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

作　　者：Alexis Rump Patrick Ostheim Stefan Eder Cornelius Hermann Michael Abend Matthias Port 

机构地区：[1]Bundeswehr Institute of Radiobiology,Neuherberg Str.n,80937 Munich,Germany

出　　处：《Military Medical Research》2021年第3期336-351,共16页军事医学研究（英文版）

摘　　要：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 costeffectiveness 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 d

关 键 词：Radiological emergency Dirty bomb Medical countermeasures Radionuclide incorporation Decorporation treatment Screening Efficiency Data envelopment analysis 

分 类 号：R197.1[医药卫生—卫生事业管理] F224[医药卫生—公共卫生与预防医学]