Hospital Bioterrorism Planning and Burn Surge

Abstract

On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity. A t 11:27 a.m. on June 9, 2009, the first of many 911 calls began flooding the emergency communications center. The calls for help described an explosion at an industrial plant in Garner, North Carolina, a town in Wake County near Raleigh. Approximately 300 employees had reported for work that morning. By the end of the day, 3 were dead and 68 injured (another patient would succumb to his injuries months later).An investigation concluded that the explosion resulted from a gas leak. Once the gas leak found an ignition source, DOI: 10.1089DOI: 10. /bsp.2013 the ensuing conflagration and explosion sent a shock wave through the concrete building, causing exterior walls to collapse, crushing cars parked next to the building, and blowing large holes in the ceiling. As these walls and ceiling sections collapsed, they ripped open additional supply lines of gas and ammonia and exposed electrical lines in multiple sections of the building, culminating in a horrific and deadly scene.and Bioterrorism: Biodefense Strategy, Practice, and Science Volume 12, Number 1, 2014 ª Mary Ann Liebert, Inc.The subsequent investigation concluded there had been no purposeful intent, and terrorism was ruled out. Nevertheless, one method of terrorizing a population is to purposefully explode an incendiary device to injure, mutilate, and kill people and to destroy buildings and infrastructure. 1 While this disaster lacked purposeful intent, the response, rescue, and outcomes reflected many of the efforts of the past decade in which terrorism and b...

Nurses' and Medical Officers' Knowledge, Attitude, and Preparedness Toward Potential Bioterrorism Attacks

“…In recent years, terrorists have also developed the interest in using bioweapons to cause panic and fear through the causation of disease. Terrorists attempted to cause a disaster with anthrax through the postal system during the 2001 terrorist attacks in the United States ( Clarke, 2002 ; Kearns et al., 2014 ; McFee et al., 2004 ; Murphy, 2004 ). Recent events such as the disappearance of vials containing the severe acute respiratory syndrome virus from a French laboratory or the alleged selling of the toxin abrin through a black market website confirm that there is no place for unpreparedness or passive attitudes when it comes to bioterrorism preparedness (Lupkin, 2014; Wigglesworth, 2014 ).…”

“…The preparedness of health professionals will largely depend on their knowledge and attitudes toward bioterrorism preparedness. Some improvements in the preparedness of health-care systems against bioterrorism only started in some developed countries when anthrax was posted to some top officials during September 11, 2001, attacks in the United States ( Clarke, 2002 ; Kearns et al., 2014 ; McFee et al., 2004 ; Murphy, 2004 ). Overall, biological weapons are easily obtained and easily disseminated, and they result in significant mortality and morbidity ( Smeltzer et al., 2008 ).…”

“…Programs such as Bioterrorism Hospital Preparedness Program in the United States which is aimed at offering national guidance and financial support to state- and local-level agencies against bioterrorism should be replicated across African countries ( Office of the Assistant Secretary for Preparedness and Response, Hospital Preparedness Program, 2012 ). The Bioterrorism Hospital Preparedness Program was originally focused on building capacity in pediatric departments, trauma units, and burn care centers, in response to a terrorist attack ( Kearns et al., 2014 ; Office of the Assistant Secretary for Preparedness and Response, Hospital Preparedness Program, 2012 ). Bioterrorism planning efforts usually include planned development, revision of emergency medical services, extensive education, protocols, destination guidelines, and hospital coordination ( Kearns et al., 2014 ).…”

“…The Bioterrorism Hospital Preparedness Program was originally focused on building capacity in pediatric departments, trauma units, and burn care centers, in response to a terrorist attack ( Kearns et al., 2014 ; Office of the Assistant Secretary for Preparedness and Response, Hospital Preparedness Program, 2012 ). Bioterrorism planning efforts usually include planned development, revision of emergency medical services, extensive education, protocols, destination guidelines, and hospital coordination ( Kearns et al., 2014 ). All of these efforts contribute to an effective response and positive patient outcomes during periods of bioterrorism ( Kearns et al., 2014 ).…”

“…Appropriate knowledge, positive attitudes, and preparedness of health professionals against bioterrorism in a lower middle-income country such as Ghana can help reduce casualty rates during an attack ( Gera, Gupta, Verma, Singh, & Gupta, 2017 ). Although the threat of biological warfare seems remote to most countries ( Das & Kataria, 2010 ), bioterrorist attacks such as September 11, 2001, anthrax attacks in the United States ( Kearns et al., 2014 ; McFee, Leikin, & Kiernan, 2004 ; Murphy, 2004 ) and other available evidence shows that many countries, as well as terrorists, are rapidly acquiring biological weapons for future use against opponents ( Cary, 2009 ). Terrorist attacks have frequently been reported in African countries such as Kenya, Nigeria, Tanzania, and Egypt.…”