Resiliency of the Ontario health care system to care for casualties due to conflict with a near-peer adversary: a population-based modeling study

Background — The threat of conflict between near-peer adversaries provides unique challenges to any health care system. As evidenced by the Ukraine-Russia conflict, sustained combat across broad geographic areas has led to a large number of casualties. Furthermore, the utilization of thermobaric and incendiary weapons has been associated with high proportions of combined multisystem blunt, penetrating, thermal, and blast injuries. The management of large volume of casualties with complex injuries will require significant resources. Military and civilian health care systems that may face a sustained and large evacuation of casualties to the homeland for definitive and rehabilitative care must plan accordingly.

Methods — Actual health care resource utilization was calculated between January 1, 2017, and March 31, 2023, in Ontario, Canada, through analyses of population-based administrative data sets. Existing hospital resources were stratified into ward, intensive care (ICU), burn care, and rehabilitation and expressed as mean weekly bed days. We then modeled the weekly addition of evacuated casualties into the health care system with the outcome expressed as added capacity required assuming civilian standard of care would be maintained. Clinical scenarios, which vary in patient volume (84, 140, 280, and 560 new patients/week) and duration (4, 12, 26, and 52 weeks), were modeled. Models were limited to trauma centers or the entire health care system.

Results — Added trauma center ward and/or ICU capacity peak requirements ranged from +3% in short low-volume scenarios to +25% in long very high-volume scenarios (+1% to +9% respectively when the entire system was modeled). Rehabilitation capacity would require larger increases ranging from +4% to +37%. However, added burn capacity required ranged from +159% to +1,200% of existing capacity.

Discussion — Given that Ontario hospitals (ICU, burn, ward, and rehabilitation) typically run close to or exceed their funded capacity, additional casualty volumes will require new resources and innovative strategies to manage patient flow.