=Paper=
{{Paper
|id=Vol-2035/paper11
|storemode=property
|title=Simulation Modeling and Research of the Functional Capabilities of the Medical Special Task Unit in Case of an Accident at a Radiation Hazardous Facility
|pdfUrl=https://ceur-ws.org/Vol-2035/paper11.pdf
|volume=Vol-2035
|authors=Andrey A. Tarasiev,Alexey A. Sheklein,Konstantin A. Aksyonov,Igor F. Savchenko,Maxim L. Chuvashev
}}
==Simulation Modeling and Research of the Functional Capabilities of the Medical Special Task Unit in Case of an Accident at a Radiation Hazardous Facility==
https://ceur-ws.org/Vol-2035/paper11.pdf
Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
Simulation Modeling and Research of the Functional Capabilities of
the Medical Special Task Unit in Case of an Accident at a Radiation
Hazardous Facility
Andrey A. Tarasiev Alexey A. Sheklein Konstantin A. Igor F. Savchenko Maxim L.
Ural Federal Ural Federal Aksyonov Military-medical Chuvashev
University University Ural Federal Academy Military-medical
Yekaterinburg, Yekaterinburg, University St. Petersburg, Academy
Russian Federation Russian Federation Yekaterinburg, Russian Federation St. Petersburg,
andrew4800@mail.ru alexbrain@bk.ru Russian Federation Russian Federation
wiper99@mail.ru
Abstract
The purpose of this work is to study the existing approaches to the evacuation
of the affected accident at a radiation hazardous facility, the search for
shortcomings and limitations in the existing organization of the work of the
special task force. In the process of work: the stages of evacuation of the
injured accident at a radiation hazardous facility were investigated, the
analysis of limitations and possibilities for the operation of a special purpose
medical unit was carried out. As a result of the research, an imitation model
was created, modeling results were analyzed, based on the simulation results,
an assessment was made of the work at each stage of the special medical unit,
the required number of hospital beds at the points on the evacuation path was
calculated, the analysis of alternative variants of medical- evacuation
measures.
1 Introduction
Experience in eliminating emergency situations at a radiation-hazardous facility, how to organize and provide assistance
primarily with the help of medical and preventive institutions, as close as possible to the locations of the location of
potentially hazardous facilities. In all cases of the accident, irrespective of the size of the sanitary losses, the administration
of the affected facility and the senior health officials take measures to call the medical strengthening team from the disaster
medicine center. This reinforcement group organizes and carries out sorting of the affected and provision of urgent qualified
medical care.
As a result, the main groups of people are selected, waiting for referral in medical institutions with the definition of
priority. The primary link in the emergency medical service is the so-called rapid reaction teams.
The main task of the brigades is to provide emergency medical assistance to the affected and to hospitalize them in
specialized local, regional or central medical institutions.
"Protection", which decides the decisions assigned to it through regional centers, rapid response teams and outreach
autonomous, a hospital on pneumoframe modules.
2 Organization of a special medical unit
In the hearth of the lesion immediately after the emergence of the accident is the first and first medical aid to the injured
medical personnel of the emergency facility and the ambulance brigades arriving in the first 1-2 hours.
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Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
The main task in this period is the withdrawal (removal) of the victims from the accident zone, the necessary sanitation,
placement depending on the conditions in the medical unit or other premises and the provision of first medical assistance
[1].
In case of radiation accidents, the brigades include:
Radiologist - 2 people;
Hematologist-laboratory assistant - 1 person;
Physicist-dosimetrist - 2 people;
Hygienist-hematologist - 1 person.
The process of evacuation and assistance to the victims can be broken down into the following stages:
Collection of victims in the sorting post, sorting of victims by groups;
Sorting platform (area) - here is sorting according to the severity of the condition of the affected;
Department of special treatment for sanitary treatment of groups that received radiation damage;
Surgery and intensive care units;
Hospital department;
Evacuation area.
The autonomous hospital is completed as follows:
In the operating room are:
Surgeon - 2 people;
Anesthesiologist - 1 person;
Surgical nurse - 2 people;
Sister-anesthetist 1 person;
Sanitary - 1 person.
These specialists work at one surgical table. The hospital department is completed by physicians of therapeutic
specialties (therapist, neurologist, dermatovenerologist, infectious disease specialist), as well as middle (nurses) and junior
(nurses) personnel.
