Impact of antidote quantity, timing and prehospital strategies in nerve agent mass casualty events: a simulation study

The results highlight the importance of rapid hospital transport, swift antidote availability and administration during urban chemical MCIs. AMS team arrival time emerged as the strongest predictor of preventable mortality, showing a sigmoid-shaped curve where delays beyond 11 min led to sharp increases in death. Antidote supply showed a dose-dependent effect, but the impact diminishes with delayed administration, underscoring the need for timely delivery over sheer volume. To reduce preventable deaths in chemical MCIs, policy makers should focus on streamlining AMS team deployment, prioritizing rapid evacuation, and addressing logistical bottlenecks in decontamination and transport.