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Immediately after an earthquake a healthcare system within a city, comprising several hospitals, endures an extraordinary demand. This paper proposes a new methodology to estimate whether the hospital network has enough capacity to withstand the emergency caused by an earthquake. The ability of healthcare facilities and to provide a broad spectrum of emergency services immediately after a seismic event is assessed through a metamodel that assumes waiting time as main response parameter to assess the hospital network performance. The First Aid network of San Francisco subjected to a 7.2 Mw magnitude earthquake has been used as case study. The total number of injuries and their distributions among the six major San Francisco's Emergency Departments have been assessed and compared with their capacity that has been determined using a survey conducted by the medical staff of the hospitals. The numerical results have shown that three of the six considered San Francisco's hospitals cannot provide emergency services to the estimated injured. Two alternatives have been proposed to improve the performance of the network. The first one redistributes existing resources while the second one considers additional resources by designing a new Emergency Department. [ABSTRACT FROM AUTHOR]

Drug overdose is now the leading cause of unintentional death nationwide, driven by increased prescription opioid overdoses. To better understand urban opioid overdose deaths, this paper examines geographic, demographic, and clinical differences between heroin-related decedents and prescription opioid decedents in San Francisco from 2010 to 2012. During this time period, 331 individuals died from accidental overdose caused by opioids (310 involving prescription opioids and 31 involving heroin). Deaths most commonly involved methadone (45.9 %), morphine (26.9 %), and oxycodone (21.8 %). Most deaths also involved other substances (74.9 %), most commonly cocaine (35.3 %), benzodiazepines (27.5 %), antidepressants (22.7 %), and alcohol (19.6 %). Deaths were concentrated in a small, high-poverty, central area of San Francisco and disproportionately affected African-American individuals. Decedents in high-poverty areas were significantly more likely to die from methadone and cocaine, whereas individuals from more affluent areas were more likely die from oxycodone and benzodiazepines. Heroin decedents were more likely to be within a younger age demographic, die in public spaces, and have illicit substances rather than other prescription opioids. Overall, heroin overdose death, previously common in San Francisco, is now rare. Prescription opioid overdose has emerged as a significant concern, particularly among individuals in high-poverty areas. Deaths in poor and affluent regions involve different causative opioids and co-occurring substances. [ABSTRACT FROM AUTHOR]