EAPSI: Quantifying the effect of centralization on the resilience of the regional healthcare system in the 2010-11 Canterbury earthquake sequence

在世界范围内，医疗保健系统已被确定为关键的基础设施，必须保持社区有效应对地震等灾害的功能。许多灾后恢复研究都假设可以从独立医院的表现来预测整个系统的功能。然而，医疗保健是一个由提供者和设施组成的网络系统，而不是一组独立的实体。因此，为了更好地理解灾后医疗保健服务，重要的是捕获系统所有部分的贡献和相互作用。本研究将应用工程技术分析复杂的系统，以弹性为基础的框架，以表征医疗保健在系统水平。该框架将用于确定地震事件后集中化对整体医疗保健系统性能的影响。在2010-2011年的坎特伯雷地震序列中遭受严重破坏的坎特伯雷地区，为研究从一系列破坏性地震中恢复的高度集中的医疗保健系统提供了一个独特的机会。这项工作将与Sonia Giovinazzi博士和新西兰坎特伯雷大学合作进行。医疗保健系统将通过与管理人员、工程师和医疗保健提供者的访谈来描述。重点将放在系统内各组织如何分配创建激增能力所需的资源，如空间（包括基础设施）、人员和物资。本研究还将考察地震后资源配置的变化。故障树分析将应用于将医疗保健系统的高级功能（例如，提供手术的能力）与基本水平的资源性能（例如，污水损失）在四种情况下联系起来：地震前分散、地震前集中、地震后分散和地震后集中。每个条件下的弹性将使用为本研究开发的基于功能的弹性度量来计算情景事件。NSF EAPSI奖是与新西兰皇家学会合作资助的。

Healthcare systems have been identified worldwide as critical infrastructure that must remain functional for communities to effectively respond to disasters such as earthquakes. Much disaster resilience research has assumed that system-wide functionality can be predicted from the performance of independent hospitals. Healthcare, however, functions as a networked system of providers and facilities, rather than a set of independent entities. Therefore, to better understand healthcare delivery after a disaster, it is important to capture the contributions and interactions of all parts of the system. This study will apply engineering techniques for analyzing complex systems to a resilience-based framework in order to characterize healthcare at a system level. This framework will be used to determine the effect of centralization on overall healthcare system performance following seismic events. The Canterbury region, which sustained severe damage in the 2010-2011 Canterbury Earthquake Sequence, provides a unique opportunity to study a highly centralized healthcare system recovering from a series of devastating earthquakes. This work will be performed in collaboration with Dr. Sonia Giovinazzi and the University of Canterbury in New Zealand.The healthcare system will be characterized through interviews with administrators, engineers, and healthcare providers. Emphasis will be placed on how organizations within the system allocate resources needed to create surge capacity, such as space (including infrastructure), staff, and supplies. This study will also examine how resource allocation changed after the earthquakes. Fault-tree analysis will be applied to connect the high-level functionality of the healthcare system (e.g., ability to provide surgery) with base-level performance of resources (e.g. loss of sewage) under four conditions: decentralized pre-earthquake, centralized pre-earthquake, decentralized post-earthquake, and centralized post-earthquake. Resilience under each condition will be calculated for scenario events using functions-based resilience metrics developed for this study. This NSF EAPSI award is funded in collaboration with the Royal Society of New Zealand.