Simedis 2.0 : On the Road Toward a Comprehensive Mass Casualty Incident Medical Management Simulator

Rouck, Ruben De; Debacker, Michel; Hubloue, Ives; Koghee, Selma; Utterbeeck, Filip Van; Dhondt, Erwin

doi:10.1109/wsc.2018.8632369

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Decontamination is implemented as a time-delay in parallel lanes and includes disrobing, dry padding with absorbent materials and then re-robing. The decontamination and AMS times are based on internal experiments performed at a tertiary hospital in Brussels, which are comparable with times reported in the literature [39,40]. Mobile victims self-decontaminate, and immobile victims get decontaminated by the re ghters.…”

Section: Decontamination and Amssupporting

confidence: 59%

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

De Rouck,

Benhassine,

Debacker

et al. 2023

Preprint

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Introduction Chemical mass casualty incidents (MCIs) pose a substantial threat to public health and safety, with the capacity to overwhelm healthcare infrastructure and create societal disorder. Computer simulation systems are becoming an established mechanism to validate these plans due to their versatility, cost-effectiveness and lower susceptibility to ethical problems. Methods We created a computer simulation model of an urban subway sarin attack analogous to the 1995 Tokyo sarin incident. We created and combined evacuation, dispersion and victim models with the SIMEDIS computer simulator. We analyzed the effect of several possible approaches such as evacuation policy (‘Scoop and Run’ vs ‘Stay and Play’), three strategies (on-site decontamination and stabilization, off-site decontamination and stabilization, and on-site stabilization with off-site decontamination), preliminary triage, victim distribution methods, transport supervision skill level, and the effect of search and rescue capacity. Results Only evacuation policy, strategy and preliminary triage show significant effects on mortality. The total average mortality ranges from 14.7 deaths in the combination of off-site decontamination and Scoop and Run policy with pretriage, to 24 in the combination of onsite decontamination with the Stay and Play and no pretriage. Conclusion Our findings suggest that in a simulated urban chemical MCI, a Stay and Play approach with on-site decontamination will lead to worse outcomes than a Scoop and Run approach with hospital-based decontamination. Quick transport of victims in combination with on-site antidote administration has the potential to save the most lives, due to faster hospital arrival for definitive care.

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Section: Decontamination and Amssupporting

confidence: 59%

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

De Rouck,

Benhassine,

Debacker

et al. 2023

Preprint

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“…We intend to use these injury profiles as part of a discrete event simulator called SIMEDIS, used to analyze the disaster medical response chain (8,32). These injury profiles are included in the building of a continuous victim model, where the evolution of a victim's health state is modeled over time as a categorical sum of the heart rate, GCS, respiratory rate, systolic blood pressure and oxygen saturation (33).…”

Section: Discussionmentioning

confidence: 99%

Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response

Rouck

Benhassine

Debacker

et al. 2023

Front. Public Health

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In the last decades, Chemical, Biological, Radiological and Nuclear (CBRN) threats have become serious risks prompting countries to prioritize preparedness for such incidents. As CBRN scenarios are very difficult and expensive to recreate in real life, computer simulation is particularly suited for assessing the effectiveness of contingency plans and identifying areas of improvement. These computer simulation exercises require realistic and dynamic victim profiles, which are unavailable in a civilian context. In this paper we present a set of civilian nerve agent injury profiles consisting of clinical parameters and their evolution, as well as the methodology used to create them. These injury profiles are based on military injury profiles and adapted to the civilian population, using sarin for the purpose of illustration. They include commonly measured parameters in the prehospital setting. We demonstrate that information found in military sources can easily be adjusted for a civilian population using a few simple assumptions and validated methods. This methodology can easily be expanded to other chemical warfare agents as well as different ways of exposure. The resulting injury profiles are generic so they can also be used in tabletop and live simulation exercises. Modeling and simulation, if used correctly and in conjunction with empirical data gathered from lessons learned, can assist in providing the evidence practices for effective and efficient response decisions and interventions, considering the contextual factors of the affected area and the specific disaster scenario.

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“…subject matter experts (Debacker et al, 2016;De Rouck et al, 2018). The flexibility of our new approach resides in the fact that hundreds or thousands of victims can be generated very quickly at simulation runtime, and in a very computer efficient manner (we calculated the average time to generate 468 victims to be 20.62 ± 1.56 seconds based on 10 replications on a single laptop equipped with an i9-12900H processor using 32Gb of ram).…”

Section: Author Contributionsmentioning

confidence: 99%

“…However, modelling the health state of victims is challenging due to the unpredictability of the clinical progression of injuries, particularly in severe cases, and the further deterioration of health when multiple injuries are present. Debacker et al have proposed an approach in their SIMEDIS simulator, which considers predetermined clinical conditions for a database of 205 distinct victims who are classified as being critically, seriously, or lightly injured (Debacker et al, 2016;De Rouck et al, 2018). The clinical parameters, including blood pressure, pulse rate, respiratory rate, and motor response, are updated according to time.…”

Section: Introductionmentioning

confidence: 99%

Simulating Victim Health State Evolution From Physical and Chemical Injuries in Mass Casualty Incidents

Benhassine,

De Rouck,

Debacker

et al. 2023

New Trends in Computer Sciences

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The field of discrete-event simulation for medical disaster management is relatively new. In such simulations, human victims are generated using pre-determined transitions from one health state to the next, based on a set of triggers that correspond to treatment or the clinical progression of untreated injuries or diseases. However, this approach does not account for subtle differences in clinical progression. We propose a parameter-based model to characterize the evolution of symptoms at first for physical and nerve agent chemical injuries. We used a Gompertz function to predict the time of death in trauma based on forensic data. Then we separately considered the effects of the chemical warfare agent sarin (GB) being the origin of the chemical injuries for the purpose of modelling a GB attack in a metro station. We emphasize that our approach can be extended to other CBRN threats pending knowledge of clinical progressions available in the literature for the purpose of casualty estimations. The intent is to provide an estimate of time to death without any treatment and overlay this model with a treatment model, improving the evolution of the health state. A modification for non-life-threatening injuries is included without losing generality. Improvement functions modelling medical treatment are proposed. We argue that the availability of injury scores vs mortality can greatly enhance the validity of the model.

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Simedis 2.0 : On the Road Toward a Comprehensive Mass Casualty Incident Medical Management Simulator

Cited by 6 publications

References 11 publications

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

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

Creating realistic nerve agent victim profiles for computer simulation of medical CBRN disaster response

Simulating Victim Health State Evolution From Physical and Chemical Injuries in Mass Casualty Incidents

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