurosurg New Taipei Taiwan Taipei Hosp Minist Hlth & Welf Dept Chest Med New Taipei Taiwan

Objective: The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE). Methods: Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge. Results: The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital's ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands. Conclusion: Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

关键词： disaster planning emergency response Formosa Fun Coast Dust Explosion mass casualty incident

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Ranking hospitals' burn care capacity using cluster analysis on open government data

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COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021年 207卷 106166-106166页

作者： Ho, Hui Yan chuang, sheuwen Dai, Niann-Tzyy Cheng, Chia-Hsin Kao, Wei-Fong Taipei Med Univ Sch Hlth Care Adm Taipei Taiwan Taipei Med Univ Grad Inst Data Sci 12F172-1Sec 2Keelung Rd Taipei 10675 Taiwan Taipei Med Univ Hlth Policy & Care Res Ctr Taipei Taiwan Triserv Gen Hosp Natl Def Med Ctr Div Plast & Reconstruct Surg Taipei Taiwan Taipei Med Univ Coll Med Sch Med Dept Emergency Med Taipei Taiwan

Background and objective: To deal with burn mass casualty incidents (BMCIs), various countries have established national or regional BMCI emergency response plans (ERPs). A burn care capacity ranking model for hospitals can play an integral role in ERPs by providing essential information to emergency medical services for distributing and handling mass burn patients. Ranking models vary across countries and contexts. However, Taiwan has had no such model. The study aims to develop a ranking model for classifying hospitals' burn care capacity in preparation for the development of a national BMCI ERP. Methods: Multiple methods were adopted. An expert panel provided consultations on data selection and clustering validation. Data on 116 variables from 535 hospitals were collected via open data platforms under the Ministry of Health and Welfare. Data selection and streamlining was conducted to determine 42 variables for cluster analysis. SAS 9.4 was used to analyze the data set-via a hierarchical cluster analysis using Ward's method, followed by a tree-based model analysis to identify the criteria for each cluster. Both internal and external cluster validation were performed. Results: Four clusters of burn care capacity were determined to be a suitable number of clusters. All hospitals were arranged into capacity levels accordingly. Results of the Kruskal-Wallis test showed that the difference between clusters were significant. Tree-based model analysis revealed four determining variables, among which the refined level of emergency care responsibility hospital was found to be most influential on the clustering process. Responses from the questionnaire were used as an external valida-tion tool to corroborate with the cluster analysis results. Conclusion: The use of open government data and cluster analysis was suitable for developing a ranking model to determine hospitals' burn care capacity levels in Taiwan. The proposed ranking model can be used to develop a BMCI emergen

关键词： Cluster analysis Hierarchical clustering Burn mass casualty incident Formosa Fun Coast Dust Explosion Mass casualty distribution

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International comparison of burn medical care systems and emergency response plans for burn mass casualty incidents

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Taiwan Journal of Public Health 2020年第3期39卷 243-256页

作者： chuang, sheuwen Dai, Niann-Tzyy Ho, Hui-Yan Graduate Institute of Data Science Taipei Medical University 12FNo. 172-1 Sec. 2 Keelung Rd. Daan Dist. Taipei Taiwan Health Policy and Care Research Center Taipei Medical University Taipei Taiwan Division of Plastic and Reconstructive Surgery Department of Surgery Tri-Service General Hospital National Defense Medical Center Taipei Taiwan

Objectives: The purpose of this study is to compare and learn from the burn care systems and emergency response plans for burn mass casualty incidents (BMCI) across developed countries. Methods: Based on the availability of English information, the United States, United Kingdom, Switzerland, and Australia were selected for comparison with Taiwan. Two categories are compared across the 5 countries: the basic medical care systems for burn patients, and emergency response plans for BMCIs. Results: In contrast to Taiwan, the United States, Australia, United Kingdom, and Switzerland have established basic burn care systems and regional or national emergency response plans for BMCIs. The number of layers within both burn care systems and nation-wide emergency response plans for BMCIs varies from country to country. Emergency response plans for BMCIs in Australia was designed with two levels, and with three levels in Switzerland, four levels in the United States, and six levels in the United Kingdom. In denselypopulated metropolitan areas such as New York City, hospitals are divided into four levels of burn care abilities as part of the regional emergency response plan for BMCIs. Conclusions: Based on the results of the study and the characteristics of Taiwan's metropolitan population and medical care systems, the article recommends referring to the burn-center regional emergency response plans for BMCIs of New York City to develop a regional to national BMCI plans, and ranking method for burn care capabilities of hospitals as a short to medium-term improvement goal for Taiwan's burn care system. © 2020 Chinese Public Health Association of Taiwan. All rights reserved.

