Biomedical Engineering Reference
In-Depth Information
should be placed in the contaminated ambulance,
and further contaminated patients should be trans-
ported by that “dirty” unit.
Aeromedical transport can also be considered for
patients involved in terrorist events. In this event,
making certain that the patient has been decontam-
inated first is even more important. Contaminating
a $200,000 ambulance is one thing, contaminating
a $10 million dollar aircraft is another. It should
be noted that immediately after the attacks on
September 11, 2001, all aircraft in the country
were grounded, including aeromedical flights. So
depending on the event, helicopter transport may
not be available.
Besides the obvious quick transport ability of
aeromedical services, they can also assist in effec-
tively spreading patients to hospitals and facilities
further from the scene in a quick fashion.
While transportation is arranged, receiving facil-
ities need to be notified. All hospitals have
emergency plans and decontamination facilities
and protocols for their implementation and use.
Knowing the decontamination process at the
receiving hospitals is important, in order to keep
from contaminating the hospital. This starts with
an early notification to the receiving facility that
potential victims of terrorism are enroute to their
location. This notification allow for multiple things
to happen at the hospital. First, it gives the hospital
the opportunity to lockdown and deny access to
non-decontaminated patients. Second, it gives them
time to set up their decontamination systems.
Thirty minutes is about as quick as many hospi-
tals can prepare to decon patients. Remember that
not all patients will arrive by EMS. Many will self
transport. Japanese hospitals had about 5500 casu-
alties from the release of Sarin gas in the Tokyo
subway system in 1995. About 4700 of them were
not at the actual site of the gas release. Some only
saw it on TV and went to the hospital. Last, early
notification by field personnel allows the hospital
to recall or hold over staff to properly care for the
large influx of patients.
When designating a receiving hospital to a trans-
porting ambulance, common sense should prevail
when it comes to choosing the destination. Imagine
a scenario where the local civic center is five
blocks from the nearest hospital. A terrorist has
exploded a bomb and there are a large number of
walking wounded and about 30 critical and urgent
patients. The first reaction might be to transport
all of the critical patients to the local hospital. The
problem with this is that that hospital is most likely
where all of the walking wounded have gone. If the
hospital is within a short distance of the event it is
likely these patients will get in before decontami-
nation can be established. Therefore it is likely that
this hospital has become contaminated if WMD
were involved in the bombing. This hospital may
become unavailable to EMS providers when they
get control of the scene and begin transporting
patients. Transporting to the more distant hospi-
tals might be a better solution as it is likely fewer
patients will have arrived there and they will be
less likely to be contaminated.
Early contact with all of the hospitals will allow
them the time they need to prepare for the influx
of patients. It is the key to successful patient flow
and transportation.
8.9 Return to Service
Once a terrorist event is contained and the response
phase for EMS providers has been completed, the
process of taking the system out of emergency
response mode and putting it back into day to day
operations starts.
Critical Incident Stress Debriefing (CISD)
should be required of all responding personnel
prior to their being allowed to return to normal
operations/shift work. Early integration of mental
health teams can head-off feelings of guilt, help-
lessness, frustration, and anxiety by EMS providers
after a terrorist event (see Chapter 11).
CISDs can be career and life saving for the
providers involved. Providers needing professional
follow-up care can be identified at an early stage
and be assisted with putting their lives back into
perspective and order after these events.
During CISD debriefings, EMS providers are
given the opportunity to discuss the events that
they were involved in, including areas that did
not go as planned or that did not end with good
results. The environment is one of support and no