Transportation by hospital is carried out using stretchers. Evacuation from the hospital is carried out with the help of
air transport.
3 Formulation of the problem
To study the internal work of the detachment, the following test data was taken, describing the work of the detachment in
the event of an accident at a radiation hazardous object.
During the accident, 600 people were injured. At the same time, 134 of them diagnosed radiation sickness (RS) among
them.
The structure of RS severity was as follows:
Lightweight - 31%,
Average - 37%,
Heavy and extremely heavy - 16% each.
The combination of thermal explosion factors and radiation factors leads to the following groups of victims forming on
the sorting post::
Gr1 – with isolated radiation lesions (radiation sickness) 20% of all received;
Gr2 – with combined radiation-mechanical lesions (radiation sickness and mechanical trauma) 20% of all received;
Gr3 – with combined radiation-thermal lesions (radiation sickness and burns, both thermal and radiation burns due
to -irradiation, as well as their combinations) 20% of all received;
Gr4 – with isolated mechanical trauma 20% of all received;
Gr5 – with somatic pathology (patients) 20% of all received.
The last 2 groups are those who have avoided radiation damage (Table 1).
Table 1. The structure of the incoming flow by category from the total
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Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
Gr1 Gr 2 Gr 3 Gr 4 Gr 5
Degrees of severity Total by group
20% 20% 20% 20% 20%
Lightweight 4% 4% 5% 8% 10% 31%
Average 7% 8% 8% 6% 8% 37%
Heavy 4% 4% 3% 4% 1% 16%
Extremely heavy 5% 4% 4% 2% 1% 16%
Each of the groups has its own "trajectory" of passing functional units (Figure 1).
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Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
Operating theater
№1 (4) 1,5-2,5ч
Gr4,Gr5 (l/w):
Gr2,Gr4 total 18%
1,2% Gr1(l/w, av),Gr2(l/w, av),
2,4% Gr3(l/w, av), Gr4(av),
Gr5(h, e.h ): total 58%
1,2% 12%
Sorting
area (SA) (1) Sorting area (2)
Sorting process, 10,8%
5-10min. Chamber of intensive care
№1(5)
10% 6+12=18h
90% 12h
Preparation for evacuation to a
specialized radiological center
(SRC) (9)
Gr1,Gr2, Special treatment department
Gr3 – (STD) (3) Hospital department (HD) (8)
60% Operating theater №2 (6) up All groups except Gr4,Gr5
to 1h (l/w) up to 60-72 h
0,6%
5,4%
Gr3 0,6%
1,2%
6%
6%
Chamber of intensive care №2
(7)
up to 60h
Gr1
Chamber of intensive care
№3(10)
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Figure 1. The trajectory of the passage
Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
Priority in care is given to those affected with a heavier lesion. In view of the localization of the work of the detachment,
all the movements between the stages are fleeting and are not taken into account in this model.
Groups 1-3 are sent in full to the sanitary treatment in the special treatment department (STD) from the sorting area
(SA). The treatment time for light and moderate severity is 10 minutes, with up to 6 people being treated at the same time,
and for severe and extremely severe (stretchers) - 25 minutes, while the victims are treated one at a time.
Then the groups are moved to the sorting platform. The time spent for sorting is 5-10 minutes. Persons with mild and
moderate severity lesions are sent to the hospital department (HD), and then, after pre-examination and therapy, are
prepared for evacuation to a specialized radiological center.
Individuals belonging to groups 2 and 4 with severe and extremely severe lesions are sent either to the operating room
with a probability of 10% and / or to the intensive care unit with a 90% probability.
In total, about 20% of people need operative interventions of both groups, and half of them (10%) first pass through the
intensive care unit № 1 on average for 6 hours (from 2 to 8 hours), then goes to the operating room on average for 1.5 hours
(from 1 to 2.5 hours).
All the operated persons need to be in the intensive care unit number 1 on average up to 12 hours (from 6 to 24 hours).
In the intensive care unit and intensive care can be at the same time up to 8 people affected.
