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

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.