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Surge capacity is one of the most important sub domains identified in the Goal (HSPD-8). The recent TOPOFF 3 exercise demonstrated the importance of enhancing surge capacity to respond to a complex terrorist event or other incident involving mass casualties. The term ‘surge capacity’ is often restricted to heath systems and their ability to absorb large numbers of additional patients. AHRQ and other agencies have provided millions of dollars in funding to study and implement means to improve the surge capacity of the American healthcare system. The Johns Hopkins Office of CEPAR alone has received $3.5 million in competitive research grants related to hospital surge capacity. Many municipalities and regions have made detailed assessments of their healthcare surge capabilities. Specific training courses have been developed by the DHS, CDC, OSHA, and AHRQ to improve healthcare workers’ response. However, the other societal and organizational resources that may be available to improve surge capacity have not been similarly supported.

We will intentionally expand the connotation of surge capacity to refer to the entire disaster response system’s elasticity to respond to the effects of a high consequent event. Formal networks have embedded surge responses within their plans. One area of potential surge is in the “informal network” communities. Currently, most of these are ephemeral, not well understood, and disconnected from the whole. The entire nation’s response capabilities would be tremendously enhanced if formal networks were able to harness and bring cohesion to the immense potential capacity represented by informal community networks.

Regional, state and national health systems are striving to increase health systems (hospitals and clinics) surge capacity in preparation for anticipated acts of terrorism, avian influenza pandemic and a multitude of other public health threats which may result in mass casualties. In order to plan for the provision of high quality acute care and its integration with current response systems in such high consequence incidents, quantitative methods are needed which predict variables such as the number and type of victims requiring medical attention, type and severity of injury as well as geographical and temporal distributions. Concomitantly, methods are needed to quantify existing health systems resources required to respond to specific mass casualty scenarios during the first 24-72 hours, including the most efficient mechanism to mobilize the needed numbers and types of medical personnel, facilities, supplies and equipment.

Our nation’s healthcare community lacks decision-support programs that model public health emergencies and/or terrorism scenarios and which capture key elements and strategies for an effective and coordinated health systems response involving multiple agencies and healthcare facilities.

There is a need for the development of computer software tools which model the expected number and nature and geographical distribution of the injured/affected from a given event (CBRNE) as well as the time elapsed since the event. This information, taken in conjunction with available health care response capacity of hospitals, public health, emergency management, emergency medical services, mental health, and others, would enable disaster planning personnel to determine when to expect surges in demand for healthcare. It would also enable planning across organizations within a health system by quantifying key resources including medical personnel, facilities, supplies and equipment that would be required to respond to specific mass casualty scenarios. This model could be employed for emergency preparedness planning and real time response at the regional, state and national levels.