Is your jurisdiction ready for a terrorist attack? In a recent report from the September 11 Commission, Vice Chairman Lee Hamilton, a former Congressman from Indiana, said, "We believe that another attack will occur. It's not a question of if. We are not as well-prepared as we should be." While Hamilton was most likely talking about our national preparedness there are numerous areas of our country that have become well-prepared. Through federal grants many communities have accumulated equipment and training to better handle terrorism events. Decontamination (decon) issues have also been at the forefront of preparation efforts. While many of these efforts have been well thought out and conducted with good intentions there are some that argue that the response community needs to rethink what may happen at terrorist events.
In a recent article entitled, "Control the site, then decon? History says no" (1) by Joseph Scanlon, the issue of what may occur at terrorism emergencies is outlined. Scanlon writes that while many agree that in response to terrorist attacks the emergency scene should be managed, decon should be conducted on-scene for all contaminated people, and hospitals should be alerted, it probably won't happen that way. Scanlon shows through numerous case studies, including the Matsumoto and Tokyo sarin attacks in 1994 and 1995, respectfully, that there will be no one site for the emergency, responders enter the emergency picture late, and hospitals will receive victims fairly soon after the event begins. He goes on in the article to ask, "If that's the way things actually happen, why do we persist in planning the way we do?". In order to better prepare for terrorism events and response, Scanlon believes the response community should avoid the idea that chemical or terrorism incidents will occur at just one site or location but may easily spread through secondary contamination. He warns that responders should be aware that the site, or sites, may not be easily controlled, and that decon efforts will most likely not be set-up or operating quick enough to stop contaminated victims from leaving the area. All of the above warnings are based on past incidents, warns Scanlon.
A call to reality is needed! Terrorism attacks will most likely be aimed at large gatherings of people in order to have high impact and receive the notice of the media. Response agencies will most likely be alerted soon after the attack begins but will it be quick enough? Considering the response time, or lead time, and it is readily apparent that first responders will be playing the game of catch-up. It will most likely be impossible to control the scene, the flow of people, and the migration of exposed victims. To ask victims, who may be severely bothered by the acute health effects of a chemical agent, to wait in an orderly manner while decontamination efforts are set-up is laughable. A little empathy is needed here in planning efforts. Stand in the victims shoes for a moment and then answer this question; will you wait to be deconned if your breathing is compromised and your skin is very irritated?
The good intentioned efforts over the past several years may not be enough and they may even be unrealistic. Decon efforts should center around this concept; How can responders do the most good in the shortest period of time? When a terrorist attack has occurred and hundreds to thousands of people have been exposed to lethal agents, responders simply cannot spend time on setting up elaborate decon facilities. The window of opportunity is extremely small in which victims can be saved.