Weapons of Mass Destruction Events With Contaminated Casualties

Abstract

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sudden presentation of large numbers of contaminated individuals. Guidelines for managing contaminated patients have been based on traditional hazardous material response or military experience, neither of which is directly applicable to the civilian HCF. We discuss HCF planning for terrorist events that expose large numbers of people to contamination. Key elements of an effective HCF response plan include prompt recognition of the incident, staff and facility protection, patient decontamination and triage, medical therapy, and coordination with external emergency response and public health agencies. Controversial aspects include the optimal choice of personal protective equipment, establishment of patient decontamination procedures, the role of chemical and biological agent detectors, and potential environmental impacts on water treatment systems. These and other areas require further investigation to improve response strategies.

Hospital preparedness for victims of chemical or biological terrorism

“…A well-fitting respirator with an organic vapor or high-efficiency particulate air cartridge could provide a meaningful level of protection against some chemical agents, and it might be better than using no respiratory protection in a crisis situation. 24 This study did not characterize the types of available cartridges.…”

“…31,32 The present study defined "minimum recommended" physical resource preparedness by the following criteria: (1) a hazardous materials or chemical weapons plan; (2) either (a) an ED indoor area with isolated ventilation and a shower with water containment ("integral decontamination unit") or (b) an outdoor portable decontamination unit; (3) at least 1 self-contained breathing apparatus or supplied air-line respirator; and (4) at least 1 chemical-protective garment. Less stringent definitions for "questionably effective" levels of physical resource preparedness included (1) access to a conventional shower in lieu of criteria 2a and 2b, given that wastewater containment may be a low priority in a mass casualty situation, 24 or (2) a chemical cartridge air-purifying respirator in lieu of criterion 3. A chemical cartridge respirator, particularly in combination with a high-efficiency particulate air filter, could provide protection against some chemical agents.…”

“…A chemical cartridge respirator, particularly in combination with a high-efficiency particulate air filter, could provide protection against some chemical agents. 24 For the hypothetical anthrax incident, medication preparedness was defined by the reported availability of ciprofloxacin or doxycycline sufficient to provide prophylaxis for 2 days, with the assumption that replacement stocks would become available thereafter. [33][34][35] The risks of secondary aerosolization and person-to-person transmission of anthrax are negligible 36,37 ; therefore, scenario preparedness was defined only by having a biological weapons plan and the necessary antibiotic supply, without any requirement for specific physical resources.…”

“…18 In this context, an increasing number of authors writing in major journals have advocated the need for health care providers and hospitals to make specific plans for response to incidents involving chemical or biological weapons, and they have put forth principles and guidelines for such plans. [18][19][20][21][22][23][24] Other reviewers, however, have expressed concern that the magnitude of government support for domestic terrorism initiatives may be disproportionate to the probability of such incidents occurring, particularly compared with government support for initiatives to address existent public health problems that affect large segments of the population. 25 A substantial need for additional expenditures at the local level to ensure true preparedness for managing victims of terrorist incidents, particularly without the commitment of additional federal funds, could reduce the availability of limited state and local funds for other health care and public health problems.…”

The Quality of Homeland Security and Health Care Systems: The Texas Rangers Initiative

“…Healthcare facilities are an essential component of an emergency response system but, at the present time, are poorly prepared for an incident [3] . The greatest challenge may be the sudden presentation of a large number of contaminated individuals.…”