Scarce Resources for Nuclear Detonation: Project Overview and Challenges

Abstract

terrorist nuclear detonation of 10 kilotons would have catastrophic physical, medical, and psychological consequences and could be accomplished with a device in a small truck. Tens of thousands of injured and ill survivors and uninjured, concerned citizens would require medical care or at least an assessment and instructions. In proximity to the incident location, there would be a huge imbalance between the demand for medical resources and their availability. 1-3 Beyond the immediate blast area, much of the infrastructure would remain intact. Most people would reach medical care by selfreferral and require sorting and assessment to determine what medical intervention is necessary, appropriate, and possible. No society has the resources to deliver the full spectrum of care needed in the time frame required. Yet, careful planning and a clear understanding of how best to allocate scarce resources, triage and evacuate patients, and implement crisis standards of care have the potential to save thousands of lives and provide comfort to those unlikely to survive. The US government and nongovernment experts continue to develop planning guidance, 1,4-8 medical countermeasures, 9,10 and medical specialty capacity and capabilities. 11-13 This Scarce Resources for a Nuclear Detonation Project provides data, supporting information, and tools for medical planners and responders to address the issues of scarce resources 14 and plan for triage and resource allocation in the first 4 days postdetonation, when there will be severe shortages.

The Medical Decision Model and Decision Maker Tools for Management of Radiological and Nuclear Incidents

“…There are, of course, some limitations when using exercises in that they are somewhat artificial as the outcome is known, some actions are notional, and the public response and impact of misinformation from social networking is not in play. While this model has been developed for radiological and nuclear incidents (Coleman et al 2011), which have an immediacy and complexity due to their being no-notice incidents accompanied by fear of radiation, this approach could apply to management of other types of incidents as well. Fundamentally, this approach brings together the decision making requirements for medical management, the deliberative benefits of expert working groups, and the need for immediate information.…”

Disaster Planning

“…As such, conventional trauma centers, regional and community hospitals would all be called on during such catastrophic events to manage injured for extended periods of time. [33][34][35][36][37] It is also reasonable to presume there will be a significant financial component to be considered in the management of a large-scale burn disaster for all hospitals.…”

Comparison of the Needs for Biodosimetry for Large-scale Radiation Events for Military versus Civilian Populations

“…Consequently, most survivors of the initial event who received life-threatening radiation exposures will have been indirectly exposed via fallout, and therefore such exposures will tend to be homogeneous. For people located in areas with the potential for high dose from fallout, one of the most effective measures to prevent such exposure will be to impose sheltering in place to allow radioactive decay to reduce dose prior to exposure (Coleman et al 2011a;National Security Staff 2010).…”

“…Taking samples or making measurements in physically compromised individuals; 2. Making measurements and obtaining results rapidly to facilitate decision making on priorities for treatment, especially where the resources and personnel for treatment may be very stressed Coleman et al 2011a); 3. Minimizing confounding of the estimates of radiation dose due to the simultaneous occurrence of trauma; and 4.…”

“…Procedures will not be expected to have to deal with special populations (e.g., children, elderly, disabled, or pregnant women)-all groups that the civilian response is expected to include (Coleman et al 2011a).…”