Preparedness for the Rio 2016 Olympic Games: Hospital Treatment Capacity in Georeferenced Areas

ARTIGO ARTICLE 1 Preparedness for the Rio 2016 Olympic Games: hospital treatment capacity in georeferenced areas Preparação para os Jogos Olímpicos Rio 2016: capacidade de tratamento hospitalar em áreas georreferenciadas La preparación para los Juegos Olímpicos de Río 2016: capacidad de tratamiento hospitalario en áreas georreferenciadas Carolina Figueiredo Freitas 1 Claudia Garcia Serpa Osorio-de-Castro 2 Kimberley Irene Shoaf 3 Raulino Sabino da Silva 2 Elaine Silva Miranda 1 Abstract Recently, Brazil has hosted mass events with recognized international rel- 1 Faculdade de Farmácia, Correspondence Universidade Federal E. S. Miranda evance. The 2014 FIFA World Cup was held in 12 Brazilian state capitals Fluminense, Niterói, Brasil. Faculdade de Farmácia, and health sector preparedness drew on the history of other World Cups 2 Escola Nacional de Saúde Universidade Federal Pública Sergio Arouca, Fluminense. and Brazil’s own experience with the 2013 FIFA Confederations Cup. The Fundação Oswaldo Cruz, Rio Rua Dr. Mário Viana 523, current article aims to analyze the treatment capacity of hospital facilities de Janeiro, Brasil. Niterói, RJ 24241-000, Brasil. in georeferenced areas for sports events in the 2016 Olympic Games in the 3 Department of Family [email protected] and Preventive Medicine, city of Rio de Janeiro, based on a model built drawing on references from University of Utah, Salt Lake the literature. Source of data were Brazilian health databases and the Rio City, U.S.A. 2016 website. Sports venues for the Olympic Games and surrounding hospitals in a 10km radius were located by geoprocessing and designated a “health area” referring to the probable inflow of persons to be treated in case of hospital referral. Six different factors were used to calculate needs for surge and one was used to calculate needs in case of disasters (20/1,000). Hospital treatment capacity is defined by the coincidence of beds and life support equipment, namely the number of cardiac monitors (electrocardiographs) and ventilators in each hospital unit. Maracanã fol- lowed by the Olympic Stadium (Engenhão) and the Sambódromo would have the highest single demand for hospitalizations (1,572, 1,200 and 600, respectively). Hospital treatment capacity proved capable of accommodat- ing surges, but insufficient in cases of mass casualties. In mass events most treatments involve easy clinical management, it is expected that the current capacity will not have negative consequences for participants. Mass Casualty Incidents; Delivery of Health Care; Hospitals; Geographic Locations http://dx.doi.org/10.1590/0102-311X00087116 Cad. Saúde Pública, Rio de Janeiro, 32(7):e00087116, jul, 2016 2 Freitas CF et al. Introduction The current article aims to analyze the treatment capacity of hospital facilities in georefe- In Brazil, events that involve mass gatherings renced areas for sports events in the 2016 Olym- are held every year, and the country has recently pic Games in the city of Rio de Janeiro, based hosted major international events. The 2014 FIFA on a model built drawing on references from World Cup was held in 12 Brazilian state capitals. the literature. In some World Cup host cities, operational plans were produced that included health and health surveillance preparedness 1,2,3. Health sector Method preparedness drew on the history of other World Cups and Brazil’s own experience with the 2013 Study scenario FIFA Confederations Cup. Planning was based on the prevailing health system’s structure. The municipality of Rio de Janeiro is located at Health sector preparedness measures for longitude 43º12’W and latitude 22º54’S in the mass events pointed to improvement in services Southeast region of Brazil. Arenas, parks, and capacity and quality. For the 2014 FIFA World stadiums were built or organized, forming com- Cup, improvements were proposed in access to plexes for the competitions, distributed in four services, activation of deactivated hospital beds, regions determined by the event’s organization: and the construction of new Emergency Care Barra da Tijuca, Maracanã, Copacabana, and Units to increase the installed capacity 1,2,3. Deodoro. Probable causes of disease, injury, and death in major events have been reported in the litera- Geoprocessing ture and are generally context-related. The health threats depend on climatic factors, participants’ The study obtained the addresses of the compe- profile, and type of event 4. Intrinsic factors in tition venues from the official website of the Rio mass gatherings further influence the health out- de Janeiro Olympic and Paralympic Games (Rio comes. The agglomeration of people with diverse 2016; http://www.brasil2016.gov.br/pt-br/olim origins and health conditions favors transmis- piadas/instalacoes). The hospital addresses were sible diseases, which become real threats 5. The obtained from the National Registry of Health physical