Allocation of Scarce Resources After a Nuclear Detonation: Setting the Context

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>The purpose of this article is to set the context for this special issue of <jats:italic>Disaster Medicine and Public Health Preparedness</jats:italic> on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S20-S31)</jats:p>

Scarce Resources for Nuclear Detonation: Project Overview and Challenges

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.…”

“…The physical infrastructure damage will limit transportation and access to those in need. 15 The detonation will release dangerous levels of radiation immediately and also for hours to days from fallout. Combined injury (defined as physical trauma plus radiation) greatly increases the fatality risk even with maximal medical treatment, which will not be readily available.…”

“…14,21 Understanding the expected injury types has implications for triage decision making as outlined by Coleman and colleagues. 22 Four damage zones are defined in Planning Guidance for Response to a Nuclear Detonation 4 and detailed by Knebel et al 15 : severe dam-age, moderate damage, light damage, and dangerous fallout. The dangerous fallout zone footprint, in which there is sufficient radiation to produce the acute radiation syndrome, will reach its maximal extent after approximately 1.5 hours and then shrink rapidly as fallout decays.…”

“…The resulting articles in this special issue of Disaster Medicine and Public Health Preparedness are not intended to be exhaustive reviews, and they reflect the judgment and opinion of the experts, not those of the governmental agencies or academic institutions that employ them. [14][15][16][17][18][19][20][21][22] The recommendations are based on the available data, recognizing that the human and animal data on radiation injury alone and on combined injury are limited.Model output for casualty types and number are described in a general manner. 15 (The Department of Health and Human Services has detailed models from which the data and guidance in these articles are based for the consequences of nuclear detonation in a range of cities, from a variety of heights of burst, and under a range of meteorological conditions, and for scarcity of specific resources for medical management of acute radiation syndrome.…”

Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events

“…Planning an effective response following a large radiation event such as a nuclear power plant disaster or a terrorist event involving an improvised nuclear device presents many challenges to policy-makers and those responsible for public response (1,2) . These challenges are complicated by not having a comparative framework suitable for evaluating which currently available methods or those in advanced development are capable of addressing the needs in the context of a large disaster.…”