Public Health Response Model Estimates Bombing Consequences of Three Historical Events

Abstract

Emergency medical response after mass casualty bombing events impacts victim outcomes. Preparedness efforts and scenario analysis via a public health response model may help mitigate morbidity and mortality from an explosive attack. The stock-and-flow model implementation and analysis were conducted using three, well-documented, historical bombing events: Birmingham Pubs, Centennial Olympic Park, and Boston Marathon. The explosives public health response model was evaluated using the known injuries sustained in the historical events and subsequent patient outcomes. Injury type and severity were used by the model to predict hospital routing, countermeasure consumption, and victim outcomes, including treatment efficacy. The model predictions are compared to the literature reports available for each event, and statistical acceptance criteria were results within two standard deviations of the historical data. The Birmingham Pubs bombings historically had 182 surviving casualties, and it is predicted there are 181 (±1.5) surviving casualties; Centennial Olympic Park bombing had 111 surviving casualties, and the model predicts 111 (±0); and Boston Marathon bombings resulted in 281 surviving casualties, and the model predicts 280 (±5.1). For all three historical events, the model predicts within two standard deviations for all examined parameters (alive, fatal, hospital routing, fatal untreated, and fatal ineffective treatment) except for the modeled hospital routing of Centennial Olympic Park bombing. Historically, all surviving victims were transported (111 patients) to area hospitals, and the model predicts 83 (±9.9) hospital transports with more people receiving sufficient care at attack site triage. The public health response model examined herein is an effective planning and mitigation tool for event preparedness to reduce risk based on historical accuracy with victim outcomes. Optimization of triage, hospital routing, and countermeasure consumption can improve victim outcome with this modeling tool. Explosives continue to be a public health risk, and mitigation efforts, such as this model, provide avenues for improved health care response.