Chapter 7. 1 KT and 10 KT Nuclear Device
This
chapter describes the assumptions for the nuclear scenario (both the 1 KT and
10 KT), 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.
7.1 Severity
Categories
For the 1
KT and 10 KT scenarios, patients arrive at the hospital(s) in one of eleven
conditions:
- Burns
(1) / moderate:
2nd degree burns on hands and face
- Burns
(2) / severe:
3rd degree burns on hands and face (and 1st degree over the rest of the
body)
- Trauma
(1) / people
who receive multiple lacerations from flying glass
- Trauma
(2) / people
who receive blunt trauma
- Trauma
(3) / people
in collapsed houses and other light buildings
- Trauma
(4) / people
in collapsed skyscrapers
- Radiation
(1) / mild:
nausea, vomiting, anorexia, fever, infections
- Radiation
(2) / moderate:
more severe mild symptoms, plus bleeding, fatigue, and weakness
- Radiation
(3) / severe:
more severe moderate symptoms, plus headache, prostration, dizziness, and
disorientation
- Fallout
(1) / mild: 1Gy
equivalent dose for blood effects, no other equivalent dose (some bleeding
and infection issues)
- Fallout
(2) / severe:
4Gy for blood effects (problems with bleeding and infection) and about
0.75 Gy for lethality and GI effects (some small fraction of people will
die and others get nausea, vomiting, etc.)
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 follow:
Casualty
Condition
|
Percent (1KT)
|
Percent (10KT)
|
Burns (1) / moderate: 2nd degree burns on hands and
face |
0.5% |
0.1% |
Burns (2) / severe: 3rd degree burns on hands and
face (and 1st degree over the rest of the body) |
0.5% |
0.0% |
Trauma (1) / people who receive
multiple lacerations from flying glass |
8.1% |
2.7% |
Trauma (2) / people who receive
blunt trauma |
0.1% |
0.0% |
Trauma (3) / people in collapsed
houses and other light buildings |
13.5% |
65.8% |
Trauma (4) / people in collapsed
skyscrapers |
34.0% |
27.3% |
Radiation (1) / mild: nausea, vomiting, anorexia,
fever, infections |
0.2% |
0.0% |
Radiation (2) / moderate: more severe mild symptoms, plus
bleeding, fatigue, and weakness |
0.5% |
0.1% |
Radiation (3) / severe: more severe moderate symptoms,
plus headache, prostration, dizziness ,and disorientation |
0.9% |
0.0% |
Fallout (1) / mild: 1Gy equivalent dose for blood
effects, no other equivalent dose (some bleeding and infection issues) |
17.7% |
1.7% |
Fallout (2) / severe: 4Gy for blood effects (problems
with bleeding and infection) and about 0.75 Gy for lethality and GI effects
(some small fraction of people will die and others get nausea, vomiting,
etc.) |
24.1% |
2.3% |
This
breakdown by casualty condition is based on work performed during development
of the original Surge Model in 2005. In brief, for the nuclear scenarios, we
modeled the effects of the blast looking at thermal, radiation, and blast
effects at different radii from the center of the attack as well as whether
individuals were in direct line-of-sight to the blast or were protected by
buildings, walls, or other materials. More specifically:
- Thermal effects
are burns received from the thermal heat wave radiating from the blast.
Casualties that arrive at the hospital are those who received second- or third-degree
burns and exclude those that were vaporized or immediately killed. All these
patients also experience radiation effects.
-
Blast effects
include trauma resulting from the pressure wave of the blast. The pressure will
cause the collapse of both skyscrapers and lighter buildings, as well as
breaking all the windows of buildings further out. It will also cause flying
debris to hit pedestrians. These effects are calculated based on the pressure
at each radius and the resultant effects.
-
Radiation effects
looked at both direct radiation affecting individuals and fallout which can be
inhaled for long-term effects. Based upon the exposure and decay rate for these
materials, we calculated the likelihood of mild, moderate, and severe radiation
and mild and severe fallout.
The
distribution of these effects is based upon a fixed weapon size of 1KT or 10KT.
7.2 Casualty
Arrival Pattern
Casualties
are assumed to present at the hospital(s) when symptoms appear. For this
scenario, all patients arrive on day 1.
