Modeling hospital surgical capacity in mass casualty incidents: a national metric of the MassCare index

Abstract

Background The a priori assessment of medical response capacity for disasters in each hospital is crucial to establish the maximum receivable number of patients and the best allocation strategy. The objective of this study was to calculate the maximal surgical capacity of each French hospital for adult victims of mass casualty incidents (MCI) during working hours (Tmax-MassCare-A1-B1-C1).Methods Data were taken from the 2019 national SAE survey, which records the activity and resources of French hospitals. The Tmax-MassCare-A1-B1-C1 indicator was calculated using resources for each hospital with sufficient data, as the minimum of its number of operating rooms, surgeons, and anaesthetists or anaesthesia nurses declared. Linear regression models were used to predict this Tmax-MassCare indicator using the hospital activity measured in the PMSI database, an exhaustive database used for payment purposes. Estimates of MCI surgical capacity per million inhabitants (p.m.h.) were further calculated by French region.Results Of the 875 hospitals included, 15.8% had missing data on resource variables precluding calculation of the Tmax-MassCare indicator without imputation. The capacity calculated for the remaining hospitals would be better predicted with the assumption that one patient in the MCI situation could be admitted for every 1441 annual procedures (R2 = 0,87, univariate linear regression model). Using this approximation, the MCI surgical capacity was 81.5 patients p.m.h. in metropolitan France and 47.6 in overseas France.Conclusion The maximal MCI surgical capacity in adults can be estimated using the annual number of procedures as a proxy. Further studies are needed to provide estimators outside of working hours and for paediatric victims.