| Scenarios |
Description |
Potential of Critically Ill Patients (Patients Receiving Mechanical Ventilation), No. |
Requirements for Critical Care |
Likely Duration of Critical Care |
Likely Duration of Ventilation |
Probability of External Support |
|
| Nuclear detonation: 10-kiloton improvised nuclear device |
Terrorists assemble a nuclear device using highly enriched uranium. The device is detonated in the business district of a large city |
Tens to hundreds of thousands (hundreds to thousands) |
Burns; blast injury; bone marrow suppression; septic shock; cardiovascular collapse |
Patient surges will occur in waves over several weeks |
Days to weeks |
If a single device, external support is likely but limited by risk of secondary exposure |
| Anthrax attack |
A tractor-trailer truck drives through rush-hour traffic in a large urban city spraying approximately 100 L of wet-fill Bacillus anthracis (anthrax), exposing approximately 330,000 persons; 13,000 cases of inhalation anthrax would be expected |
13,000–25,000 (approximately 13,000) |
Pneumonia with respiratory failure; septic shock; ARDS |
Days to weeks |
Days to weeks |
Likely to arrive in 24 to 96 h if localized attacks only |
Pandemic influenza |
A pandemic of influenza sweeps the globe and affects a state with 11 million people |
Approximately 10,000 (approximately 5,700) |
ARDS; pneumonia; septic shock; myocardial infarction |
Weeks to months |
Days to weeks |
External assistance unlikely |
| Biological attack with pneumonic plague |
Terrorists release pneumonic plague in the bathrooms of the major airport of the city, at the main sports arena, and at the major train station |
Approximately 6,000 (approximately 6,000) |
Pneumonia; septic shock |
Days to weeks |
Days to weeks |
Likely in 24 to 96 h if an isolated attack; however, because of rapid spread to other cities by those infected at the airport, external help will be delayed |
| Chemical attack: blister agent |
Terrorists use a light aircraft to spray a blister agent (sulphur mustard and lewisite) into a packed college football stadium. The attack causes a large number of casualties that require urgent and long-term medical treatment, but few immediate fatalities occur |
Hundreds to thousands (hundreds) |
Upper airway obstruction; ARDS; trauma injuries from stampede out of stadium; sepsis arising from secondary infections in those with compromised skin |
Days to weeks |
Days |
Likely in 24 to 96 h if an isolated attack |
| Terrorist attack on industrial sites |
Terrorists launch rocket-propelled grenades at a petroleum refining plant and bomb several nearby container ships. Multiple fires occur, releasing smoke containing cobalt, nickel, molybdenum, cadmium, mercury, vanadium, platinum, isocyanates, nitriles, and epoxy resins |
Hundreds (tens to hundreds) |
Burns; blast trauma; smoke inhalation; exacerbation of chronic respiratory conditions |
Days to weeks |
Days |
Likely in 24 to 96 h if an isolated attack |
