Truth hurts – hard lessons from Australia's largest mass casualty exercise with contaminated patients

Abstract

In response to the increasing threat of a mass casualty incident involving chemical, biological or radiological agents, and concern over the preparedness of our hospital system to cope with patients from such an incident, we conducted the largest hospital-based field exercise involving contaminated patients that has been held in Australia. In the present paper, we outline the background to, and methodology of, Exercise Supreme Truth, and the efforts made to increase its realism. We focus our discussion on three issues highlighted by the exercise, which we believe have enormous implications for the development of hospital chemical, biological or radiological plans and the likelihood of their success--hospital security, crowd control and decontamination.

Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data

“…In the aftermath of the Bhopal disaster there was no mass casualty emergency response system in place and local hospitals were soon overwhelmed with casualties [5]. Even with the UK’s current capability of implementing mass decontamination procedures at a safe distance from the Hot Zone it is still likely that many casualties will quickly leave the scene and self-present at hospitals largely in the following six hours [16]. This brings into question our assumption that ambulant casualties having performed their initial disrobe (averaging approximately 10 minutes, see Figure A8 in the Supplementary Material) will be queuing for the MD1 prior to its construction.…”

Effective Responder Communication Improves Efficiency and Psychological Outcomes in a Mass Decontamination Field Experiment: Implications for Public Behaviour in the Event of a Chemical Incident

“…Incidents involving mass decontamination may present further challenges for emergency responders since they involve crowds [8], which may be perceived by responders as a source of disorder and ‘panic’ during emergencies [11].…”

Perceived Responder Legitimacy and Group Identification Predict Cooperation and Compliance in a Mass Decontamination Field Exercise

“…Whilst the evidence above provides important insights into the way members of the public experience the decontamination process, it is taken from small-scale incidents (< 30 people), rather than incidents involving mass decontamination. Mass decontamination may present different challenges for members of the public and responders since it involves crowds (Edwards, Caldicott, Eliseo, & Pearce, 2006). Social psychological theories of crowd behaviour in emergencies and disasters may therefore provide important insights into factors which play a part in the successful management of incidents involving mass decontamination.…”

“…Mass decontamination requires large numbers of people to wait their turn in order to go through the decontamination process, and so orderly and cooperative behaviour from members of the public will be essential to facilitate the smooth-running of the process. Put differently, a disorderly public response could turn a major incident into a catastrophe, resulting in increased spread of any contaminant into the wider community (Edwards et al, 2006).…”