Casualties estimation

Assessment of the impact of the use of gas in the First World War on the Western, Eastern and Italian Fronts is difficult. Analysis of casualty figures is doomed to failure because of a contemporary lack of definition and classification. Gas casualty estimates by several national sources exceed a million but elements of uncertainty exist on the precise cause of death or major source of injury in those who were both gassed and wounded. Also comparison of gas and other battlefield injuries shows vast swings in the proportions on different fronts in different years (Table 2.2). 

Ludwig Haber s book [859a] provides a modern, incisive and detailed analysis of the casualty statistics for World War I, and has been used here as the most reliable source available. Fig. 1.17 illustrates the estimated gas casualities, and Fig. 1.18 shows parallel data for gas deaths. The total number of casualties estimated by Haber (just over half-a-million) [859a] is less than half of Prentiss estimate (ca. 1,300,000) [1660]. In a similar relationship,... 

Unfortunately, Haber [859a] did not attempt to anaiyze his data according to the gas inflicting the casualties - an impossibiy difficult task to perform with any degree of precision, given the many imcertainties involved. Prentiss [1660] did attempt such an analysis, but we know that most of his casualty estimates are too high. Moreover, his anaiysis was based on the data of the American Expeditionary Force, which were only in action in 1918, and... 

Table 1-3. Casualty estimate for initial chemical hazards.

B. An accurate prediction of the number of casualties resulting from a nuclear strike is necessary for adequate medical support and should be made available to medical staff officers. Basic casualty estimations should be broken down into types of casualties so that total bed requirements can be more accurately predicted, particularly in view of the prolonged hospitalization associated with the treatment of patients with bums and combined injuries. One enemy nuclear strike on a given area can produce casualties far in excess of the treatment capability of local medical resources. The effectiveness and adequacy of the rescue, evacuation, and treatment effort during the first 24 hours after such an attack are critical. Area commanders must be informed rapidly of the magnitude of the damage and the estimated medical load in order to provide rescue and treatment resources in sufficient quantities or request the proper assistance from higher headquarters, adjacent units, or allied units. NATO AMedP-8 (Draft) provides information on the casualty rates from a nuclear detonation. 

C. Various systems of casualty and damage assessment have been developed. Such systems are rather involved and depend on many variables such as method and time of delivery, type of burst, size of weapon, weather and climatic conditions, wind direction and speed, fallout dose rate, etc. The gathering and compilation of such data are time consuming and may not be accomplished until many hours after the disaster. The US Army Office of the Surgeon General is developing a system of casualty estimation that will provide rapid and reasonably accurate estimates of the number and types of casualties produced by a given enemy nuclear attack. 

Table 5-B Casualty Estimate for Initial Chemical Hazards 5-7...

One of the major inputs necessary for earthquake casualty estimation is a correlation between the number and severity of injuries and the damage level of the structures. This is not easily attainable due to the limited quality and lack of information in earthquake casualty data. Several studies that proposed casualty rates with respect to various building types and damage levels are available in the literature (e.g. Coburn and Spence 1992). However, casualty rates derived for other regions of the world... 

Spence, R.J.S., Baxter, RJ. Zuccaro, G. 2004. Building vulnerability and human casualty estimation for a pyroclastic flow a model and its application to Vesuvius. Journal of Volcanology and Geothermal Research, 133, 321-343. doi http //dx.doi.org/10.1016/S0377-0273(03)00405-0. 

Typical events that are considered are fire, explosion, ship collision, and the failure of pressurized storage vessels for which historical data established the failure frequencies. Assessment of consequences was based partly on conservative treatment of past experience. For example ilic assessment of the number of casualties from the release of a toxic material was based on past histoiy conditioned by knowledge of the toxicology and the prevailing weather conditions. An altemati. e used fault trees to estimate probabilities and identify the consequences. Credit is taken in this process for preventative measures in design, operation, and maintenance procedures. Historical data provide reliability expected from plant components and humans. 

Ingestion of poisonous chemical If the chemical has been confined to the mouth, give large quantities of water as a mouthwash ensure that the mouthwash is not swallowed If the chemical has been swallowed, small amounts of water may be administered, more if the chemical is corrosive administer a specific antidote if one exists Do not induce vomiting Arrange transport to hospital Information to accompany the casualty Chemical swallowed Details of treatment already given Estimate of quantity/concentration of chemical consumed... 

The toxic effects model uses concentration-time profiles from the respiratory and skin protection models as input to estimate casualty probabilities. Two approaches are available a simple linear dose-effect model as incorporated in RAP and a more elaborate non-linear response model, based on the Toxic Load approach. The latter provides a better description of toxic effects for agents that show significant deviations of simple Haber s law behaviour (i.e. toxic responses only depend on the concentration-time product and not on each quantity separately). 

The possibility of contamination of patients may be determined in the field, en route to a treatment facility, or at a treatment facility, depending on the condition of the patients. The facility receiving the patients should be informed of the estimated number of casualties, the natures of their injuries, and details on any suspected contamination that may be present. Injured personnel should be sorted and treated according to standard medical guidelines. If possible, individuals suspected of being contaminated should be separated from other patients and receive preliminary decontamination prior to treatment (see Section 7.3 for decontamination procedures). 