structure of the venues where events Establishments – CNES [Cadastro Nacional de take place, such as problems with access routes Estabelecimentos de Saúde]. Healthcare estab- and emergency exits and/or lack of public safe- lishments pertaining to hierarchical levels 5,6,7, ty measures can also lead to incidents 6. Health and 8 were selected, since these levels are classi- problems related to the events can also overload fied as hospital care units. All the addresses were health services 7. then geocoded to obtain the geographic coordi- According to studies on the causes of demand nates (latitude and longitude), allowing the geo- for medical care and severity according to type processing, performed in ArcGIS, version 10.1.1 of event, in most events the incidents are minor (Environmental Systems Research Institute, Red- and do not require medical evacuation 1. Dur- lands, USA. http://www.esri.com/software/arc ing preparedness for the 2014 FIFA World Cup, gis/index.html). it was estimated that 1% to 2% of the public at A 10-kilometer radius was drawn around each the match venues might need some medical care, competition venue 13, illustrated with a colored and of these, 0.2% to 0.5% would require high circle, referring to the probable inflow of persons complexity care and consequently evacuation to to be treated in case of hospital referral. This al- a hospital facility 3. lowed identifying large areas that would concen- In the international literature, studies on trate health care. The hospitals were identified previous World Cups report estimates on the individually on a map, within each large area. demand for hospital care ranging from 0.002% a 0.05%, and from 0.5% to 2% for the need of hos- Model pitalization in case of a disaster 8,9,10,11. In addition to the equipment needed for med- • Calculation of needs ical evacuation, cases of hospital care require pro- vision of basic equipment and physical infrastruc- In case of an increase in the demand for medi- ture for diagnosis and treatment. Takahashi et cal evacuation and/or hospitalizations due to a al. 12 estimated hospital treatment capacity in dif- surge, calculation of needs is based on the maxi- ferent situations, based on coinciding availabil- mum estimate of the public in attendance at the ity of beds and essential life support equipment, event venues. In the current study the informa- such as ventilators and electrocardiographs. tion on the venues’ capacity was obtained from Cad. Saúde Pública, Rio de Janeiro, 32(7):e00087116, jul, 2016 HOSPITAL TREATMENT CAPACITY FOR THE OLYMPIC GAMES IN 2016 3 the official Rio 2016 website. Each area’s maxi- unit 12. The sum by area was obtained from the mum demand was obtained as the sum of the in- results for each hospital. dividual maximum capacities of the competition venues on the days or periods in which the sports Ethical considerations contests were scheduled to take place, according to the official calendar published by the Olympic The current project is nested in the Pharmaceuti- Games organization (https://www.rio2016.com/ cal Care Preparedness Project for mass events in sites/default/files/users/rio2016_files/guia_in Brazil (Prepare Brazil Project), approved by the gressoport_2015_diario.pdf, accessed on 20/ Ethics Research Committee of Escola Nacional Mar/2016). de Saúde Pública Sergio Arouca/Fundação Os- Six different factors were used to calculate waldo Cruz (CAAE 177965.13.6.0000.5240). needs. The surge categories were: 0.05/1,000, ad- opted in Japan for the 2002 FIFA World Cup 11; 0.07/1,000, based on a historical series of mass Results gatherings in Australia 10; 0.5/1,000, based on planning for the 2010 FIFA World Cup in South Figure 1 shows nine areas: red, blue, green, black, Africa 8; and calculations based on the Brazil- pink, orange, yellow, white, and gray. In a 10-ki- ian Ministry of Health’s report on the 2013 FIFA lometer radius around all the competition ven- Confederations Cup, which pointed to several ues, a total of 338 hospital units were identified, possibilities, namely 0.02/1,000, 0.04/1,000, both public and private, with and without emer- 0.05/1,000,and 0.1/1,000, all for high complexity gency care. The majority of the hospital units care and assuming that 1% to 2% of the public are located in the green, black, yellow, white and will need some medical care 3. gray areas. To calculate the demand for medical evac- Except for the red area, all the areas had hos- uation and/or hospitalizations due to a surge pitals that could be georeferenced to more than with mass casualties, the calculation was based one event venue. The choice was made to analyze on the maximum capacity of each competition each area alone. venue, as a function of the assumption that the Table 1 shows the areas, competition venues incident would be locally restricted, namely that with their maximum capacities, and number of it would not involve all the venues in a given ar- corresponding hospitals.

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