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Modeling Analysis

Using the Model of Resource and Time-Based Triage (MORTT) to Guide Scarce Resource Allocation in the Aftermath of a Nuclear Detonation

Rocco Casagrande, PhD, Nick Wills, MS, Elizabeth Kramer, BS, Louise Sumner, BS, Mark Mussante, BS, Rachel Kurinsky, BS, Patrick McGhee, BS, Luba Katz, PhD, David M. Weinstock, MD and C. Norman Coleman, MD

Author Affiliations: Dr Casagrande, Mr Wills, Ms Kramer, Ms Sumner, Mr Mussante, Ms Kurinsky, and Mr McGhee are with Gryphon Scientific; Dr Katz is with Abt Associates; Dr Weinstock is with the Dana-Farber Cancer Institute, Harvard Medical School; and Dr Coleman is with the Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services.

Conventional triage algorithms assume unlimited medical resource availability. After a nuclear detonation, medical resources are likely to be particularly limited, suggesting that conventional triage algorithms need to be rethought. To test various hypotheses related to the prioritization of victims in this setting, we developed the model of resource- and time-based triage (MORTT). This model uses information on time to death, probability of survival if treated and if untreated, and time to treat various types of traumatic injuries in an agent-based model in which the time of medical practitioners or materials can be limited. In this embodiment, MORTT focuses solely on triage for surgical procedures in the first 48 hours after a nuclear detonation. MORTT determines the impact on survival based on user-selected prioritization of victims by severity or type of injury. Using MORTT, we found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity. Furthermore, more lives would be saved if victims with combined injury (ie, trauma plus radiation >2 Gy) are prioritized after nonirradiated victims with similar trauma.

Key Words: resource allocation • nuclear weapons • radiation injuries • algorithms • time factors • comorbidity • trauma • emergency medical services • mass casualty incidents • mortality • prognosis • severity of illness index • surgical procedures, operative • triage • modeling • nuclear detonation • improvised nuclear device • combined injury

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