Development and initial validation of a stochastic discrete event simulation to assess disaster preparedness

Abstract: Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible and easy-to-use. Emergo Train System (ETS) is an analogue simulation system used for disaster preparedness assessments. This thesis aimed to digitalize the ETS model and develop a stochastic simulation software for improved disaster preparedness assessments. Simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analogue ETS disaster preparedness assessment exercise. The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other parameters. It consists of two main programs; an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analogue exercise showed a general high agreement in terms of patient outcome. The analogue exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death. Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analogue capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.