ABSTRACT
Sports mega-events, such as the Olympic Games or the Super Bowl, are attractive targets for terrorist organizations, due to their visibility, size, and number of people involved. Two characteristics of sports mega-events, however, make them distinctive in comparison with other well-studied target protection problems in counterterrorism analysis (such as transportation hubs or infrastructure facilities). First, defensive measures are often publicly known. Second, their finite horizon means that deterrence against any attack must be prioritized. In this article we thus propose a method that identifies the best portfolio of defensive measures the defense may adopt, given a fixed budget, to minimize the chances of suffering a terrorist attack during a sports mega-event. The method makes some relevant contributions to adversarial risk analysis: (i) it represents attackers that can choose among multiple attack scenarios and the no-attack scenario; (ii) it measures the deterrence effect caused by synergic portfolios of defensive measures; and (iii) it proposes an algorithm that identifies dominated portfolios and may, thus, overcome the scalability problems inherent to this portfolio optimization. We apply this method to a real-world defense problem, revisiting the defensive countermeasure planning for the 2016 Brazilian Olympic Games in Rio de Janeiro, Brazil. In the case study, we find a nonlinear relationship between budget expenditure and deterrence, as well as a decreasing marginal effectiveness use of resources after a given budget threshold, which would support a more efficient allocation of investments in the Games defense.
Subject(s)
Terrorism , Brazil , Humans , Terrorism/prevention & controlABSTRACT
OBJECTIVES: Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics. METHODS: Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified. RESULTS: Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had "facilitated transfer" arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed. CONCLUSION: ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