7.3 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. 1-3, 7, 9,10, 15, 16, 20, 25,
and 26 [for trauma] and 33–38 [for burns] listed
at the end of this section) are:
LOS by Unit |
Burn 2 |
Burn 3 |
Trauma 1 |
Trauma 2 |
Trauma 3 |
Trauma 4 |
Rad 1 |
Rad 2 |
Rad 3 |
Fallout 1 |
Fallout 2
|
ED |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Floor, not via ICU |
7 |
17 |
5 |
5 |
5 |
5 |
7 |
8 |
14 |
7 |
7 |
Floor, via ICU |
7 |
7 |
8 |
8 |
6 |
8 |
4 |
8 |
28 |
4 |
28 |
ICU |
9 |
31 |
10 |
10 |
6 |
6 |
3 |
24 |
30 |
3 |
30 |
7.4 Combined Path Probabilities and Lengths of Stay
The table below shows the assumed probabilities of
different "paths" through the hospital(s).
Path |
Burn 2 |
Burn 3 |
Trauma 1 |
Trauma 2 |
Trauma 3 |
Trauma 4 |
Rad 1 |
Rad 2 |
Rad 3 |
Fallout 1 |
Fallout 2
|
ED → Discharge |
0% |
0% |
2% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
ED → Death* |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
ED → Floor → Discharge |
6% |
0% |
54% |
31% |
9% |
6% |
80% |
46% |
2% |
67% |
6% |
ED → Floor → Death |
0% |
0% |
0% |
0% |
16% |
11% |
10% |
4% |
1% |
8% |
1% |
ED → Floor → ICU → Death |
0% |
0% |
6% |
3% |
1% |
1% |
0% |
14% |
6% |
0% |
2% |
ED → Floor → ICU → Floor → Discharge |
4% |
0% |
9% |
5% |
1% |
0% |
0% |
9% |
1% |
0% |
0% |
ED → Floor → ICU → Floor → Death |
0% |
0% |
1% |
1% |
3% |
2% |
0% |
1% |
1% |
0% |
0% |
ED → ICU → Death |
7% |
53% |
10% |
21% |
16% |
19% |
1% |
14% |
71% |
2% |
71% |
ED → ICU → Floor → Discharge |
82% |
45% |
16% |
34% |
13% |
6% |
9% |
10% |
9% |
22% |
9% |
ED → ICU → Floor → Death |
0% |
3% |
2% |
5% |
41% |
56% |
0% |
1% |
10% |
1% |
10% |
*By definition no trauma patients admitted to the
hospital(s) were dead on arrival (DOA)
The breakdown of length of stay by patient type summed
over all paths is:
Average LOS by Patient Outcome |
Burn 2 |
Burn 3 |
Trauma 1 |
Trauma 2 |
Trauma 3 |
Trauma 4 |
Rad 1 |
Rad 2 |
Rad 3 |
Fallout 1 |
Fallout 2
|
Survivors |
16.56 |
39.00 |
10.16 |
13.44 |
10.39 |
10.66 |
8.00 |
16.54 |
52.67 |
8.00 |
38.85 |
Fatalities |
6.59 |
16.13 |
8.93 |
8.27 |
7.40 |
8.10 |
4.87 |
14.28 |
16.70 |
4.71 |
16.41 |
Average Combined |
15.75 |
26.34 |
9.92 |
11.88 |
8.07 |
8.40 |
7.64 |
15.75 |
20.85 |
7.63 |
19.90 |
7.5 Overall
Outcome Probabilities
Based on
these inputs
(based on references
no. 1-3, 7, 9,10, 15, 16, 20, 25,
and 26 [for trauma] and 33–38 [for burns] listed
at the end of this section), the overall discharge and death probabilities are:
Outcome |
Burn 2 |
Burn 3 |
Trauma 1 |
Trauma 2 |
Trauma 3 |
Trauma 4 |
Rad 1 |
Rad 2 |
Rad 3 |
Fallout 1 |
Fallout 2
|
Discharge |
92% |
45% |
81% |
70% |
22% |
12% |
89% |
65% |
12% |
89% |
16% |
Death |
8% |
55% |
19% |
30% |
78% |
88% |
11% |
35% |
88% |
11% |
84% |
7.6 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
|
Lambda1
|
Burns-Moderate
|
Burns-Severe
|
Trauma-Lacerations
|
Trauma-Blunt
|
ED |
ICU |
Floor |
ED |
ICU |
Floor |
ED |
ICU |
Floor |
ED |
ICU |
Floor |
Med/Surg Bed |
One Bed |
Capacity |
Floor |
1 |
0.083 |
0 |
0 |
0.083 |
0 |
0 |
0.083 |
0 |
0 |
0.083 |
0 |
0 |
ICU Bed |
One Bed |
Capacity |
ICU |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
1 |
0 |
1 |
1 |
Burn Bed |
One Bed |
Capacity |
Burn |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
Operating Room |
One OR Suite |
Capacity |
OR |
1 |
0.083 |
0 |
0 |
0.25 |
0 |
0 |
