Optimizing Medical Care during a Nerve Agent Mass Casualty Incident Using Computer Simulation.

Area of Science:

• Emergency Medicine
• Public Health Simulation
• Disaster Preparedness

Background:

• Chemical mass casualty incidents (MCIs) present significant public health challenges, potentially overwhelming healthcare systems.
• Computer simulations offer a versatile, cost-effective, and ethical method for validating emergency response plans.

Purpose of the Study:

• To evaluate the impact of different response strategies on mortality during a simulated urban subway sarin attack.
• To compare the effectiveness of 'Scoop and Run' versus 'Stay and Play' evacuation policies.

Main Methods:

• A computer simulation model (SIMEDIS) integrated evacuation, dispersion, and victim models.
• Simulated a sarin attack scenario mirroring the 1995 Tokyo incident.
• Analyzed variables including evacuation policy, decontamination strategy, triage, and transport.

Main Results:

• Evacuation policy, decontamination strategy, and preliminary triage significantly affected mortality rates.
• The 'Scoop and Run' policy with off-site decontamination and pretriage resulted in the lowest mortality (14.7 deaths).
• The 'Stay and Play' policy with on-site decontamination and no triage resulted in higher mortality (24 deaths).

Conclusions:

• A 'Scoop and Run' approach with hospital-based decontamination is superior to 'Stay and Play' with on-site decontamination for urban chemical MCIs.
• Rapid victim transport combined with on-site antidote administration can maximize survival by expediting definitive hospital care.