Preparedness of Hospitals to Respond to a Radiological Terrorism Event as Assessed by a Full-Scale Exercise

Abstract

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review

“…Preparedness 5,12,13,16,18,19,20,21,22,24,25,26,27,28,29,30,31,32,33 The ED is a complex system consisting of organisational, technological, and individual factors which is further complicated by the multifaceted demands of CBRNe events, resulting in under preparedness 2. Response 11,21,30,34,35,26,36,37,38,39,40 Response is determined by first receivers willingness to respond to unknown CBRNe exposure and the organisational management of surge capacity 3. Decontamination 5,13,16,23,41,42,43,44,45,46 Decontamination remains an area of ambiguity, amplified by first receivers lack of knowledge on decontamination procedures 4.…”

“…Furthermore one study suggested that the limitations in the ED CBRNe response was a reflection of overall hospital preparedness 33 . Studies reported a number of solutions to enhance the ED CBRNe response, including creating surge capacity 21,36 -which is the hospitals ability to accommodate a transient sudden rise in demand for healthcare following an event 21,36 . Implementing specific triage routes (time and sequence for patient management) have been proposed to create surge capacity 37,38 as well as applying actions such as a decrease in new admissions, discharge of patients earlier, cancelling elective surgeries, organising day care for children of staff, and designating victim flow areas 11,39,40 .…”

“…Implementing specific triage routes (time and sequence for patient management) have been proposed to create surge capacity 37,38 as well as applying actions such as a decrease in new admissions, discharge of patients earlier, cancelling elective surgeries, organising day care for children of staff, and designating victim flow areas 11,39,40 . Surge capacity was however, suggested to be restricted by the failure to fully integrate interagency training, planning, and co-ordination 11,21,36 .…”

Assessment of community hospital disaster preparedness in New York State

“…Hospital preparedness for radiological terrorism was assessed through a regional fullscale exercise involving 11 hospitals. The researchers found that hospitals were not prepared to handle and decontaminate mass casualties (Jasper et al, 2005). Becker and Middleton (2008) conducted 10 focus groups on radiological attack preparedness with 77 ED physicians and nurses at hospitals in three regions of the country.…”

Disaster Preparedness, Triage, and Surge Capacity for Hospital Definitive Care Areas: Optimizing Outcomes when Demands Exceed Resources

“…The simplest form is when a few individuals literally sit around a table and discuss the sequence of their responses to events of a hypothetical disaster based on a written scenario. More complex variations of exercises can be from the hospital [43] or regional level (which includes first responders, communication systems, and local agencies) [44,45] to national or multinational disaster rehearsals [46,47]. Common to all of these exercises are a careful pre-event plan, some degree of reality simulation, anticipation of relevant participants' responses (often a group of observers), and most importantly, a post hoc analysis of how the response was executed.…”