Assessing Medical Preparedness to Respond to a Terrorist by Institute of Medicine, Board on Health Sciences Policy,

By Institute of Medicine, Board on Health Sciences Policy, Committee on Medical Preparedness for a Terrorist Nuclear Event, Susan R. McCutchen, Michael McGeary, Georges C. Benjamin

A nuclear assault on a wide U.S. urban by means of terrorists--even with a low-yield improvised nuclear gadget (IND) of 10 kilotons or less--would reason a great number of deaths and serious accidents. the massive variety of injured from the detonation and radioactive fallout that may persist with will be overwhelming for neighborhood emergency reaction and healthiness care platforms to rescue and deal with, even assuming that those structures and their group of workers weren't themselves incapacitated by means of the development. the us has been suffering for your time to handle and plan for the specter of nuclear terrorism and different guns of mass destruction that terrorists may perhaps receive and use. the dep. of fatherland safeguard lately shriveled with the Institute of medication to carry a workshop, summarized during this quantity, to evaluate scientific preparedness for a nuclear detonation of as much as 10 kilotons. This e-book offers a candid and sobering examine our present nation of preparedness for an IND, and identifies numerous key parts during which we'd start to concentration our nationwide efforts in a manner that might increase the general point of preparedness.

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There would be many eye injuries, both retinal burns in those who happened to be facing the detonation point and injuries from shattered window glass. An unknown number of people would be injured in vehicle and other types of accidents caused by temporary blindness from the flash of the detonation. For medical and public health planning purposes, it would also be prudent to expect anywhere from tens of thousands to more than one hundred thousand injuries from radioactive fallout, although this number could be greatly reduced if there were advance preparations for mass evacuations and sheltering in place and if there were effective means for providing people with the information they could use to reduce their exposure as much as possible.

The Department of Defense (DoD) uses the DIME system for triage, in which the patient priority categories are Delayed, Immediate, Minimal, and Expectant. A similar system, Simple Triage and Rapid ­Treatment (START), is widely used in the civilian community to sort casualties into categories: • • • • Those needing immediate attention Those for whom treatment of life-threatening but potentially treatable injuries can be delayed Those who have minimal injuries The expectant, that is, those who will die despite treatment Using START (or the pediatric version, JumpSTART), triage can be performed in one minute per patient using an algorithm to check respiration, perfusion, and mental status.

During his presentation, he suggested that there would be a disproportionate need for eye care (because of broken glass and other missiles and retinal burns) and for burn beds. There are approximately 1,500 burn beds in the country, which are typically 80 to 90 percent full on any given day. He concluded with a list of factors affecting health care access in a 10-kt event: • • • • • The number of individuals concerned that they might have been exposed who would go to medical facilities and seek evaluation The extent of transportation problems because of gridlock, rubble in the streets, damage to highways, loss of power to traffic lights, and other factors The availability of hospital security (a lack of security accounted for most of the hospital closures in the aftermath of Katrina) The number of accessible hospital beds and medical personnel willing and able to work The number of nearby and usable 3,000-foot runways to land C-130s for air evacuation19 19 During another presentation, there was discussion of using railroads, which radiate from all urban areas, for evacuation of victims.

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