关键词： Burn care systems Burn mass casualty incidents Emergency response plan International comparison

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An international systems-theoretic comparison of hospital accreditation: developing an implementation typology

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INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 2019年第5期31卷 371-377页

作者： chuang, sheuwen Howley, Peter P. Gonzales, Shawon S. Taipei Med Univ Hlth Policy & Care Res Ctr 12 F172-1Sec 2 Keelung Rd Taipei 10675 Taiwan Taipei Med Univ Grad Inst Data Sci Taipei 10675 Taiwan Univ Newcastle Sch Math & Phys Sci Stat Callaghan NSW 2308 Australia Taipei Med Univ Sch Hlth Care Adm Taipei 10675 Taiwan

Objective The integration of quality indicators into the accreditation process has been recognized as a promising strategy worldwide. This study was to explore the implementation patterns of hospital accreditation through the lens of a systems-theory based model, and determine an international accreditation implementation typology. Design A qualitative comparative study of five established international hospital accreditation systems was undertaken based on a systems-theoretic holistic healthcare systems relationship model. A set of key attributes relevant to three systems-theoretic model relationships guided data collection, comparison and synthesis. Setting Hospital accreditation systems in five countries: America, Canada, Australia, Taiwan and France. Results An accreditation implementation typology was developed based on the data synthesis of the similarities and differences among the relationships. A typology including five implementation types of hospital accreditation systems (TYPE I-V) was induced. TYPE I is a basic stand-alone accreditation system. The higher types represent stronger relationships among accreditation system, healthcare organizations and quality measurement systems. The five settings have shifted their accreditation approaches from the basic type (TYPE I). Conclusions The implementation typology of hospital accreditation could serve as a roadmap for refining hospital accreditation systems toward an integrative approach for continuous quality improvement.

关键词： hospital accreditation quality measurement system continuous quality improvement systems-theory

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Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

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WORLD JOURNAL OF EMERGENCY SURGERY 2021年第1期16卷 59-59页

作者： chuang, sheuwen Woods, David D. Reynolds, Morgan Ting, Hsien-Wei Balkin, Asher Hsu, Chin-Wang Taipei Med Univ Grad Inst Data Sci Taipei Taiwan Taipei Med Univ TMU Res Ctr Hlth & Welf Policy 12F172-1Sec 2 Keelung Rd Taipei Taiwan Ohio State Univ Dept Integrated Syst Engn Columbus OH 43210 USA Minist Hlth & Welf Taipei Hosp Dept Neurosurg New Taipei Taiwan Taipei Municipal Wanfang Hosp Emergency Dept Taipei Taiwan

Background Large-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events. Methods The Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework. Results A four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans. Conclusions The study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.

关键词： Mass casualty incident Formosa Fun Coast Dust Explosion Preparedness plan Emergency medical service Surge capacity Burn disaster

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Beyond surge: Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion

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BURNS 2019年第4期45卷 964-973页

作者： chuang, sheuwen Chang, Kuo-Song Woods, David D. Chen, Hsiao-Chun Reynolds, Morgan E. Chien, Ding-Kuo Taipei Med Univ Grad Inst Data Sci Taipei Taiwan Taipei Med Univ Hlth Policy & Care Res Ctr Taipei Taiwan MacKay Mem Hosp Dept Emergency Med Taipei Taiwan Mackay Med Coll Sch Med Taipei Taiwan Ohio State Univ Dept Integrated Syst Engn Columbus OH 43210 USA

Purpose: To provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. Material and methods: The critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge. Results: Fifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead. Conclusion: In the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation

关键词： Mass burn casualty Formosa Fun Coast Dust Explosion Emergency management continuum Disaster planning Cognitive systems engineering Surge capacity

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Corrigendum: An international systems-theoretic comparison of hospital accreditation: developing an implementation typology

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International journal for quality in health care : journal of the International Society for Quality in Health Care 2020年第10期32卷 724页

作者： sheuwen chuang Peter P Howley Shawon S Gonzales

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