passages: PMC-1828719-sec-06__text
passages: sec
passages: Mass casualty estimation on a geographic basis
  The Defense Threat Reduction Agency (DTRA) has expended considerable effort to develop models for calculating mass casualties from a nuclear detonation. In order to specifically evaluate urban medical systems vulnerability we are employing the PC based Consequence Assessment Tool Set (CATS) v6, with ESRI's ArcGIS9 [14], CATS/JACE (Joint Assessment of Catastrophic Events) v5 with ESRI's ArcView 3.3, Hazard Prediction and Assessment Capability (HPAC) V4.04SP3 [15], as well as custom GIS and database software applications. HPAC does excellent Chemical Biological and Nuclear (CBN) modeling, although output could provide more flexibility. Additionally, results can be exported to CATS for further analysis and display. All three programs can access the current weather data from both classified and unclassified weather servers. Examples of uses of CATS/HPAC are hurricane, tidal surge and earthquake damage, prediction of the results from nuclear, biological and chemical releases, assessment of persons and infrastructure affected and at risk (e.g. which hospitals and pharmacies are under a CBN plume and are thus out of commission), and mobilization of surviving and nearby infrastructure outside the plume that would be needed to address healthcare and other emergency response needs of the community.
  These models have been, and continue to be, developed with a view to better estimating the impact of WMD weapons in an offensive setting. However, recent DTRA enhancements and our modifications have facilitated their use in helping estimate potential casualties from a WMD terrorist incident. One area of intense interest, and somewhat of a vacuum in public health planning, has been the utility of this approach in estimating medical care vulnerabilities in such an attack, and for the calculation of the distribution of surviving medical care resources. While much work has already occurred in estimating the impact of chemical weapons (due to the dual use in chemical spill management from transportation and industrial accidents), or in nuclear power plant accident management, much less research and development has gone into estimating the impact on our civilian population of a nuclear weapon detonation from a terrorist incident in a large urban area. The models already calculate such factors as the impact of blast, thermal effects and fallout, but results are often not available at the detail level needed for civil defense purposes, casualty management, and planning the use of scarce health resources in response to a nuclear weapon detonation. Furthermore, the models do not readily facilitate the calculation of injuries from multiple effects such as burns and blast with fallout or prompt radiation. The complexity of the urban three-dimensional landscape and its local impact on thermal, blast and radiation is also poorly understood. Additionally, given their traditional world-wide focus, and the increased sensitivity to providing information on the U.S.A. of use to terrorists, the models do not provide detailed or current data that exists for the United States that would help provide better casualty estimates and response. The models can be customized locally and data updated if the user has sufficient expertise. However, there is often a significant duplication of effort due to overlapping jurisdictions and the lack of data sharing due to security and other considerations.
  CATS and HPAC are also useful for creating realistic scenarios for training and planning before a disaster strikes, thus enabling responders to drill and exercise so they know roughly what to expect and how to react. Contingency plans can be created using comprehensive national and more detailed population and infrastructure data. Should disaster strike, the affected population and the impact on critical facilities can be quickly assessed, although efforts frequently need to be expended to ensure regional and local databases are current and useful.
  