Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE)

Coleman, C. Norman; Bader, Judith L.; Koerner, John F.; Hrdina, Chad; Cliffer, Kenneth D.; Hick, John L.; James, James J.; Mansoura, Monique K.; Livinski, Alicia A.; Nystrom, Scott; DiCarlo, Andrea L.; Marinissen, Maria Julia; Wathen, Lynne; Appler, Jessica M; Buddemeier, Brooke; Casagrande, Rocco; Estes, Derek; Byrne, Patrick F.; Kennedy, Edward M.; Jakubowski, Ann A.; Case, Cullen; Weinstock, David M.; Dainiak, Nicholas; Hanfling, Dan; Garrett, Andrew L.; Grant, Natalie N; Dodgen, Daniel; Redlener, Irwin E.; MacKAY, Thomas F; Treber, Meghan; Homer, Mary J; Taylor, Tammy P.; Miller, Aubrey; Korch, G; Hatchett, Richard

doi:10.1017/dmp.2018.163

Cited by 32 publications

(28 citation statements)

References 26 publications

(27 reference statements)

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“…Processing and analysis of samples from all known or suspected irradiated individuals for biodosimetry is too labor intensive, a significant bottleneck in identifying treatment-eligible exposures [32]. While rapid interpretation of cytogenetic biodosimetry data is feasible [36], sample acquisition and data generation exceed the capacities of small teams of first responders and individual testing laboratories [37]. The proposed approach may partially overcome capacity resource limitations of first responders and biodosimetry laboratories to provide data for triage assessment of entire populations.…”

Section: Discussionmentioning

confidence: 99%

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Rogan

Mucaki

et al. 2020

PLoS ONE

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Background Accurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing. Aim To significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents. Methods Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples. Initially, locations proximate to these sites were randomly sampled (generally 0.1% of population). Empirical Bayesian kriging established radiation dose contour levels circumscribing these sites. Densification of each plume identified critical locations for additional sampling. After repeated kriging and densification, overlapping grids between each pair of contours of successive plumes were compared based on their diagonal Bray-Curtis distances and root-mean-square deviations, which provided criteria (<10% difference) to discontinue sampling.

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Section: Discussionmentioning

confidence: 99%

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Rogan

Mucaki

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Processing and analysis of samples from all known or suspected irradiated individuals for biodosimetry is too labor intensive, a significant bottleneck in identifying treatment-eligible exposures (32). While rapid interpretation of cytogenetic biodosimetry data is feasible (36), sample acquisition and data generation exceeds the capacities of small teams of first responders and individual testing laboratories (38). The proposed approach may partially overcome capacity resource limitations of first responders and biodosimetry laboratories to provide data for triage assessment of entire populations.…”

Section: Discussionmentioning

confidence: 99%

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Rogan

Mucaki

et al. 2020

Preprint

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Background: Accurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing. Aim: To significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents. Methods: Physical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples. Initially, locations proximate to these sites were randomly sampled (generally 0.1% of population). Empirical Bayesian kriging established radiation dose contour levels circumscribing these sites. Densification of each plume identified critical locations for additional sampling. After repeated kriging and densification, overlapping grids between each pair of contours of successive plumes were compared based on their diagonal Bray-Curtis distances and rootmean-square deviations, which provided criteria (<10% difference) to discontinue sampling. Results/Conclusions: We modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3-10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 58 and 347 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥ 2Gy were identified. Under sub-optimal sampling conditions, the number of iterations and samples were increased and accuracy was reduced. Geostatistical mapping limits the number of required dose assessments, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.

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“…In order to maintain the continuity of the standard of care in MCI or CBRNE disaster, hospitals must distinguish 3 levels of care situations: "Conventional care" as usual care, "Contingency care" as functionally equivalent care in contingency situation, and "Crisis care" as crisis standard of care for space, staff, and supplies such as securing disaster reserve beds by using nonpatient care areas like conference room for patient care [5,24]. It is important to separate patient with guardian, staff entry areas, triage areas, and parking lots and to manage uni ed entrances and exits of hospitals in MCI or CBRNE disaster [1,2,5,7]. ED staff require administrative support to manage patients e ciently by avoiding bottleneck phenomena of ED registration.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of disaster response, in the conventional traumatic mass casualty incident (MCI) situation, based on the evaluation of the extent of damage by the physical injury mainly by the medical resource provider, the patient severity classi cation and prioritization of treatment are promoted for e cient resource distribution [5]. However, in the special situation that corresponds to chemical, biological, radiological, nuclear, and explosive (CBRNE) disaster, including previous considerations covered by the conventional traumatic MCI, another consideration of special situations such as zone setup, personal protective equipment (PPE), most suitable special triage in CBRNE situation, decontamination, and antidote management if applicable is required [6][7][8]. Gumi, Gyeongsangbuk-do, Republic of Korea is a state-governed industrial city with factories located in an industrial park [9,10].…”

Section: Introductionmentioning

confidence: 99%

What A Disaster! The Hydrofluoric Acid Leak in Gumi City in 2012: Lessons What We Have Earned From Review of the Past Hospital’s Disaster Response

Shin¹,

Oh²,

Lee³

et al. 2020

Preprint

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Objective: This study aimed to analyze the characteristics of hydrogen fluoride–exposed patients (HFEPs) treated at an emergency department (ED) at a local university hospital, and to review the hospital's disaster response according to staff, stuff, space, and system (4Ss).Method: This is retrospective observational chart review and descriptive study included 199 HFEPs among 2628 of total ED patient who visited a local university emergency medical center for treatment between September 27 and October 20, 2012, following an HF leak at the Hub Globe factory in Gumi City, Republic of Korea. Descriptive results concerning 4Ss were obtained from interview with ED specialist staff physician on duty during the study period. According to the criteria of the American Burn Association, patients requiring burn center referral were assigned to the major burn group (MBG) as severe condition. Result: During the first 24 h after the accident, 161 (80.9%) HFEPs were treated in the ED. Among the 55 (27.6%) patients in the MBG, 8 (4% of the HFEPs) came to the ED during the acute phase (within the first 8 h after the leak began). During the acute phase, the ED was staffed with three doctors and three nurses. Among the total 2628 patients in the ED during the study period, 262 (9.97%) patients, including 167 (83.92%) of the 199 HFEPs, were there during the subacute phase, defined as the 24 h after the acute phase. During the subacute phase, the ED staff consisted of six doctors and 10 nurses. No concepts according to 4Ss that allowed for the expansion of ED space with securing disaster reserve beds or an increase in manpower with duty time adjustments or duty relocation for ED working personnel were in place as well as reinforcement of logistics such as antidote or PPE or disaster related measures of administration department or decontamination zone setup or decontamination or disaster related diagnostic testing measures or unification and management of the entrances and exits of hospital or implementation of previously designated disaster triage.Conclusion: Hospital disaster response was insufficient for all aspects of 4Ss. Detailed guidance for hospital disaster management plan establishment is required.

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Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE)

Cited by 32 publications

References 26 publications

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling

What A Disaster! The Hydrofluoric Acid Leak in Gumi City in 2012: Lessons What We Have Earned From Review of the Past Hospital’s Disaster Response

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