Managing Bioterrorism Mass Casualties in an Emergency Department: Lessons Learned From a Rural Community Hospital Disaster Drill

Abstract

Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks.

Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?

“…Luther et al (2006) carried out a study in an Australian ED using a mock simulation: areas of concern related to decontamination and the recognition of the situation at triage. Vinson's (2007) study carried out in a Pennsylvania ED, involving a simulated bioterrorist event had similar findings. Although the lessons learned following the simulation cannot be generalized to all hospitals, they highlight areas where responders continue to run into difficulties: primarily decontamination of patients and appropriate triage.…”

“…At the time of this study there was no UK research available that focused specifically upon nursing staff preparedness for a CBRNe incident: only that which assessed departmental capability by Anathallee et al, 2007. The UK is not alone in failing to adequately prepare for such major incidents. Luther et al (2006) and Vinson (2007) assessed staff preparedness within the ED for an incident relating to a chemical, biological and/or radiological threat, by simulating the event. No studies were found that also assessed the other two components of nuclear and explosive, grouped within the term CBRNe.…”

Perceptions of emergency nurses during the human swine influenza outbreak: A qualitative study

“…The participants in this study highlighted the importance of staff training to combat HSI outbreak. Effective training would equip nurses with the knowledge and clinical skills applicable to patient care, which would benefit their capabilities for handling major health emergency threats such as pandemic situations (Leiba et al, 2006;Vinson, 2007). In addition to enhancing the pandemic preparedness of the frontline staff through preliminary training, the smooth functioning of the healthcare institution in response to disease outbreaks should also be maintained (Hynes, 2006).…”

Disaster Response to the Release of Biohazardous Agents: Instrument Development and Evaluation of a Firefighter's Exercise

“…The utility of exercises using simulated incident scenes for improving the response performance has been reported by a limited number of publications. [6][7][8][9][10][11][12] Methods of monitoring and evaluation of response activities include: (1) a post-exercise self-assessment questionnaires for rescue workers; 7,11 (2) post-exercise questionnaires filled out by simulated victims; 11 and (3) the use of trained, external observers. 11,13 However, the methods used for documentation and evaluation usually are kept confidential.…”