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Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model

Authors Yu W, Lv Y, Hu C, Liu X, Chen H, Xue C, Zhang L

Received 30 October 2017

Accepted for publication 2 December 2017

Published 31 January 2018 Volume 2018:12 Pages 207—222

DOI https://doi.org/10.2147/PPA.S155603

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu


Wenya Yu,* Yipeng Lv,* Chaoqun Hu,* Xu Liu, Haiping Chen, Chen Xue, Lulu Zhang

Department of Military Health Service Management, College of Military Health Service Management, Second Military Medical University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Objectives: Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs.
Methods: This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command.
Results: Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people.
Conclusion: The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Keywords: system dynamics model, emergency medical system, mass casualty incidents

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