0.042 |
0 |
0 |
0.167 |
0 |
0 |
Airborne Isolation Room |
One Bed |
Capacity |
Isolation |
0.9 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Intensivists (CCM) |
FTE |
Staff |
CCM |
0.7 |
0.083 |
0.083 |
0 |
0.083 |
0.083 |
0 |
0.083 |
0.083 |
0 |
0.083 |
0.083 |
0 |
Critical care nurses (CCN) |
FTE |
Staff |
CCN |
1 |
0.167 |
0.5 |
0 |
0.333 |
0.5 |
0 |
0.125 |
0.5 |
0 |
0.25 |
0.5 |
0 |
Surgeons |
FTE |
Staff |
Surgeon |
0.3 |
0.33 |
0.25 |
0.083 |
0.33 |
0.25 |
0.083 |
0.167 |
0.167 |
0.042 |
0.167 |
0.167 |
0.042 |
Non-intensivists (MD) |
FTE |
Staff |
MD |
0.9 |
0.167 |
0 |
0.042 |
0.167 |
0 |
0.042 |
0.167 |
0 |
0.042 |
0.167 |
0 |
0.042 |
Non-critical care nurses (RN/LPN) |
FTE |
Staff |
RN |
1 |
0.042 |
0 |
0.146 |
0.042 |
0 |
0.146 |
0.042 |
0 |
0.146 |
0.042 |
0 |
0.146 |
Respiratory Therapists (RT) |
FTE |
Staff |
RT |
0.7 |
0.083 |
0.083 |
0.042 |
0.083 |
0.083 |
0.042 |
0.083 |
0.083 |
0.042 |
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 |
0.042 |
0.042 |
0 |
0.042 |
0.042 |
0 |
Radiologic Technicians |
FTE |
Staff |
Rad Tech |
0.3 |
0.021 |
0.021 |
0 |
0.021 |
0.021 |
0 |
0.042 |
0.042 |
0 |
0.042 |
0.042 |
0 |
Pharmacists (PharmD/RPh) |
FTE |
Staff |
Pharmacist |
0.7 |
0.021 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
Mechanical ventilator |
Machine Time |
Capacity |
Ventilator |
0.9 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
Ventilator equipment |
One Ventilator |
Equipment |
Vent Tubing |
0.9 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
0 |
1 |
0 |
Oxygen (O2) |
24h O2 for Vent |
Supplies |
Oxygen |
0.9 |
1 |
2 |
0 |
1 |
2 |
0 |
1 |
2 |
1 |
1 |
2 |
1 |
Oxygenation monitoring equipment |
Machine Time |
Equipment |
O2 Monitoring |
0.9 |
0.167 |
1 |
1 |
0.333 |
1 |
1 |
0.125 |
1 |
1 |
0.25 |
1 |
1 |
Surgical supplies |
Trauma Set |
Supplies |
Surgical |
0.3 |
1 |
0.25 |
0.125 |
1 |
0.25 |
0.125 |
1 |
0.25 |
0.125 |
1 |
0.25 |
0.125 |
Radiology supplies |
Radiographic Film |
Supplies |
Radiological |
0.3 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
Cirprofloxacin or Doxycycline |
400mg/100mg bid |
Pharmacy |
Antibiotics |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Rifampin or other 2nd line agent |
600mg po bid |
Pharmacy |
Antibiotics |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Antibiotcs for Secondary Pneumonia |
Assorted |
Pharmacy |
Antibiotics |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
0 |
Surgical Infection Prophylaxis/Treatment |
Assorted |
Pharmacy |
Antibiotics |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Neutropenia Prophylaxis/Treatment |
Assorted |
Pharmacy |
Antibiotics |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Antibiotics intravenous infusion set |
One IV Piggyback |
Supplies |
IV set |
1 |
1 |
0.5 |
0.5 |
1 |
0.5 |
0.5 |
1 |
0.5 |
0.5 |
1 |
0.5 |
0.5 |
Hemodynamic medications |
Assorted |
Pharmacy |
Hemodynamic |
0.7 |
0 |
0 |
0 |
1 |
1 |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
Intravenous fluids |
24h LR or equiv. |
Pharmacy |
IVF |
0.7 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Intravenous infusions set |
One IV Set |
Supplies |
IV Set |
0.7 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Laboratory machines |
Machine Time |
Lab/Radiology |
Laboratory |
0.7 |
0.083 |
0.083 |
0.042 |
0.083 |
0.083 |
0.042 |
0.083 |
0.083 |
0.042 |
0.083 |
