Using the Model of Resource and Time-Based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>Conventional triage algorithms assume unlimited medical resource availability. After a nuclear detonation, medical resources are likely to be particularly limited, suggesting that conventional triage algorithms need to be rethought. To test various hypotheses related to the prioritization of victims in this setting, we developed the model of resource- and time-based triage (MORTT). This model uses information on time to death, probability of survival if treated and if untreated, and time to treat various types of traumatic injuries in an agent-based model in which the time of medical practitioners or materials can be limited. In this embodiment, MORTT focuses solely on triage for surgical procedures in the first 48 hours after a nuclear detonation. MORTT determines the impact on survival based on user-selected prioritization of victims by severity or type of injury. Using MORTT, we found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity. Furthermore, more lives would be saved if victims with combined injury (ie, trauma plus radiation &gt;2 Gy) are prioritized after nonirradiated victims with similar trauma.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S98-S110)</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.…”

“…Many of the trauma casualties from blast, glass breakage, and motor vehicle crashes will have no radiation exposure, and many people in the fallout zone will have radiation exposure but no physical trauma. 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 model of resource and time-based triage 21 was built to test triage methods for prioritizing victims presenting to hospitals, given the likely pattern of casualties after a nuclear detonation.…”

“…21 It indicates that people in the moderate category survive at a much greater rate (5% vs 30% mortality) if treated. In a constrainedresources environment, prioritizing injured people in the moderate category over people in the severe life-threatening injured category saves 50% more victims, and this increases in proportion as resources become more constrained.…”

“…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.…”