Smith Silas W, Portelli Ian, Narzisi Giuseppe, Nelson Lewis S, Menges Fabian, Rekow E Dianne, Mincer Joshua S, Mishra Bhubaneswar, Goldfrank Lewis R
Department of Emergency Medicine, Bellevue Hospital Center, 462 First Ave, Room A345A, New York, NY 10016, USA.
Disaster Med Public Health Prep. 2009 Jun;3(2):75-87. doi: 10.1097/DMP.0b013e3181a88899.
To develop and apply a novel modeling approach to support medical and public health disaster planning and response using a sarin release scenario in a metropolitan environment.
An agent-based disaster simulation model was developed incorporating the principles of dose response, surge response, and psychosocial characteristics superimposed on topographically accurate geographic information system architecture. The modeling scenarios involved passive and active releases of sarin in multiple transportation hubs in a metropolitan city. Parameters evaluated included emergency medical services, hospital surge capacity (including implementation of disaster plan), and behavioral and psychosocial characteristics of the victims.
In passive sarin release scenarios of 5 to 15 L, mortality increased nonlinearly from 0.13% to 8.69%, reaching 55.4% with active dispersion, reflecting higher initial doses. Cumulative mortality rates from releases in 1 to 3 major transportation hubs similarly increased nonlinearly as a function of dose and systemic stress. The increase in mortality rate was most pronounced in the 80% to 100% emergency department occupancy range, analogous to the previously observed queuing phenomenon. Effective implementation of hospital disaster plans decreased mortality and injury severity. Decreasing ambulance response time and increasing available responding units reduced mortality among potentially salvageable patients. Adverse psychosocial characteristics (excess worry and low compliance) increased demands on health care resources. Transfer to alternative urban sites was possible.
An agent-based modeling approach provides a mechanism to assess complex individual and systemwide effects in rare events.
开发并应用一种新型建模方法，以大都市环境中的沙林毒气释放场景为例，支持医疗和公共卫生灾难规划及应对。
开发了一个基于主体的灾难模拟模型，该模型纳入了剂量反应、激增反应和社会心理特征原则，并叠加在地形精确的地理信息系统架构之上。建模场景包括在一个大都市的多个交通枢纽被动和主动释放沙林毒气。评估的参数包括紧急医疗服务、医院激增能力（包括灾难计划的实施）以及受害者的行为和社会心理特征。
在5至15升的被动沙林毒气释放场景中，死亡率从0.13%非线性增加到8.69%，主动扩散时达到55.4%，这反映了更高的初始剂量。在1至3个主要交通枢纽释放毒气后的累积死亡率同样随剂量和全身应激呈非线性增加。死亡率的增加在急诊科占用率80%至100%的范围内最为明显，类似于先前观察到的排队现象。有效实施医院灾难计划可降低死亡率和伤害严重程度。缩短救护车响应时间并增加可用响应单位可降低潜在可救治患者的死亡率。不良的社会心理特征（过度担忧和低依从性）增加了对医疗资源的需求。转移到城市的其他地点是可行的。
基于主体的建模方法提供了一种机制，可用于评估罕见事件中复杂的个体和系统层面的影响。
