{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:45:26Z","timestamp":1791888326424,"version":"4.3.4"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"unspecified","delay-in-days":285,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100021704","name":"Administration for Strategic Preparedness and Response","doi-asserted-by":"publisher","award":["GS00Q14OADU122 \/ 75A50222F80005"],"award-info":[{"award-number":["GS00Q14OADU122 \/ 75A50222F80005"]}],"id":[{"id":"10.13039\/100021704","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1935789326104625_sec1\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Response agencies use mathematical modeling to quantify the consequences of mass-casualty incidents. Medical consequence models estimate the number of people to be treated for their injuries and rely on triage protocols based on injury severity to estimate the number of people who are expected to die. Available models ignore the time required to be rescued, which presents an incomplete picture of how many people would live long enough to be rescued and treated. We propose a new damage zone-based population sorting algorithm to improve estimates of people who would require treatment after a nuclear detonation in a U.S. urban setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104625_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We expanded the Administration for Strategic Preparedness and Response (ASPR)nuclear detonation model to include specific blast injuries such as casualties with fractures or hemorrhage. We evaluated 3 population sorting methods: no sorting (i.e., count everyone as treatable), sorting based on Department of War (DOW)\/North Atlantic Treaty Organization (NATO) expectant rules, and damage zone-based population sorting. Damage zone-based population sorting introduces a new population category termed unrescuable, who are expected to die before being rescued based on the damage zone, injury severity, and the expected timing of response operations. We assessed the impact of population sorting on the number of injured and the number of injuries to be treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104625_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Damage zone-based sorting significantly decreases the estimates of expectants and increases estimates of the population requiring medical treatment for the most serious trauma injuries compared to population sorting based on DOW\/NATO expectant rules.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1935789326104625_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The new damage zone-based population sorting method represents an important modeling refinement that incorporates realism into modeling results estimating the number of trauma-injured people requiring treatment and numbers of specific trauma injuries that would need to be treated in the aftermath of a nuclear detonation. We saw that the choice of population sorting method can influence the allocation of medical countermeasures required to respond in mass-casualty incidents, impacting medical countermeasure requirements, development, and investments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/dmp.2026.10462","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:51:00Z","timestamp":1791885060000},"source":"Crossref","is-referenced-by-count":0,"title":["Incorporating Realism: Damage Zone-Based Population Sorting for Nuclear Detonation Modeling"],"prefix":"10.1017","volume":"20","author":[{"given":"Suzanne","family":"Wright","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/012cvds63","id-type":"ROR","asserted-by":"publisher"}],"name":"Leidos Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelima","family":"Yeddanapudi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/012cvds63","id-type":"ROR","asserted-by":"publisher"}],"name":"Leidos Inc"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Paletta","sequence":"additional","affiliation":[{"name":"Tunnell Government Services, Inc."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2118-9204","authenticated-orcid":false,"given":"Vlado","family":"Antonic","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/029y69023","id-type":"ROR","asserted-by":"publisher"}],"name":"BARDA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5451-3885","authenticated-orcid":false,"given":"Narayan V.","family":"Iyer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/029y69023","id-type":"ROR","asserted-by":"publisher"}],"name":"BARDA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"S1935789326104625_r11","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X20000291"},{"key":"S1935789326104625_r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.05.019"},{"key":"S1935789326104625_r21","unstructured":"21. Prabowo, Y , Kamal, AF , Latief, W , et al. Epidemiology of orthopaedic injuries at the local hospital following earthquake in Palu, Indonesia, 2018. J Orthop Trauma Surg Rel Res. 2019 Dec 17;14(3). Accessed March 2025. https:\/\/www.jotsrr.org\/articles\/epidemiology-of-orthopaedic-injuries-at-the-local-hospital-following-earthquake-in-palu-indonesia-2018.pdf"},{"key":"S1935789326104625_r22","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-017-0115-8"},{"key":"S1935789326104625_r25","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001123"},{"key":"S1935789326104625_r19","unstructured":"19. Shariat, S , Mallonee, S , Stidham, SS . Physical injuries and fatalities resulting from the Oklahoma City bombing. Summary of reportable injuries in Oklahoma: Oklahoma City Bombing injuries. Oklahoma State Department of Health. December 1998. Accessed March 2025. https:\/\/oklahoma.gov\/content\/dam\/ok\/en\/health\/health2\/documents\/okc-bombing.pdf"},{"key":"S1935789326104625_r9","unstructured":"9. Department of Homeland Security (DHS). Nuclear\/radiological incident annex to the response and recovery federal interagency operational plan. May 2023. Accessed March 2025. https:\/\/www.fema.gov\/sites\/default\/files\/documents\/fema_incident-annex_nuclear-radiological.pdf"},{"key":"S1935789326104625_r5","unstructured":"5. Fletcher, ER , Richmond, DR , Yelverton, JT . Glass fragment hazard from windows broken by airblast. 1980. Lovelace Biomedical and Environmental Research Institute, Inc. Albuquerque, NM. Accessed March 2025. http:\/\/www.dtic.mil\/cgi-bin\/GetTRDoc?AD=ADA105824&Location=U2&doc=GetTRDoc.pdf"},{"key":"S1935789326104625_r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2011.06.012"},{"key":"S1935789326104625_r20","volume-title":"Morbidity and Mortality Weekly Report (MMWR) Weekly","volume":"2001","year":"2002"},{"key":"S1935789326104625_r16","doi-asserted-by":"publisher","DOI":"10.1097\/HP.0b013e31829cf221"},{"key":"S1935789326104625_r6","unstructured":"6. Rich, T , Callahan, M , Hassol, A , et al. The AHRQ surge model: a tool for estimating medical resources required to treat casualties resulting from WMD attacks. 2006. Project performed for Agency for Healthcare Research and Quality. Abt Associates. Boston, MA."},{"key":"S1935789326104625_r26","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827a3704"},{"key":"S1935789326104625_r7","unstructured":"7. American College of Surgeons (ACS). Trauma program overview: National Trauma Data Bank\u00ae (NTDB\u00ae). 2024. Accessed October 2024. https:\/\/www.facs.org\/quality-programs\/trauma\/quality\/national-trauma-data-bank\/reports-and-publications\/"},{"key":"S1935789326104625_r12","article-title":"Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation","author":"Coleman","journal-title":"Disaster Med Public Health Prep"},{"key":"S1935789326104625_r17","unstructured":"17. United States Centers for Disease Control and Prevention (CDC). Radiation emergencies, acute radiation syndrome: information for clinicians. Website. April 2024. Accessed October 2024. https:\/\/www.cdc.gov\/radiation-emergencies\/hcp\/clinical-guidance\/ars.html"},{"key":"S1935789326104625_r14","unstructured":"14. Headquarters (HQ) Department of the Army, the Navy, and the Air Force, and Commandant, Marine Corps. Army FM 4-02.283, Navy NTRP 4-02.21, Air Force AFMAN 44-161(I), Marine Corps MCRP 4-11.11B. Treatment of nuclear and radiological casualties. Headquarters, Departments of the Army, the Navy, and the Air Force, and Commandant, Marine Corps. December 2001. Accessed March 2025. https:\/\/ia804605.us.archive.org\/0\/items\/MManuals\/UsMultiserviceTreatNuclearRadiologicalCasualties.pdf"},{"key":"S1935789326104625_r18","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"S1935789326104625_r2","doi-asserted-by":"publisher","DOI":"10.1017\/dmp.2025.10167"},{"key":"S1935789326104625_r23","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16101675"},{"key":"S1935789326104625_r24","doi-asserted-by":"publisher","DOI":"10.1590\/S1020-49892005000800013"},{"key":"S1935789326104625_r27","article-title":"Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006","author":"Kelly","year":"2008","journal-title":"J Trauma"},{"key":"S1935789326104625_r1","doi-asserted-by":"publisher","DOI":"10.1001\/dmp.2011.25"},{"key":"S1935789326104625_r4","volume-title":"Defense Nuclear Agency Technical Report DNA-TR-92-134. 1993","author":"Levin"},{"key":"S1935789326104625_r10","article-title":"Using the model of resource and time-based triage (MORTT) to guide scarce resource allocation in the aftermath of a nuclear detonation","author":"Casagrande","journal-title":"Disaster Med Public Health Prep"},{"key":"S1935789326104625_r8","unstructured":"8. 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