Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources

Alexis Rump; Patrick Ostheim; Stefan Eder; Cornelius Hermann; Michael Abend; Matthias Port

doi:10.1186/s40779-020-00291-3

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Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources

RESEARCH | Updated：2023-02-28

- Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources
- Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources
- 解放军医学杂志（英文版） 2021年8卷第3期页码：336-351
- Affiliations：
  
  Bundeswehr Institute of Radiobiology, Neuherberg Str. 11, 80937 Munich, Germany
- Author bio：
  
  * AlexisRump@bundeswehr.org
- Funds：
- DOI：10.1186/s40779-020-00291-3
  中图分类号：
- 纸质出版：2021-09
- Accepted：
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Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources[J]. 解放军医学杂志（英文版）, 2021,8(3):336-351.

Rump et al.: Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources. Mil Med Res, 2021, 8: 3.
Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources[J]. 解放军医学杂志（英文版）, 2021,8(3):336-351. DOI： 10.1186/s40779-020-00291-3.

Rump et al.: Preparing for a "dirty bomb" attack: The optimum mix of medical countermeasure resources. Mil Med Res, 2021, 8: 3. DOI： 10.1186/s40779-020-00291-3.

摘要

Abstract

Background:

In radiological emergencies with radionuclide incorporation

decorporation treatment is particularly effective if started early. Treating all people potentially contaminated ( "urgent treatment" ) may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.

Methods:

The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix

we departed from a large-scale scenario (60

000 victims) and based on purchase prices of antidotes and screening equipment in Germany

we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.

Results:

Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment

an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The cost-effectiveness of preparedness for a "dirty bomb" attack is less than for common health care

but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.

Conclusion:

To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed

the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for "dirty bomb" attacks is an issue of principle that must be dealt with by political leaders.

关键词

Keywords

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