Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response

Rouck, Ruben De; Benhassine, Mehdi; Debacker, Michel; Dugauquier, Christian; Dhondt, Erwin; Utterbeeck, Filip Van; Hubloue, Ives

doi:10.3389/fpubh.2023.1167706

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…Such an endeavor could involve enacting stricter regulations on the storage and transport of hazardous materials, coupled with a steadfast commitment to international conventions explicitly prohibiting the use of such weapons. 29,30 On the often-overlooked psychological front, the traumatic nature of CBRN incidents necessitates the establishment of robust psychosocial support systems. 31,32 This should be realized in the form of therapy, counselling, and community-based rehabilitation programs; all designed to expedite the recovery process for victims and the broader community.…”

Section: Discussionmentioning

confidence: 99%

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Public Health Responses to CBRN Terrorism in the Middle East and North Africa

Mani,

Plummer,

Kuhn

et al. 2024

Disaster med. public health prep.

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Objective: Escalating global challenges such as disasters, conflict, and climate change underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures. Methods: Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems. Results: The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies. Conclusions: The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Public Health Responses to CBRN Terrorism in the Middle East and North Africa

Mani,

Plummer,

Kuhn

et al. 2024

Disaster med. public health prep.

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Advancing Military Medical Planning in Large Scale Combat Operations: Insights From Computer Simulation and Experimentation in NATO’s Vigorous Warrior Exercise 2024

Benhassine,

Quinn,

Stewart

et al. 2024

Military Medicine

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Introduction The ongoing conflict in Ukraine from Russian invasion presents a critical challenge to medical planning in the context of multi-domain battle against a peer adversary deploying conventional weapon systems. The potential escalation of preventable morbidity and mortality, reaching a scale unprecedented since World War II, underscores the paramount importance of effective phases of care from Point of Injury (PoI)/Point of Wounding (PoW) or Point of Exposure (PoE) to Role 1 (R1) and Role 2 (R2) echelons of care. The NATO Vigorous Warrior (VW) Live Exercise (LIVEX) serves as a strategic platform for NATO and its partners, providing an opportunity to challenge operational concepts, experiment, innovate life-saving systems, and foster best practices across the Alliance. Materials and Methods This study delineates the strategic application of the VW LIVEX platform for the adaptation of the computational simulation software Simulation for the Assessment and Optimization of Medical Disaster Management (SIMEDIS) within the context of Large-Scale Combat Operations (LSCO). The SIMEDIS computer simulator plays a pivotal role by furnishing real-time insights into the evolving injury patterns of patients, employing an all-hazards approach. This simulator facilitates the examination of temporal shifts in medical timelines and the ramifications of resource scarcity against both morbidity and mortality outcomes. The VW LIVEX provides a unique opportunity for systematic validation to evaluate the results of the computer simulator in a realistic setting and identify gaps for future concepts of operations. Results We report the process and methodologies to be evaluated at the VW LIVEX in far forward and retrospective medical support operations. Using the SIMEDIS simulator, we can define battlefield scenarios for varied situations including artillery, drone strikes, and Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) attacks. Casualty health progressions versus time are dependent on each threat. Mortality is computed based on the concepts found in Tactical Combat Casualty Care (TCCC) of “self-aid”/“buddy-aid” factoring in the application or absence of definitive traumatic hemorrhage control and on the distribution policy of victims to medical treatment facilities through appropriate Command and Control (C2) (“Scoop and Run” versus “Stay and Play”). The number of medical supplies available along with the number of transport resources and personnel are set and are scalable, with their effect on both morbidity and mortality quantified. Concept of Medical Operations can be optimized and interoperability enhanced when shared data are provided to C2 for prospective medical planning with retrospective data. The SIMEDIS simulator determines best practices of medical management for a myriad of injury types and tactical/operational situations relevant to policy making and battlefield medical planning for LSCO. Conclusions The VW LIVEX provides a Concept Development and Experimentation platform for SIMEDIS refinement and conclusive insights into medical planning to reduce preventable morbidity and mortality. Recommending further iterations of similar methodologies at other NATO LIVEXs for validation is crucial, as is information sharing across the Alliance and partners to ensure best practice standards are met.

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Simulating Victim Health State Evolution From Physical and Chemical Injuries in Mass Casualty Incidents

Benhassine,

De Rouck,

Debacker

et al. 2023

New Trends in Computer Sciences

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The field of discrete-event simulation for medical disaster management is relatively new. In such simulations, human victims are generated using pre-determined transitions from one health state to the next, based on a set of triggers that correspond to treatment or the clinical progression of untreated injuries or diseases. However, this approach does not account for subtle differences in clinical progression. We propose a parameter-based model to characterize the evolution of symptoms at first for physical and nerve agent chemical injuries. We used a Gompertz function to predict the time of death in trauma based on forensic data. Then we separately considered the effects of the chemical warfare agent sarin (GB) being the origin of the chemical injuries for the purpose of modelling a GB attack in a metro station. We emphasize that our approach can be extended to other CBRN threats pending knowledge of clinical progressions available in the literature for the purpose of casualty estimations. The intent is to provide an estimate of time to death without any treatment and overlay this model with a treatment model, improving the evolution of the health state. A modification for non-life-threatening injuries is included without losing generality. Improvement functions modelling medical treatment are proposed. We argue that the availability of injury scores vs mortality can greatly enhance the validity of the model.

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Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response

Cited by 4 publications

References 38 publications

Public Health Responses to CBRN Terrorism in the Middle East and North Africa

Public Health Responses to CBRN Terrorism in the Middle East and North Africa

Advancing Military Medical Planning in Large Scale Combat Operations: Insights From Computer Simulation and Experimentation in NATO’s Vigorous Warrior Exercise 2024

Simulating Victim Health State Evolution From Physical and Chemical Injuries in Mass Casualty Incidents

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