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Allocation of Scarce Resources During Mass Casualty Events

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Allocation of Scarce Resources During Mass Casualty Events Evidence Report/Technology Assessment Number 207 Allocation of Scarce Resources During Mass Casualty Events Agency for Healthcare Research and Quality Evidence-Based Practice Advancing Excellence in Health Care • www.ahrq.gov Evidence Report/Technology Assessment Number 207 Allocation of Scarce Resources During Mass Casualty Events Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10062-I Prepared by: Southern California Evidence-based Practice Center Santa Monica, CA Investigators: Justin W. Timbie, Ph.D., RAND Corporation Jeanne S. Ringel, Ph.D., RAND Corporation D. Steven Fox, M.D., M.S., RAND Corporation Daniel A. Waxman, M.D., RAND Corporation Francesca Pillemer, Ph.D., RAND/University of Pittsburgh Christine Carey, M.A., RAND Corporation Melinda Moore M.D., M.P.H., RAND Corporation Veena Karir, PharmD., M.S., RAND/University of Pittsburgh Tiffani J. Johnson, M.D., RAND/University of Pittsburgh, Children’s Hospital of Pittsburgh Neema Iyer, M.P.H., RAND Corporation Jianhui Hu, M.P.P., RAND Corporation Roberta Shanman, M.L.S., RAND Corporation Jody Wozar Larkin, M.L.I.S., RAND Corporation Martha Timmer, M.S., RAND Corporation Aneesa Motala, B.A., RAND Corporation Tanja R. Perry, B.H.M., RAND Corporation Sydne Newberry, Ph.D., RAND Corporation Arthur L. Kellermann, M.D., M.P.H., RAND Corporation AHRQ Publication No. 12-E006-EF June 2012 This report is based on research conducted by the Southern California–RAND Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, Md. (Contract No. 290-2007-10062-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. Funding to support Allocation of Scarce Resources During Mass Casualty Events was provided by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response through an Interagency Agreement with the Agency for Healthcare Research and Quality (Contract No. 290-2007-10062-I). The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested Citation: Timbie JW, Ringel JS, Fox DS, Waxman DA, Pillemer F, Carey C, Moore M, Karir V, Johnson TJ, Iyer N, Hu J, Shanman R, Larkin JW, Timmer M, Motala A, Perry TR, Newberry S, Kellermann AL. Allocation of Scarce Resources During Mass Casualty Events. Evidence Report No. 207. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-2007-10062-I.) AHRQ Publication No. 12-E006-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the nation. The reports undergo peer review and public comment prior to their release as a final report. AHRQ expects that EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers, as well as the health care system as a whole, by providing important information to help improve health care quality. We welcome comments on this evidence report. Comments may be sent by mail to the Task Order Officer named in this report to: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Richard Ricciardi, Ph.D., N.P., FAANP Director Task Order Officer Evidence-based Practice Program Center for Primary Care, Prevention Agency for Healthcare Research and Quality and Clinical Partnerships Agency for Healthcare Research and Quality iii Acknowledgments The authors would like to thank Aram Dobalian, M.P.H., Director of the Department of Veterans Affairs Emergency Management Evaluation Center (VEMEC) at the VA Greater Los Angeles Healthcare System (VAGLAHS), and Kristi Koenig, M.D., professor of emergency medicine at the University of California, Irvine, for their invaluable input and guidance on the report. Both are nationally recognized experts in disaster medicine and health system preparedness. The authors would also like to thank members of the public who submitted comments on a draft version of this report. Technical Expert Panel Tim Davis, M.D., M.P.H. National Disaster Medical System Deborah Levy, Ph.D., M.P.H. Washington, DC Centers for Disease Control and Prevention National Center for Preparedness, Detection, Daniel Fagbuyi, M.D. and Control of Infectious Diseases Children’s National Medical Center Atlanta, GA Washington, DC Meredith Li-Vollmer, Ph.D., M.A. DeAnn Friedholm, M.P.A. Seattle & King County Consumers Union Seattle, WA Washington, DC Jeffrey Lowell, M.D. Cynthia Hansen, Ph.D. Washington University School of Medicine Department of Health and Human Services St. Louis, MO Office of the Assistant Secretary for Preparedness and Response Major General Lester Martinez-Lopez, Office of Preparedness and Emergency M.D., M.P.H., FAAFP Operations Brandon Regional Hospital Washington, DC Valrico, FL James Hodge, J.D., L.L.M. Mark Williams, M.D., FACP, FHM Arizona State University Northwestern University Feinberg School of Tempe, AZ Medicine Chicago, IL Mary Jagim, R.N., B.S.N., CEN, FAEN Intelligent InSites Charlotte Yeh, M.D. Moorhead, MN AARP Services, Inc. Tewksbury, MA Kathy Kinlaw, M.Div. Emory University Atlanta, GA iv Peer Reviewers Susan Allan, M.D., J.D., M.P.H. Cheri Hummel University of Washington California Hospital Association Seattle, WA Sacramento, CA Georges Benjamin, M.D., FACP, FNAPA, Roberta Kanter, M.D. FACEP (E), Hon FRSPH Upstate Medical University American Public Health Association Syracuse, NY Washington, DC Leslee Stein-Spencer, R.N., M.S. Colonel Connie Boatright, M.S.N., R.N. Chicago Fire Department Managed Emergency Surge for Healthcare Chicago, IL (MESH) Consultant Indiana Primary Health Care Joseph Waeckerle, M.D., FACEP Association University of Missouri–Kansas City School Indianapolis, IN of Medicine Leawood, KS Eric Frykberg, M.D. University of Florida Matthew Wynia, M.D., M.P.H. Jacksonville, FL University of Chicago Chicago, IL v Allocation of Scarce Resources During Mass Casualty Events Structured Abstract Objectives. This systematic review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs). Specifically, the review addresses the following questions: (1) What strategies are available to policymakers to optimize the allocation of scarce resources during MCEs? (2) What strategies are available to providers to optimize
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