Coordination of Autonomous Healthcare Entities: Emergency Response to Multiple Casualty Incidents

Abstract

In recent years, many urban areas have established healthcare coalitions (HCCs) composed of autonomous (and often competing) hospitals, with the goal of improving emergency preparedness and response. We study the role of such coalitions in the specific context of response to multiple-casualty incidents in an urban setting, where on-scene responders must determine how to send casualties to medical facilities. A key function in incident response is multi-agency coordination. When this coordination is provided by an HCC, responders can use richer information about hospital capacities to decide where to send casualties. Using bed availability data from an urban area and a suburban area in the United States, we analyze the response capability of healthcare infrastructures under different levels of coordination, and we develop a stress test to identify areas of weakness. We find that improved coordination efforts should focus on decision support using information about inpatient resources, especially in urban areas with high inter-hospital variability in resource availability. We also find that coordination has the largest benefit in small incidents. This benefit is a new value proposition for HCCs, which were originally formed to improve preparedness for large disasters.