Increasing overtriage may have positive, negative, or mixed effects on critical mortality in this trauma system simulation model. These results, which contrast with prior analyses describing a positive linear relationship between overtriage and mortality, highlight the need for alternative metrics to describe trauma system response after MCIs. We explore using the relative number of critical patients to available and staffed treatment units, or the critical surge to capability ratio, which exhibits a consistent and nonlinear association with critical mortality in this model.

. Delays in detecting and initiating response to large-scale, covert aerosol anthrax releases in a major city would render even highly effective CRI-compliant mass prophylaxis campaigns unable to prevent unsustainable levels of surge hospitalizations. Although outcomes may improve with more rapid epidemiological identification of affected subpopulations and increased collaboration across regional public health and hospital systems, these findings support an increased focus on prevention of this public health threat.

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greater tolerance of triage errors as they are caught and corrected at successive levels of care.Is this kind of modeling study helpful? Yes. Despite some obvious limitations, the article generates a fruitful discussion surrounding a core question in disaster medicine: how does overtriage influence critical mortality? It also emphasizes more broadly the critical role that triage plays in determining outcome, and therefore, the importance of intensive training in triage among medical providers who may be confronted by the unique challenges of mass casualty care. In analyzing its flaws, we are reminded that "planning should take into consideration how people and organizations are likely to act, rather than expecting them to change their behavior to conform to the plan." 5 In essence, the article becomes a call for more research in triage, focused on an insightful combination of theoretical modeling with evidence from real-life experience.

Hospital preparedness for nosocomial or community-wide outbreaks of communicable disease includes the capability for rapid, self-reliant administration of prophylaxis to its workforce, with the goal of minimal disruption of patient care, here called hospital "self-prophylaxis." We created a new discrete-event simulation model of a hypothetical hospital wing to compare the operational charateristics of standard single-line, "first-come, first-served" dispensing clinics with those of 2 staff management strategies that can dramatically reduce staff waiting time while centralizing dispensing around existing pharmacy-distribution points.