title: Allocation of scarce resources after a nuclear detonation: setting the context.
abstract: The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.
authors.affiliation: Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, USA. ann.knebel@hhs.gov
authors.forename: Ann R
authors.initials: AR
authors.lastname: Knebel
authors.forename: C Norman
authors.initials: CN
authors.lastname: Coleman
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Cliffer
authors.forename: Paula
authors.initials: P
authors.lastname: Murrain-Hill
authors.forename: Richard
authors.initials: R
authors.lastname: McNally
authors.forename: Victor
authors.initials: V
authors.lastname: Oancea
authors.forename: Jimmie
authors.initials: J
authors.lastname: Jacobs
authors.forename: Brooke
authors.initials: B
authors.lastname: Buddemeier
authors.forename: John L
authors.initials: JL
authors.lastname: Hick
authors.forename: David M
authors.initials: DM
authors.lastname: Weinstock
authors.forename: Chad M
authors.initials: CM
authors.lastname: Hrdina
authors.forename: Tammy
authors.initials: T
authors.lastname: Taylor
authors.forename: Marianne
authors.initials: M
authors.lastname: Matzo
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bader
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Livinski
authors.forename: Gerald
authors.initials: G
authors.lastname: Parker
authors.forename: Kevin
authors.initials: K
authors.lastname: Yeskey
mesh_terms: D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration; D005107:Explosions / Q000145:classification; D006801:Humans; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data; D054043:Nuclear Weapons; D010166:Palliative Care; D011832:Radiation Injuries / Q000628:therapy; D011847:Radioactive Fallout; D018788:Radioactive Hazard Release / Q000145:classification; D040841:Resource Allocation / Q000379:methods*; D023481:Terrorism; D014218:Triage
chemical_list: D011847:Radioactive Fallout