Hospital Resource Allocation in Mass-Casualty Incidents: A Major Trauma Centre’s Experience
Ritchie, D., Christchurch Hospital, Christchurch, New Zealand Jackson, B., Christchurch Hospital, Christchurch, New Zealand Wakeman, C., Christchurch Hospital, Christchurch, New Zealand Creagh, T., Christchurch Hospital, Christchurch, New Zealand
Introduction: Christchurch Hospital is a major trauma centre that has played a key role in the management of mass-casualty incidents (MCIs) within New Zealand – including the recent March 2019 Christchurch Mosque Shootings and the December 2019 Whakaari (White Island) Volcanic Eruption.
Aims: The aim of this study was to analyse hospital resource utilisation at Christchurch Hospital (e.g. monetary costs, non-measured and opportunity costs, and human resources) during two recent MCIs.
Methods: Retrospective analysis of cross-sectional data from local hospital and trauma datasets.
Results: There were 45 and 8 casualties that presented as index cases to Christchurch Hospital in the Mosque and Whakaari MCI cohorts respectively. The total length of stay was 15,054 hours (average of 335 hours per patient) in the Mosque cohort and 1,841 hours (average of 230 hours per patient) in the Whakaari cohort. Mean surgeon time (operative length adjusted for surgical staffing) was 388 and 879 minutes in the Mosque and Whakaari cohorts respectively. There were prominent differences in the pattern of health staffing during admission; utilisation of blood products and other consumables; requirement for radiological, pathological, and other medical services; and theatre utilisation between the two cohorts.
Conclusions: Mass-casualty incidents have had significant effects on hospital resource utilisation at Christchurch Hospital. MCIs with burns trauma utilise relatively more acute surgical resources than non-burns trauma. A specific mechanism for additional national funding in the case of severe, complex, burns-MCIs exists and has been enacted; to our knowledge no such clause exists for non-burns MCIs and therefore there may be discrepancies in funding of different forms of MCIs in New Zealand. Analysis of resource allocation and funding of MCIs at a regional and national level is required to ensure trauma centres can respond to crises effectively.