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Weapons of Mass Destruction Events With Contaminated Casualties
Effective Planning for Health Care Facilities
Anthony G. Macintyre, MD;
Lt COL George W. Christopher, USAF, MC;
COL Edward Eitzen, Jr, MC, USA;
LTC Robert Gum, MC, USA;
Scott Weir, MD;
Craig DeAtley, PA-C;
CDR Kevin Tonat, DrPH, MPH, USPHS;
Joseph A. Barbera, MD
JAMA. 2000;283:242-249.
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.
Author Affiliations: Institute for Crisis, Disaster and Risk Management (Dr Barbera) and Department of Emergency Medicine (Drs Macintyre and Weir and Mr DeAtley), George Washington University Medical Center, Washington, DC; US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md (Lt Col Christopher and COL Eitzen); US Army Center for Health Promotion and Preventive Medicine—Europe, Landstuhl Army Regional Medical Center, Landstuhl, Germany (LTC Gum); and the Office of Emergency Preparedness, US Public Health Service, Rockville, Md (CDR Tonat).
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