0.083 |
0.042 |
Laboratory supplies |
CBC/CMP Reag. |
Supplies |
Laboratory |
0.7 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
Temperature monitoring equipment |
Machine Time |
Equipment |
Temperature |
1 |
0.167 |
1 |
1 |
0.333 |
1 |
1 |
0.125 |
1 |
1 |
0.25 |
1 |
1 |
Thromboembolism prophylaxis |
Enoxaparin 40mg sc
qd |
Pharmacy |
DVT Prophylaxis |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
1 |
0 |
1 |
1 |
Urine output monitoring equipment |
Catheter and Bag |
Equipment |
U/O |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
1 |
1 |
0 |
1 |
1 |
Universal Precautions PPE |
Glove/gown/mask |
PPE |
Universal |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Chemical PPE |
Level D |
PPE |
Chemical |
0.3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Radiological PPE |
Level D |
PPE |
Radiological |
0.3 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
1 |
1 |
0 |
Waste Disposal |
Level D |
PPE |
Decon Waste |
0.3 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Mortuary Decontamination Materials |
Level D |
PPE |
Mortuary |
0.3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Atropine sulfate |
2mg |
Pharmacy |
Atropine |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Pralidoxime |
2g |
Pharmacy |
Pralidoxime |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Diazepam |
10mg |
Pharmacy |
Diazepam |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
EEG |
Machine Time |
Equipment |
Chemical |
0.1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
IV Steroids |
Hydrocortisone
50mg IV q6h |
Pharmacy |
Steroids |
0.7 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
DPTA |
1g IV |
Pharmacy |
DPTA |
0.1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Prussian blue |
3mg po tid |
Pharmacy |
Prussian Blue |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Growth Factors |
Pegfilgrastim 6mg
sc qw |
Pharmacy |
Growth factors |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
Stem Cell Transfusion |
Unit of Use |
Heme/Onc |
Stem Cell Trans |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Geiger counter |
Machine Time |
Equipment |
Radiation |
0.1 |
0.42 |
0.21 |
0.21 |
0.42 |
0.21 |
0.21 |
0.42 |
0.21 |
0.21 |
0.42 |
0.21 |
0.21 |
Enteral feedings (3/day/patient) |
Unit of Use |
Nutrition |
Enteral |
1 |
0 |
0.5 |
0 |
0 |
0.5 |
0 |
0 |
0.5 |
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 |
0 |
0.5 |
1 |
0 |
0.5 |
1 |
Sheet change |
1 linen change |
Housekeeping |
Laundry |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
Patient infection control |
FTE |
Epidemiology |
Infection Control |
0.5 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
0.021 |
0.042 |
0.042 |
0.021 |
Engineering |
FTE |
Engineering |
Facility |
0.7 |
0.042 |
0.083 |
0.042 |
0.042 |
0.083 |
0.042 |
0.042 |
0.083 |
0.042 |
0.042 |
0.083 |
0.042 |
Janitorial/Housekeeping |
FTE |
Housekeeping |
Janitorial |
1 |
0.125 |
0.125 |
0.083 |
0.125 |
0.125 |
0.083 |
0.125 |
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 |
0 |
0.083 |
0.083 |
0 |
0.083 |
0.083 |
Psychological support |
FTE |
Ancillary |
Psychologist |
0.5 |
0 |
0 |
0.042 |
0 |
0 |
0.042 |
0 |
0 |
0.042 |
0 |
0 |
0.042 |
Mortuary |
FTE |
Mortuary |
Morgue |
0.1 |
0 |
0.042 |
0.042 |
0 |
0.042 |
0.042 |
0 |
0.042 |
0.042 |
0 |
0.042 |
0.042 |
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