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How to remove the info bars If you are working in PowerPoint for Windows and have finished your poster, save as PDF and the bars will not be included. You can also delete them by going to VIEW > MASTER. On the Mac adjust the Page-Setup to match the Page-Setup in PowerPoint before you create a PDF. You can also delete them from the Slide Master. Save your work Save your template as a PowerPoint document. For printing, save as PowerPoint or “Print-quality” PDF. Student discounts are available on our Facebook page. Go to PosterPresentations.com and click on the FB icon. © 2015 PosterPresentations.com 2117 Fourth Street, Unit C Berkeley CA 94710 posterpresenter@gmail.com I. INTRODUCTION / ABSTRACT QUESTION: What are the economic costs associated with non- fatal injuries resulting from terrorism? Process: 1.Devise methods of assessing the severity of injury. 2.Obtain injury cost data from the literature. 3.Apply metrics from #1 and costs from #2 to injuries from terrorist attacks. II. MEASURES OF INJURY SEVERITY Hospitalized Injuries (HI) vs. Non-Hospitalized Injuries (NHI) Pros: easy to assess, data widely available Cons: only two levels of injury severity Length of Stay in Hospital (LOS) Pros: considers degree (duration) of hospital stay Cons: applies only to hospitalized injuries Abbreviated Injury Scale (AIS) – Table 1 Note: for multiple injuries, MAIS = maximum AIS injury Pros: widely used, good balance of usability/clinical rigor Cons: AIS ratings somewhat subjective Injury Severity Score (ISS) Definition: sum of squares of 3 highest AIS, each in a different body region (6 body regions in total) (Baker et al. 1974) Notes: range of 1–75 (44 possible values) Pros: better predictor of mortality than MAIS Cons: more difficult to assess than AIS III. INJURY COST DATA All injury cost data used is summarized in Tables 2, 3, and 4. Cost per Hospital Day Hospitalized injury cost (2010): $99,000 (CDC 2010 – Table 3) Average LOS (2010) = 4.8 days (NHDS 2010) Therefore: $21,000/day Assume: per diem cost does not vary with LOS TABLE 1: Six levels of the Abbreviated Injury Scale (AIS) Nathaniel (Nat) Heatwole, Ph.D. Center for Risk and Economic Analysis of Terrorism Events (CREATE) – University of Southern California (USC) MODELING THE ECONOMIC COST OF NON-FATAL INJURIES FROM TERRORIST ATTACKS Injury SeverityExample InjuriesP(death) AIS 1Minor Abrasion; laceration; strain/sprain; contusion 0.0067 AIS 2Moderate Simple broken bone; serious strain/sprain 0.0075 AIS 3Serious Complicated fracture; minor crush injury 0.035 AIS 4Severe Massive organ injury; heart laceration; loss of limb 0.15 AIS 5Critical Spinal cord syndrome; massive head injury 0.40 AIS 6Maximum Decapitation; partial thickness burns to >90% of body 0.79 Sources: AIS – AAAM (2008); example injuries – Willis & LaTourrette (2008), Russell et al. (2004); P(death), probability of death – Gennarelli & Wodzin (2006) FIGURE 1: Mapping ISS values onto the MAIS Source Cost Metric Severity Metric(s) Notes CDC (2010)COINHI/HIAll U.S. injuries, 2010 Per diem hospital cost COIHI/LOS ($/day) x (LOS) – see Section 3 Finkelstein et al. (2006) COI NHI/HI MAIS All U.S. injuries, 2000 Blincoe et al. (2015) COIMAIS All U.S. motor vehicle injuries, 2010 Graham et al. (1997) QOLMAIS Based on assessment of disability/impairment DOT (2015) QOL/ WTP MAIS Quality adjusted portion of life lost; wage-risk VSL a Viscusi & Aldy (2003) WTPnoneFrom wage-risk studies a Willis & LaTour- ette (2008) WTPMAIS Applies Viscusi & Aldy injury costs to MAIS COI = cost-of-injury (medical treatment + lost work); QOL = quality-of-life (more intangible costs of injury); WTP = willingness-to-pay (true value of injury risk reductions); VSL = value of a statistical life a Wage-risk studies examine wages and risk of on-the-job injury. Finkel- stein et al. (2006) Blincoe et al. (2015) Willis & LaTour- ette (2008) a DOT (2015) a Graham et al. (1997) a,b MAIS 1$4,600$12,000$0 c $28,000$0 c MAIS 2$13,000$53,000$96,600$440,000$1.0 M MAIS 3$42,000$180,000$96,600$990,000$1.5 M MAIS 4$100,000$410,000$96,600$2.5 M$660,000 MAIS 5$200,000$1.1 M$96,600$5.6 M$7.6 M MAIS 6 (fatal) $1.3 M$1.5 M$9.4 M a Using a value of a statistical life of $9.4 million (DOT 2015). b Values non-monotonic in the MAIS because of the large proportion of MAIS 4 injuries that are non-persistent. c These authors assume MAIS 1 injuries have zero cost. Source Non-Hosp. Injuries Hospitalized Injuries Fatalities Finkelstein et al. (2006) $4,900$68,000$1.3 M CDC (2010)$6,400$99,000$1.1 M Viscusi & Aldy (2003) a $28,000– $97,000 a n/a Per diem hospital cost (Section 3) n/a ($21,000/ day) x (LOS) n/a a Does not segregate injuries values by hospitalization status. ISS-based Injury Values Many terrorism injury studies assess injury severity using ISS No ISS injury values in the literature ISS based on AIS, so AIS can be mapped onto ISS (Figure 1) At each MAIS, plausible ISS values bounded between: Low: (MAIS) 2 – AIS triplet (MAIS, 0, 0) High: 3 x (MAIS) 2 – AIS triplet (MAIS, MAIS, MAIS) For example: ISS = 3  MAIS 1 ISS = 12  MAIS 2 or MAIS 3 ISS = 25  MAIS 3, MAIS 4, or MAIS 5 TABLE 2: Sources of Injury Cost Data TABLE 3: Injury Cost Data – Hospitalized / Non-Hosp. (2015$) TABLE 4: Injury Cost Data – MAIS (2015$) IV. ILLUSTRATIVE EXAMPLES Table 5 summarizes the injury costs for three terrorism injury studies, indicating that the value of injury varies considerably, both between and within studies. REFERENCES (AAAM) Association for the Advancement of Automotive Medicine (2008). The Abbreviated Injury Scale 2005, Update 2008. Baker SP, et al. (1974). “The Injury Severity Score: A Method for Describing Patients with Multiple Injuries and Evaluating Emergency Care.” J Trauma, 14(3), 187-196. Blincoe LJ, et al. (2015). The economic and societal impact of motor vehicle crashes, 2010. (Revised). NHTSA report no. DOT HS 812 013. Brismar BO, and L Bergenwald (1982). “The Terrorist Bomb Explosion in Bologna, Italy, 1980: An Analysis of the Effects and Injuries Sustained.” J Trauma, 22(3), 216-220. (CDC) U.S. Centers for Disease Control and Prevention (2010). WISQARS. http://www.cdc.gov/injury/wisqars/ (DOT) U.S. Department of Transportation (2015). Guidance on Treatment of the Economic Value of a Statistical Life (VSL) in U.S. Departmental of Transportation Analyses. Finkelstein EA, et al. (2006). The Incidence and Economic Burden of Injuries in the United States. Oxford Univ. P. Frykberg ER, et al. (1989). “The 1983 Beirut Airport Terrorist Bombing: Injury Patterns and Implications for Disaster Management.” American Surgeon, 55, 134-141. Gennarelli TA, and E Wodzin (2006). “AIS 2005: A contemporary injury scale.” Injury, 37, 1083-1091. Graham JD, et al. (1997). “The costeffectiveness of air bags by seating position.” JAMA, 278(17), 1418-1425. (NHDS) National Hospital Discharge Survey (2010). http://www.cdc.gov/nchs/. Russell R, et al. (2004). “Differences in Mortality Predictions Between Injury Severity Score Triplets: A Significant Flaw.” J Trauma, 56, 1321-1324. Sheffy N, et al. (2006). “Terror-Related Injuries: A Comparison of Gunshot Wounds Versus Secondary Fragments-Induced Injuries from Explosives.” J American College of Surgeons, 203, 297-303. Viscusi WK, and JE Aldy (2003). “The Value of a Statistical Life: A Critical Review of Market Estimates Throughout the World.” J Risk and Uncertainty, 27(1), 5-76. Willis HH, and T LaTourette (2008). “Using Probabilistic Terrorism Risk Modeling for Regulatory Benefit-Cost Analysis: Application to the Western Hemisphere Travel Initiative in the Land Environment.” Risk Analysis, 28(2), 325-339. Acknowledgements: funding support from CREATE; valuable input from Lisa Robinson and Adam Rose AUTHOR BIO Ph.D. – Engineering & Public Policy, Carnegie Mellon Univ., 2011 Dissertation topic: cost-effectiveness of protecting buildings from vehicle bomb attacks B.A. – Physics, Political Science (double major), Guilford College, 2006 Post-Doctoral Research Associate, CREATE, 2011-2015 Currently: job hunting E-mail: heatwolen@gmail.com TABLE 5: Illustrative Examples of Terrorism Injury Costs (2015$ per injured victim) Injury Costing Method Injury Severity Metric 1980 Bologna train station bombing (Brismar & Bergenwald 1982) 1989 Marine Barracks bombing (Frykberg et al. 1989) 2000-2004, various attacks, Israel (Sheffy et al. 2006) Viscusi & Aldy (2003) n/a $28,000– $97,000 $28,000– $97,000 $28,000– $97,000 CDC (2010)NHI/HI$87,000$75,000$38,000 Hospital cost a HI/LOS a $200,000 a n/a$280,000 a Finkelstein et al. (2006) NHI/HI MAIS b ISS c $60,000 $27,000 a $13,000 a $52,000 $27,000 a $28,000 a $26,000 $49,000 a $28,000 a Blincoe et al. (2015) MAIS b ISS c $120,000 a $53,000 a $110,000 a $120,000 a $230,000 a $120,000 a Willis & LaTour. (2008) MAIS b ISS c $90,000 a $97,000 a $82,000 a $97,000 a $84,000 a $97,000 a DOT (2015) MAIS b ISS c $740,000 a $440,000 a $690,000 a $720,000 a $1.3 M a $720,000 a Graham et al. (1997) MAIS b ISS c $1.2 M a $1.0 M a $960,000 a $1.3 M a $1.5 M a $1.3 M a a Hospitalized victims only. b Determined using distribution of MAIS values. c Determined by mapping mean ISS value onto MAIS (Figure 1)