Chapter 5. Mustard
This chapter describes the assumptions for the mustard scenario, including:
- The severity categories.
- The arrival pattern of casualties at the hospital(s).
- The length of stay by hospital unit (i.e., ED, ICU, and the floor).
- The path probability within the hospital(s) and the length of stay.
- The overall outcome probabilities (i.e., probability of discharge and probability of death).
- The assumed level of resource consumption per patient per day per hospital unit.
Footnotes in the text of a particular section refer to references at the end of the section. In the absence of specific references, parameter estimates were obtained from general references listed in the Hospital Module section.
5.1. Severity Categories
For the mustard scenario, patients arrive at the hospital(s) in one of two conditions:
- Irritated: hoarseness or burning in throat and lungs, irritation in eyes.
- Severe: temporary blindness, permanent eye damage, bronchopneumonia, and skin damage.
Users have the option of specifying either the number and type or simply the number of casualties who present at their hospital(s).
If the user specifies only the number of casualties, the model assumes the casualties arriving at the hospital(s) are randomly selected from among all casualties from the attack. The distribution of casualty types in this case is as follows:
Casualty Condition |
Percent |
Irritated: hoarseness or burning in throat and lungs, irritation in eyes |
42.5% |
Severe: temporary blindness, permanent eye damage, broncopneumonia, and skin damage |
57.5% |
This breakdown by casualty condition is based on work performed during development of the original Surge Model in 2005. In brief, plume modeling was used to determine different exposure levels dependent upon the radius from the attack. Then available dose-response data were used to group exposed individuals into those who died, experienced severe symptoms, or experienced irritation from the gas. The percents shown here represent the percentage in each category of those who survived the immediate effects of the attack.
5.2. Casualty Arrival Pattern
For the mustard scenario, all casualties are assumed to present at the hospital(s) on day 1.
5.3. Length of Stay By Hospital Unit
The assumed average length of stay (in days) of patients the ED, ICU, and the floor (based on references no. 2,3,7,9, and 15 listed at the end of this section) are:
Average LOS by Hospital Unit |
Irritated |
Severe |
ED |
1 |
1 |
Floor, not via ICU |
7 |
42 |
Floor, via ICU |
4 |
21 |
ICU |
3 |
21 |
5.4 Combined Path Probabilities and Lengths of Stay
The table below shows the assumed probabilities of different "paths" through the hospital(s).
Path |
Irritated |
Incapacitated |
ED → Discharge |
0% |
0% |
ED → Death |
0% |
0% |
ED → Floor → Discharge |
50% |
0% |
ED → Floor → Death |
0% |
0% |
ED → Floor → ICU → Death |
0% |
0% |
ED → Floor → ICU → Floor → Discharge |
0% |
0% |
ED → Floor → ICU → Floor → Death |
0% |
0% |
ED → ICU → Death |
0% |
0% |
ED → ICU → Floor → Discharge |
50% |
100% |
ED → ICU → Floor → Death |
0% |
0% |
The breakdown of length of stay by patient type summed over all paths is:
Average LOS by Patient Outcome |
Irritated |
Severe |
Survivors |
8.00 |
43.00 |
Fatalities |
0.00 |
0.00 |
Average Combined |
8.00 |
43.00 |
5.5. Overall Outcome Probabilities
Based on these inputs, the overall discharge and death probabilities are:
Outcome |
Irritated |
Incapacitated |
Discharge |
100% |
100% |
Death |
0% |
0% |
5.6 Resources Consumed Per Patient Per Day
The assumed level of resource consumption per patient per day is shown in the table below:
Resource |
Units |
Category |
Subcategory |
Lambda2 |
Irritated |
Severe |
ED |
ICU |
Floor |
ED |
ICU |
Floor |
Med/Surg Bed |
Unit of Use |
Capacity |
Floor |
1 |
0.083 |
0 |
0 |
0.167 |
0 |
0 |
ICU Bed |
Unit of Use |
Capacity |
ICU |
1 |
0 |
1 |
0 |
0 |
0 |
0 |
Burn Bed |
Unit of Use |
Capacity |
Burn |
1 |
0 |
0 |
0 |
0 |
1 |
0 |
Intensivists (CCM) |
FTE |
Staff |
CCM |
0.7 |
0.042 |
0.042 |
0 |
0.083 |
0.083 |
0 |
Critical care nurses (CCN) |
FTE |
Staff |
CCN |
1 |
0.083 |
0.33 |
0 |
0.167 |
0.33 |
0 |
Surgeons |
FTE |
Staff |
Surgeon |
0.3 |
0 |
0 |
0 |
0 |
0.083 |
0 |
Non-intensivists (MD) |
FTE |
Staff |
MD |
0.9 |
0.083 |
0 |
0.021 |
0.083 |
0 |
0.021 |
Non-critical care nurses (RN/LPN) |
