Computer-Aided Design

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Computer-Aided Design

• Nathaniel Hupert, M.D., M.P.H.
• Assistant Professor of Public Health and Medicine
• Division of Outcomes and Effectiveness Research
• Weill Medical College of Cornell University

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Guiding Questions

• What are the critical components of a mass
  vaccination campaign?
• What role can spreadsheet models play in
  forecasting resource requirements for mass
  vaccination campaigns?
• What are the limitations of computer modeling in
  developing mass vaccination plans?

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Components of Mass Prophylaxis Plan
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SAMPLE PATIENT FLOW DIAGRAM FOR MASS ANTIBIOTIC
DISPENSING
SAMPLE PATIENT FLOW DIAGRAM FOR MASS ANTIBIOTIC
DISPENSING
HEALTHY PEOPLE GET PROPHYLAXIS AMBULATORY SICK
GET TREATMENT
VERY SICK GET TRANSPORT TO MEDICAL FACILITY
Created by the Department to Public Health, Weill
Medical College of Cornell Univeristy, NYCOEM,
and NYCDOHMH
Created by the Department of Public Health, Weill
Medical College of Cornell University, NYCOEM,
and NYCDOHMH
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Steady-state assumption

• Steady state develops if r R/ST ? 1, where R
  patient arrival rate
• S staff
• T mean service time
• When r 1, then S RT, or

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SCHEMATIC FLOW THROUGH WEILL/CORNELL SMALLPOX
VACCINATION MODEL
R
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Weill/Cornell Smallpox Vaccination Staffing Model
PRE-EVENT
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Weill/Cornell Smallpox Vaccination Staffing Model
POST-EVENT
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SAMPLE OUTPUT OF WEILL/CORNELL SMALLPOX
VACCINATION MODEL
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SAMPLE OUTPUT OF WEILL/CORNELL SMALLPOX
VACCINATION MODEL
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Limitations

• Accuracy of any model depends on the quality of
  the underlying data
• Processing times are critical variable
• Output is design-specific
• A differently designed vaccination center may
  give a different result
• Multiple scalable centers with externally
  controlled patient flow
• Feasible but requires law enforcement input
• These numbers reflect only critical dispensing
  staff and do not include support staff for the
  centers or distribution and logistics staff

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Conclusions

• Spreadsheet modeling allows planners to think
  with numbers when designing mass prophylaxis
  response strategies
• Modeling forces critical examination of
• Assumptions about vaccination center layout and
  processes
• Availability of resources
• Model estimates are useful data to guide planning
  but do not replace the real thing LIVE,
  REALISTIC EXERCISES

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Acknowledgments

• Co-Investigators
• Jason Cuomo, MPH
• Mark A. Callahan, MD
• Alvin I. Mushlin, MD, ScM
• NYC Office of Emergency Management
• Edward Gabriel, MPA, AEMT-P
• Sam Benson, AEMT-P
• Anita Sher, MIA
• U.S. DHHS, Office of the Asst. Secy for Public
  Health Preparedness
• Capt. Ann Knebel, RN, DNSc
• NYC Dept. of Health, Communicable Disease Unit
• Marci Layton, MD
• Sue Blank, MD, MPH
• NY Presbyterian Healthcare System
• Eliot Lazar, MD
• Arthur Klein, MD
• Neal Flomenbaum, MD