Modeling the Public Health Response to Bioterrorism: Using Discrete Event Simulation to Design Antibiotic Distribution Centers

TLDR

Post‑exposure prophylaxis is a critical component of the public health response to bioterrorism. The authors use computer‑simulation modeling to design antibiotic distribution centers for bioterrorism response and propose live exercises to validate the model and improve preparedness. Discrete‑event simulation was employed to estimate staffing needs for entry screening, triage, medical evaluation, and drug dispensing in a hypothetical distribution center across low, medium, and high prevalence scenarios, using arrival rates and processing times from prior mass prophylaxis campaigns and conducting sensitivity analyses on staff utilization and surge capacity. The model indicated that 93 to 111 staff are required to process approximately 1,000 people per hour, with excess capacity roughly equal to (1‑UR) for triage, demonstrating that discrete‑event simulation is a useful tool for developing bioterrorism public health infrastructure.

Abstract

Background Post-exposure prophylaxis is a critical component of the public health response to bioterrorism. Computer simulation modeling may assist in designing antibiotic distribution centers for this task. Methods The authors used discrete event simulation modeling to determine staffing levels for entry screening, triage, medical evaluation, and drug dispensing stations in a hypothetical antibiotic distribution center operating in low, medium, and high disease prevalence bioterrorism response scenarios. Patient arrival rates and processing times were based on prior mass prophylaxis campaigns. Multiple sensitivity analyses examined the relationship between average staff utilization rate (UR) (i.e., percentage of time occupied in patient contact) and capacity of the model to handle surge arrivals. Results Distribution center operation required from 93 staff for the low-prevalence scenario to 111 staff for the high-prevalence scenario to process approximately 1000 people per hour within the baseline model assumptions. Excess capacity to process surge arrivals approximated (1-UR) for triage staffing. Conclusions Discrete event simulation modeling is a useful tool in developing the public health infrastructure for bioterrorism response. Live exercises to validate the assumptions and outcomes presented here may improve preparedness to respond to bioterrorism.