Biomedical Engineering Reference
In-Depth Information
product in the late 1990s. Considerable sums have
been spent on extensive training and equipment
designed to decontaminate thousands of people
at an incident scene and hundreds at a hospital.
Common goals in cities participating in MMRS
contracts were for hospitals to be able to decon-
taminate at least 100 ambulatory patients without
relying on external assistance (i.e., a fire service
hazmat team). Goals related to HRSA grants focus
on 500 per million of population, but do not
specify an interval. Both MMRS and HRSA goals
represent significant expectations, and to date they
have proved largely fanciful. Terrorism aside, all
acute-care hospitals should be able to success-
fully manage a
single
contaminated patient without
external resources [25]. A 2002 American Hospital
Association survey [26] reported that a majority of
hospitals had plans in place for managing chemical
and biological attacks; this is a marked increase
relative to surveys taken before 11 September 2001
[27]. This encouraging report notwithstanding,
most hospital plans likely fall into the category of
“fantasy documents” [28]—that is, meeting legal
and political requirements but not grounded in real-
istic capabilities or expectations and not conferring
functionality. The great majority still find single-
patient decontamination an elusive goal.
analogous to cardiopulmonary resuscitation (CPR):
it is a short-term step intended for use early in the
incident to buy time for more definitive measures.
In securing all or part of the facility against addi-
tional entry, staff implementing lockdown can gain
some breathing room while providing short-term
protection to themselves and their patients. Also,
as with CPR, lockdown can make the difference
between success and failure in implementation of
an emergency plan but is rarely effective on its
own; a plan that ends with lockdown is doomed
to fail.
In most exercises simulating a terrorist inci-
dent, naturally occurring disease outbreak, or unin-
tentional hazardous material release, the hospital
in question has been “overrun,” meaning that a
portion (generally the ED) or all of the facility
is no longer able to function cohesively, protect
its staff, or provide organized care to current and
prospective patients. This can be due to contam-
ination of the area, an unmanageable crush of
incoming patients, perceived threat of violence, or
loss of infrastructure. In many of these exercises,
hospital staff recognized impending failure and
requested assistance from law enforcement agen-
cies for facility security and crowd control. With
few exceptions these requests were not met (or
were met too late), although it eventually became
apparent to most participants that these needs were
indeed urgent and the loss of hospitals disastrous.
Although it is not an exaggeration to say that law
enforcement was not an eager player in hospital
security, this was not due to laxity on the part of
police. As expressed in the first TOPOFF exercise
after-action report [24], law enforcement agencies
were overrun with urgent requests for multiple
types of assistance. As they were given little to no
external guidance on how to rank request urgency,
they found themselves with too many priorities.
This issue offers a compelling example of the
need to consider hospital preparedness within the
context of
community
resources.
1.8 Staff Training
As with the public-safety sector, there is no
shortage of training and equipment for hospital
preparedness; there is also little in the way of
functional standards, guidelines, or quality control
among programs and their purveyors. Few hospi-
tals have full-time emergency managers or emer-
gency preparedness coordinators: most commonly
those responsibilities fall under “other duties as
required” for clinical managers, facilities staff,
environmental health and safety officers, or admin-
istrative staff. Whether the purview of an indi-
vidual or committee, the decisions are the same.
The lack of standardization and the vast range
of executive support almost guarantee that each
facility or hospital market will go through its own
set of decisions, all driven at least as much by
financial considerations as by need.
1.7 Decontamination
Mass decontamination has been a common focus
since antiterrorism training became a mass-market
