Defining hospital surge capacities and regional breakpoints for mass critical casualties: the national MassCare indicator

Background: This study proposes a method for a national indicator of mass care capacities in crisis situations (MassCare). Methods: MassCare was based on national recommendations, expert working groups, national administrative databases. Results: MassCare corresponds to the number of patients who can be treated immediately and simultaneously by each primary care unit, according to the NATO triage scale. Experts distinguished 3 determinants: (A) primary care unit; (B) adult or child patient, (C) working or nonworking hours. For each, the maximum MassCare (Tmax) can be estimated using national administrative databases for each hospital. Then, several surveys of hospital panels are conducted to determine the available parts of facilities, β 1 at time 0 (T0) and β 2 at time + 3h (T3): T0-MassCare-A X B X C X = β 1 *Tmax-MassCare-A X B X C X Thus, the structural capacities at T0 and T3 are estimated for each hospital with the average β observed in the panel. For critical surgical patients, the MassCare indicator is derived from the minimum of surgeons, anesthetists or nurse anesthetists, and operating rooms. For emergency department, the MassCare capacity is 2 severe patients per doctor and 2 nurses. The accessible capacities at one hour of transport from the crisis site define District-MassCare. Conclusion: MassCare is a new metric method integrated in the National Crisis Guide.