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Table 1A.. Continued

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

Chemical attack: nerve agent Terrorists release sarin vapor into the ventilation systems of three large commercial office buildings in a metropolitan area. The agent kills 95% of the people in the buildings, and kills or sickens many of the first responders and those in adjacent buildings Hundreds (tens to hundreds) Seizures; paralysis; coma; respiratory failure Days to weeks Hours to days Likely in 24 to 96 h if an isolated attack

Chlorine tank explosion A chlorine gas (liquefied under pressure) storage tank ruptures, releasing a large quantity of chlorine gas downwind of the site in Chicago 15,000–20,000 (8,000–12,000) ARDS; pulmonary edema Days to weeks Days Likely in 24 to 96 h

Earthquake A 7.5-magnitude earthquake occurs in a major metro area with a population of 10 million Tens to hundreds (tens to hundreds) Crush injuries (pulmonary contusions, renal failure) Days to weeks Hours to days Likely in 24 to 96 h

Major hurricane A category 5 hurricane that makes landfall at a major metro area with a storm surge > 20 feet above normal. Low-lying escape routes are inundated by water hours before the eye of the hurricane reaches land Minimal (may be more if existing infrastructure fails and hospital in affected area is evacuated) Trauma; sepsis from waterborne infections; drowning Days Days Likely in 24 to 96 h

Radiologic attack: radiologic dispersal devices Terrorists detonate ''dirty bombs'' containing cesium-137 in several major cities Tens to hundreds (tens to hundreds) Blast injury; radiation sickness Days to weeks Days Likely in 24 to 96 h

Conventional explosion Terrorists detonate a series of truck bombs and explosives on a transit system Tens to hundreds (tens to hundreds) Head injury; lung blast injury; burns; multiple trauma Days to weeks Days to weeks Likely in 24 to 96 h

Biological attack: foreign animal disease (foot and mouth disease) Terrorists introduce disease into the food chain None None N/A N/A N/A

Cyber attack Terrorists conduct cyber attacks against critical infrastructures reliant on the Internet None None N/A N/A N/A

^* From Department of Homeland Security.¹³ N/A = not applicable.

Data used for Ontario, Canada. Population approximately 11 million, assuming 35% attack rate over 6 weeks.

Although a cyber attack does not directly result in human casualties, given the highly technology-dependent nature of critical care, and critical infrastructure in general, computer viruses in medical equipment and electronic medical records or losses crippling the capacity for information exchange could lead to large numbers of critically ill patients.

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