FTE |
Staff |
RN |
1 |
0 |
0 |
0.33 |
0 |
0 |
0.333 |
Respiratory Therapists (RT) |
FTE |
Staff |
RT |
0.7 |
0.021 |
0.021 |
0.021 |
0.083 |
0.083 |
0.042 |
Radiology machines |
Machine Time |
Lab/Radiology |
Radiology |
0.3 |
0.021 |
0.021 |
0 |
0.021 |
0.021 |
0 |
Radiologic Technicians |
FTE |
Staff |
Rad Tech |
0.3 |
0.021 |
0.021 |
0 |
0.021 |
0.021 |
0 |
Pharmacists (PharmD/RPh) |
FTE |
Staff |
Pharmacist |
0.7 |
0.021 |
0.042 |
0.021 |
0.021 |
0.042 |
0.042 |
Mechanical ventilator |
Machine Time |
Capacity |
Ventilator |
0.9 |
0 |
0 |
0 |
1 |
1 |
0 |
Ventilator equipment |
Unit of Use |
Equipment |
Vent Tubing |
0.9 |
0 |
0 |
0 |
1 |
1 |
0 |
Oxygen (O2) |
Unit of Use |
Supplies |
Oxygen |
0.9 |
1 |
1 |
1 |
2 |
2 |
0 |
Oxygenation monitoring equipment |
Machine Time |
Equipment |
O2 Monitoring |
0.9 |
0.083 |
1 |
0 |
0.083 |
1 |
0.5 |
Surgical supplies |
Unit of Use |
Supplies |
Surgical |
0.3 |
0 |
0 |
0 |
0 |
0.25 |
0 |
Radiology supplies |
Unit of Use |
Supplies |
Radiological |
0.3 |
1 |
1 |
0 |
1 |
1 |
0 |
Antibiotcs for Secondary Pneumonia |
Assorted |
Pharmacy |
Antibiotics |
1 |
0 |
0 |
0 |
0 |
1 |
0 |
Surgical Infection Prophylaxis/Treatment |
Assorted |
Pharmacy |
Antibiotics |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
Hemodynamic medications |
Unit of Use |
Pharmacy |
Hemodynamic |
0.7 |
0 |
0 |
0 |
1 |
1 |
0 |
Intravenous fluids |
Unit of Use |
Pharmacy |
IVF |
0.7 |
0 |
0 |
0 |
1 |
1 |
1 |
Intravenous infusions set |
Unit of Use |
Supplies |
IV Set |
0.7 |
0 |
0 |
0 |
1 |
1 |
1 |
Laboratory machines |
Machine Time |
Lab/Radiology |
Laboratory |
0.7 |
0.021 |
0.021 |
0.021 |
0.021 |
0.021 |
0.021 |
Laboratory supplies |
Unit of Use |
Supplies |
Laboratory |
0.7 |
1 |
1 |
0.5 |
1 |
1 |
0.5 |
Temperature monitoring equipment |
Machine Time |
Equipment |
Temperature |
1 |
0.083 |
1 |
1 |
0.083 |
1 |
1 |
Thromboembolism prophylaxis |
Unit of Use |
Pharmacy |
DVT Prophylaxis |
1 |
0 |
1 |
0 |
0 |
1 |
1 |
Urine output monitoring equipment |
Unit of Use |
Equipment |
U/O |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
Universal Precautions PPE |
Unit of Use |
PPE |
Universal |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Chemical PPE |
Unit of Use |
PPE |
Chemical |
0.3 |
1 |
0 |
0 |
1 |
0 |
0 |
Radiological PPE |
Unit of Use |
PPE |
Radiological |
0.3 |
0 |
0 |
0 |
0 |
0 |
0 |
Waste Disposal |
Unit of Use |
Waste Mgmt |
Decon Waste |
0.3 |
1 |
0 |
0 |
1 |
0 |
0 |
Mortuary Decontamination Materials |
Unit of Use |
Mortuary |
Decon |
0.3 |
0 |
0 |
0 |
0 |
0 |
0 |
Atropine sulfate |
2mg |
Pharmacy |
Atropine |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
Pralidoxime |
2g |
Pharmacy |
Pralidoxime |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
Diazepam |
10mg |
Pharmacy |
Diazepam |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
Growth Factors |
Unit of Use |
Pharmacy |
Growth factors |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
IV Steroids |
Unit of Use |
Pharmacy |
Steroids |
0.7 |
0 |
0 |
0 |
0 |
0 |
0 |
Enteral feedings (3/day/patient) |
Unit of Use |
Nutrition |
Enteral |
1 |
0 |
0 |
0 |
0 |
0.5 |
0 |
Oral food (3 meals per day per patient) |
Unit of Use |
Nutrition |
Oral |
1 |
0 |
0.5 |
1 |
0 |
0.5 |
1 |
Sheet change |
Unit of Use |
Housekeeping |
Laundry |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Patient infection control |
FTE |
Epidemiology |
Infection Control |
0.5 |
0.021 |
0.021 |
0.021 |
0.042 |
0.042 |
0.042 |
Engineering |
FTE |
Engineering |
Facility |
0.7 |
0.042 |
0.083 |
0.042 |
0.042 |
0.083 |
0.042 |
Janitorial/Housekeeping |
FTE |
Housekeeping |
Janitorial |
1 |
0.083 |
0.125 |
0.083 |
0.125 |
0.125 |
0.083 |
Nutrition |
FTE |
Nutrition |
Counseling |
0.5 |
0 |
0.083 |
0.083 |
0 |
0.083 |
0.083 |
Psychological support |
FTE |
Ancillary |
Psychologist |
0.5 |
0.021 |
0.042 |
0.042 |
0 |
0 |
0.042 |
Mortuary |
FTE |
Mortuary |
Morgue |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
2. Lambda captures the resource requirement decay rate for a resource. Lambda = 1 implies no decay; the patient requires a constant amount of the resource while s/he is hospitalized. Lambda <1 implies that less of the resource is required each day the patient is hospitalized. Go to section 2.2 for details.
5.7 References
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