Thursday, September 10, 2009

Supervillain Attacks and Hospital Capacity

Umbrella Academy: Dallas #1 by Gerard Way and Gabriel Ba (2008)

Gerard Way and Gabriel Ba touch on something pretty interesting here in the first issue of the second arc of Umbrella Academy. After the superhero squad saves the world from annihilation at the hands of violinists and raining meteors (yeah this book is that good), the downtown area of the city--I don't actually recall which city and I don't remember whether it was mentioned--was left in shambles, with buildings destroyed, thousands left homeless, hundreds dead, and what I imagine to be thousands of injuries (though again I don't recall whether this was explicitly stated).

In the panel above, the television reporter mentions, "--hospitals unable to deal with the sheer volume of injuries as triage units scramble to cover--." This is pretty significant. Personally, if I lived in a comic book universe that suffered cataclysmic disasters once every month, I would want to be sure that we had enough hospitals in my city to care for me should I ever be taken over by an alien life force, turned evil by a mathematical equation that unmakes existence, or have a meteor land on my head. In fact, would we be able to look at provider capacity data from the American Medical Association or American Hospital Association and deduce how well a major city would be able to handle such a catastrophe?

Well, we would need considerably more information than what is offered in the panels above. However, I came across a fascinating study in the Annals of Emergency Medicine regarding hospital capacity in New York and the effect of 9/11 on discretionary reduction in occupancy. Then let me outsource this to them:

In New York State, 242 hospitals cared for a peak capacity of 2,707 children and 46,613 adults. Occupancy averaged 60% of the peak for children and 82% for adults, allowing an average statewide capacity for a surge of 268 new pediatric and 555 adult patients for each million age-specific population. After the September 11, 2001, attacks, in the New York City region, a discretionary modification of admissions and discharges resulted in an 11% reduction from the expected occupancy for children and adults.

What do these numbers actually mean? Well, according to the study, national policy as of 2004 dictates that hospitals be able to accommodate surges of 500 new patients (children and adults) per 1 million population above the current bed capacity in the event of an emergency. That is, the authors suggest that 500 new patients per million will likely overwhelm hospitals in such situations, particularly so for children since there are fewer pediatric beds per age-specific population than is the case for adults.

However, the study also suggests that more beds could be made available if needed. In fact, the data on discretionary reductions in occupancy and interviews with nurse practitioners and physicians revealed that as much as 1/3 of hospitalized adults could be discharged to accommodate new patients in the event of an emergency.

Beyond actual hospital capacity however, there are other factors. A study published by the New York Presbyterian Hospital and Cornell Weill Medical Center reported EMS communication errors and problems transporting triage burn victims to specialized centers during 9/11. Although an adequate number of beds were available, evidently only 26% of victims were successfully transported.

As far as the Umbrella Academy goes, we don't know how many people were injured and we don't know how many people died while being treated in hospitals. From the looks of it, it seems to actually be less severe than September 11 in terms of injuries and death tolls, so hospitals might have the equipment not to be too stressed. Of course, this scenario involves meteors, violins, robots, and superheroes. It could be that the injuries sustained during this attack were much more severe and required more attention and hospitalization.

The point is that in extremely disastrous supervillain attacks--the kind that has become commonplace in the DC and Marvel Universes--we might be in deep, deep trouble. I wonder if there is a larger health provider workforce and whether more funds are devoted to increased beds, etc. in these universes. There probably should be. In fact, that 500 per million population statistic would likely be greater.

If the increase in utilization from a single-payer health care system would be enough to overwhelm hospitals, imagine a weekly attack from Darkseid, Brainiac, and the Joker. Talk about a need for health reform...

11 comments:

Captain Noble said...

A few thoughts off the top of my head...I work in a 250 bed hospital doing security and emergency readiness. The reality is that for most healthcare facilities, any sort of serious disaster requires a lot of outside resources. Margins are far too slim for hospitals to be able to handle a large surge on their own. Other agencies - state, federal, non-profits - and such are vital in these situations. One of the biggest shortages is just licensed staff to be checking out the influx of people. There are some ways of dealing with this (expanding scope of care) and such, but actual bodies are necessary and usually in short supply.

I imagine that in the Marvel/DC universe, there would be more incentives to get people to go into nursing or medicine to help deal with this. I also imagine that there is a much larger budget at the state and federal level to deal with the effects of superhero battles and supervillain plots. I bet the Strategic National Stockpile (SNS) is much larger.

ShadowBanker said...

Captain Noble -- I think you're right about the expanded budget in the DC and Marvel Universes. There seems to be so much that is devoted to public insurance, hospital equipment, construction, etc. etc. What do you suppose national deficit is in these universes?

What do you think about what those nurse practitioners and physicians said, i.e. that in event of an emergency, 1/3 of hospitalized patients can be discharged within 24 hours?

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