Individuals who do not need operative interventions of both groups (severe and extremely severe Gr2, Gr4 - the
remaining 80%) need to be in the intensive care unit number 1 on average up to 12 hours. After that they are sent through
the hospital department for evacuation by air transport in helicopter or airborne resuscitation modules.
Persons belonging to groups 2 and 4, with mild and moderate severity of lesions, are sent from the sorting to the hospital
department, where pre-examination, preparation for evacuation and further evacuation are carried out. The delay of these
persons in civil defense is up to 2 days. Evacuation is carried out mainly by car sanitary transport
Persons of the third group with severe and extremely severe lesions are sent either to the operating room №2 and / or
to the intensive care unit №2 separately from the second group.
The sequence of their passage is similar to the procedure for people with a severe and extremely difficult condition
from the second and fourth groups. Then they are sent to the hospital department, where preparations are made for
evacuation and evacuation.
Timing: for surgical interventions differ and make up to 1 hour. Resuscitative and anti-shock measures in the aggregate
do not exceed 2.5 days.
The two intensive care and intensive care rooms are regular, the third ward for people of the first group with severe and
extremely severe radiation lesions № 3 is additional (non-routine), deployed at the expense of the hospital department and
dedicated anesthesiologists-resuscitators and appropriate separation units, or by strengthening the detachment a non-staff
brigade of anesthesiology and resuscitation from the military hospital. Similarly, then they are sent to the hospital
department, where preparations are made for evacuation and evacuation.
Persons belonging to the fifth group (except for the victims with mild severity) after the sorting are sent to the HD with
subsequent evacuation.
There are 100 beds in the hospital department. Persons who get in here receive planned conservative (medical) treatment
until the first practical possibility of evacuation - with evacuation facilities and the corresponding condition of the affected.
The average length of stay must be such that the total time of stay of the struck in the detachment does not exceed three
days. Otherwise, people with radiation injuries may experience early complications that need to be treated in a radiological
hospital.
The presence in the hospital department of all categories of victims is 1-3 days.
The main task of the detachment during the period of three days is to provide primary medical and sanitary (medical
and specialized) assistance. In other words, according to the classification of types of medical aid in time of war - to provide
qualified medical care with specialized elements, since in the future these persons will require specialized, including high-
tech medical assistance in stationary medical organizations of municipal, regional or federal subordination.
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Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
4 Imitation model
Simulation [5-6] and multi agent [7-8] approach are used for analysis medical unit. An imitation model of the squad's work
in the simulation system BPsimMAS was created (Figure 2).
Figure 2. Simulation model of work of the detachment
The model consists of 11 processes through which the request z1 passes, describing the state of the victim at each stage.
In this case, the following parameters are described at each stage:
Group (Gr1,Gr2,Gr3,Gr4,Gr5);
Degrees of severity (lightweight, average, heavy, extremely heavy);
Waiting time on STD;
Waiting time on sorting area;
Waiting time for operation;
Time spent in the intensive care unit;
Time spent in the hospital department;
Total time of the request in the system.
At the stages 1,2,5,7 and 8 there are 34 rules of the agent describing the decision-making process, responsible persons
at the stages, etc. Also the resources and means used at these stages (hospital units (HU), surgeons, medical orderlies, other
health workers of the detachment, etc.) are also described.
5 Conclusion
Based on the results of the simulation, the following conclusions were drawn:
As the number of arriving victims increases daily, the burden on staff at all stages increases. For example, when 50
victims arrived on the yard (2) on the first day, the minimum working time of the full number of orderlies is 4 hours and
15 minutes, and when the injured are injured on the third day, the maximum time for the nurses reaches 16 hours and 40
minutes. A similar picture is also observed in the stages 3, 7, 10.
The most critical effect is manifested in the intensive care unit №1 (5), when the maximum working time of the staff
on the third day (with the arrival of 100 victims) is approaching 24 hours!
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Proceedings of Information Technologies, Telecommunications and Control Systems (ITTCS) - 2017
As a recommendation for solving this problem, it is necessary to increase the staff of the intensive care unit and intensive
care, and to increase the number of hospital beds at least twice.
Since the finding of victims in the hospital department is planned for a period not exceeding two days, it is also
necessary to increase the number of HUs by the number of victims entering the day.
Acknowledgements
The work was supported by Act 211 Government of the Russian Federation, contract № 02.A03.21.0006.
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