Societal risks are single number measures, tabular sets of numbers, or graphical summaries that estimate risk to a group of people located in the effected zone of an incident. Since major incidents have the potential to affect many people, societal risk is a measure of risk to a group of people. It is most often expressed in terms of the frequency distribution of multiple casualty events, such as the F-N curve shown in Figure 6-5. The calculation of societal risk requires the same frequency and consequence information as individual risk. Additionally,... 

Hughes reviewed mainly British and European reports and cited official British data estimating that 75-90% of mustard gas casualties had some degree of ocular Injury. A rough estimate, based on information reported by Case and Lea,13 indicates a little over 100,000 cases of eye Injury. Hughes stated that about 10% of these injuries resulted In corneal erosion, which he considered predictive of visual degeneration. Corneal transplants or contact lenses could be expected to help many patients. 

The work of Boyland and Horning,10 Heaton,26-2 and others stimulated interest in the mutagenic and carcinogenic potential of mustard gas This was followed by the work of Case and Lea, who examined the possible carcinogenic effects of H on exposed British soldiers. They cited total British gas casualties as 160,970, 80% of whom were estimated to have been H casualties. As of January 1,... 

In 1993, the Clinton administration proposed an 8.1 billion tax on insurance and chemical companies to pay for the cleanup of the 1,300 worst Superfund sites. In return, the government would have ended attempts to recover the cleanup costs through tort suits, but only for those sites. A.M. Best, an insurance rating company, estimated that the 8.1 billion was only a downpayment on a total environmental liability of 255 billion. In contrast, the total capital of the property and casualty industry was only 180 billion. Republican opposition prevented passage in both the House and the Senate (Quint 1994). 

Place Date Chemicals Estimated amount Casualties... 

Note The figures given in this table are very rough approximations. Only in the cases of the UK and the USA are reasonably adequate casualty statistics available. For the other belligerents, the figures given are those estimated by Colonel Prentiss of the US Army Chemical Warfare Service after his careful study of all available material. His treatise, op. cit. Chemicals in War, should be consulted for further information about his estimates. 

Jakubowski et al. (13) were able to monitor the excretion of TDG in a subject accidentally exposed to sulfur mustard in a laboratory. The casualty developed blisters on hands and arms (< 1% of body area) and erythema on his face and neck (< 5 % of body area). Urine was collected over a 10-day period. A maximum excretion rate of TDG of 20 ug per day was observed between days 3 and 4, the highest concentration being 65 ng/ml. It was noted that the total amount of urine produced for analysis during the first three days was low. Concentrations >10 ng/ml were detected in urine for 7 days after the exposure. The half-life of excretion was estimated as 1.18 days. The total amount of TDG excreted over the 10-day period was 243 ug. There was mass spectrometric evidence of oligomers of TDG (e.g. 

Very high levels of MPA and /-PrMPA were detected as their TBDMS derivatives by GC/FPD in the urine of a Matsumoto casualty rendered unconscious and with low-blood AChE activity (42). Urine was collected over a 7-day period. Concentrations of i-PrMPA and MPA respectively were day 1, 760 ng/ml and 140 ng/ml day 3, 80 ng/ml and 20 ng/ml day 7, 10 ng/ml, MPA not detected (no standard of i -PrMPA was available and quantitation was based on detector response to MPA). The exposure was estimated as 2.79 mg of sarin, making crude assumptions on the percentage that would be excreted, i -PrMPA was detected as the... 

TMS derivative by GC/FPD in urine collected over 7 days from casualties of the Tokyo attack (43). Concentrations were not reported but the estimated exposures were 0.13-0.25 mg of sarin in a comatose patient and 0.016-0.032 mg in less severely intoxicated patients. Using LC/MS/MS and a more rigorous method of quantitation, /-PrMPA was detected underivatized in serum at concentrations of 3-136ng/ml in four casualties of the Matsumoto incident and 2-100ng/ml in 13 casualties of the Tokyo attack (59). All samples were taken within 2.5 hours of hospitalization. High levels of /-PrMPA correlated with low levels of butyryl-cholinesterase activity. Other positive analyses associated with these incidents were obtained by identification of inhibited cholinesterase, and are reported in Part B. 

Kage et al. (75) applied their GC/ECD/GC/MS method to the analysis of blood levels in two casualties who died from cyanide poisoning. Blood levels of cyanide and thiocyanate in a subject who died following ingestion of sodium cyanide were 0.52 and 0.10 umol/ml respectively (= 13 and 5.6 xg/ml). Levels determined in a fatal victim of smoke inhalation were 0.28 and 0.13umol respectively (= 7.3 and 7.5 xg/ml). Fatal levels of cyanide are estimated as 0.05-0.1 umol/ml (= 1.3-2.6 xg/ml). The lower levels of thiocyanate in comparison to cyanide in the blood were attributed to the sudden death they were twice the mean levels ( 0.06 pmol/ml) found in cigarette smokers. 2-Aminothiazoline-4-carboxylic acid was detected in the urine of moderate cigarette smokers at concentrations between <0.3-1.1 xM (76). 

The analytical procedure for S-[2-[(hydroxyethyl) thio]ethyl-Cys-Pro-Phe was successfully applied to blood samples from nine Iranian casualties of the Iraq-Iran war, all exhibiting skin injuries compatible with exposure to sulfur mustard. The blood samples were collected 8-9 days after the alleged exposure and stored at — 70 °C. The albumin adduct was detected in all cases, at levels estimated as corresponding to those after in vitro exposure of human blood to mustard concentrations ranging from 0.4-1.8 xM. 

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