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Fire departments, EMS providers and other emergency response agencies are being trained to deal with terrorist incidents, but recent testimony before Congress reveals that local public health systems are not prepared to respond to potential chemical or biological attacks.
Testimony came from state emergency management officials and medical personnel. Reasons given include a lack of coordination among medical, emergency management and law enforcement agencies, and the inability to detect a biological attack in a timely manner. This preparedness shortfall has been acknowledged by the Clinton Administration and it is reported that the Department of Health and Human Services is working to improve the situation.
Photo by Robert Burke
Hospital staff members set up a decontamination line and protective pathway at the entrance to a hospital emergency department. It is important for fire departments, EMS crews, hazmat teams and other responders to know which hospital emergency departments in their areas are capable of handling victims of hazmat or terrorist incidents.
Concerns about a lack of preparedness for chemical and biological incidents on the part of the medical system may, in some cases, go beyond the terrorism arena. Many hospital emergency departments are not even prepared to deal with victims of accidental hazardous materials incidents. (Because agents used in terrorist attacks are hazardous materials, no differentiation is made in this column when referring to them when discussing procedures unless they are unique to a particular material.) Patients could contaminate a hospital emergency department and close it to other types of emergencies until it can be decontaminated.
While this has been identified as a national problem, the solution rests largely with the states and, in particular, local communities. Even if federal and state resources are available to assist in a hazmat release, such help would be hours away at best - and most patients from a disaster reach the hospital within 90 minutes. Thus, hospital emergency departments must be prepared for hazmat patients and deal with them using their own resources for an extended period.
Much of the attention at a hazmat or terrorist scene is focused on treating victims and mitigating the incident. Response personnel also need to take into consideration treatment beyond the scene, i.e., the hospital, and in particular the emergency room. Many hospitals, particularly smaller ones, are not prepared to accept potentially contaminated victims from a hazardous materials or terrorist incident. While it is not necessary that every hospital emergency department have the capability of receiving contaminated victims, response personnel should know which hospitals do have that ability.
Three situations can arise from hazmat or terrorist incidents:
- One patient has been contaminated and is transported to a hospital emergency department.
- A single incident has occurred, causing many casualties.
- A disaster disrupts a large segment of a community.
The successful outcome of a hazmat or terrorist incident will depend on good pre-planning, which must include the local medical system. In addition to decontamination ability, hospitals should be identified that have the expertise to handle poison exposures, including stocks of antidotes.
Photo by Robert Burke
A nurse wearing protective clothing prepares to work in a dedicated decontamination room equipped with an eyewash shower and a portable hose.
When a community has more than one hospital, certain ones may be designated as hazmat facilities for the purpose of receiving patients from the emergency medical system. All other hospitals should at least have the ability to provide basic decontamination and care for people exposed to hazardous materials.
Contaminated victims may show up at hospital emergency rooms on their own. After the sarin nerve agent attack in the Tokyo subway, only 600 to 700 of the estimated 5,500 victims were transported to hospitals by ambulance. The remaining victims arrived in private cars, taxis and city buses.