摘要：Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans. The sudden impact of a disaster is a substantial burden on the affected population’s health and on the health system’s capacity to respond to changes in health care needs. A disaster is an unusual public health event with the potential to overwhelm the initial surge capacity of the affected health system. Disasters may create a secondary surge in casualties because of the sudden increase in need for long-term health care in the disaster population. Disaster plans and response activities are frequently designed to address and mitigate the immediate impact of the disaster on the health and safety of the affected community. But few plans fully anticipate and prepare for the secondary recovery phase, which is often plagued with cascading disasters—such as the loss of medical infrastructure—causing a major crisis in chronic disease management. These complementary health recovery issues need more attention in our disaster recovery plans and associated research portfolios. 1 In the months after a disaster, secondary surges in demand for medical care place excess strain on a fragile health care system. 2–5 The Agency for Healthcare Research and Quality (AHRQ) defines surge capacity as a “health care system’s ability to expand quickly beyond normal services to meet an increased demand for medical care in the event of bioterrorism or other large-scale public health emergencies.” 6 (p1) Surge capacity is not a new area of research; benchmarks for surge capacity have been expressed in terms of hospital bed capacity, medical equipment and supplies, population to provider ratios, personnel availability, prescription medication refills, portable triage and decontamination centers, and the ability to legally delivery health services under situations that exceed authorized capacity. 7,8 Surge capacity refers to the provision of medical care to a large volume of persons during an acute response. 9 We define secondary surge capacity as the sustained ability of a health care system to expand operational resources to meet the increased or fluctuating demand for medical care services throughout long-term recovery. The disaster literature has examined surge capacity constraints during the initial response 10,11 but has largely overlooked the surging demand in health services throughout the recovery period. Questions concerning the national state of health system surge capacity are still being answered; however, the provision of routine health services in the months and years after a disaster is an equally important and understudied challenge in disaster recovery.
