ED workers fear radiological terrorism
Emergency department physicians and nurses are deeply concerned about the ability of the nation's hospitals to deal with the medical implications of a radioactive dirty bomb or other terrorist attacks involving radioactive materials, according to a new study. Experts say the findings should be a warning to risk managers that action is needed.
The study was recently published in the American Medical Association's (AMA) Disaster Medicine and Public Health Preparedness journal. Researchers conducted a series of 10 focus groups with ED physicians and nurses in hospitals in three U.S. regions Southeast, Northeast, and the West. Study participants discussed a hypothetical "dirty bomb" scenario and the treatment of patients affected by such an attack. Participants consistently expressed the view that medical professionals, EDs, and hospital facilities are not sufficiently prepared to respond effectively to a radiological attack.
Lead author Steven M. Becker, PhD, associate professor of public health and vice chair of the Department of Environmental Health Sciences at the University of Alabama at Birmingham, says the physicians and nurses were most concerned about the hospital being overwhelmed with patients, safety of loved ones, potential staff shortages, risks for hospital personnel, and a general lack of familiarity with radiation safety and treatment issues.
"Hospital emergency departments will play a crucial role in the response to any terrorist attack involving radioactive materials," he says. "In fact, it is no exaggeration to say that the actions of hospitals will be central to the success or failure of efforts to manage a radiological terrorism attack and its health consequences."
The study, which was funded by the Centers for Disease Control and Prevention (CDC) in Atlanta, provides new insights into physician and nurse concerns and viewpoints, and reveals major preparedness challenges. Those challenges must be addressed if hospitals and the nation are to successfully face current and future threats, Becker says.
"The study has clear implications for medical preparedness and response," he says. "There is a need for increased information and training on managing radiological events, protecting staff, and treating affected patients. Likewise, there is a need for increased access to informational resources, such as specialized professional hotlines, pocket guides, posters, and toolkits. In addition, physicians' and nurses' concerns for loved ones need to be better taken into account in preparedness planning to prevent a potential shortage of health care providers."
The study results are not surprising, says Joshua Kugler, MD, chief medical officer at South Nassau Communities Hospital in Oceanside, NY. He also is chairman of the Department of Emergency Medicine and spearheads South Nassau's emergency/disaster response preparations. Among all the possible disasters that a provider can prepare for, a radiologic event is the one with which hospitals have the least experience.
"But hospitals have realized the threats posed by radiologic events, either terrorist events such as a dirty bomb or a type of exposure that may come from the use of radiologic material within the hospital," he says. "When we talk about the possibility of a dirty bomb, people are getting better prepared, but I'm not surprised to hear emergency department staff say they feel uncertain and unprepared. Much of that simply relates to the fact that we have not had to deal with that real-life scenario yet."
Jason M. Liu, MD, assistant professor of emergency medicine at the Medical College of Wisconsin in Milwaukee, agrees that much of the apprehension is related to inexperience with this particular type of emergency.
"There also is a concern about the lack of resources, the tight budgeting that is affecting every health care provider and every emergency department," he says. "No one feels like they really have adequate funding for all of their important projects, and I think we're hearing from the people in this study that they think funding and preparation for this type of event has been inadequate. This is an opportunity to persuade leaders about the importance of preparing for this event."
Kugler says the study points to particular concerns that risk managers may want to address. In particular, he notes, the respondents were concerned that they did not have the proper detection equipment for a radiologic event. Risk managers should push for adequate funding for this type of event, because the equipment will eventually be needed, he says.
"The U.S. intelligence agency issued a warning after the incident in Mumbai, India, that not only hard targets but soft targets like hospitals will be affected within the next four years," he says. "So, by 2013, there will be soft-target penetration. We all need to be prepared, whether it is biological, radiological, or nuclear. One of those events is going to take place on our soil."
Sources
For more information about preparing for radiological events, contact:
Joshua Kugler, MD, Chief Medical Officer, South Nassau Communities Hospital, One Healthy Way, Oceanside, NY 11572. Telephone: (516) 632-3000.
Jason M. Liu, MD, Assistant Professor, Emergency Medicine, Medical College of Wisconsin, Milwaukee. Telephone: (414) 805-6717.
Emergency department physicians and nurses are deeply concerned about the ability of the nation's hospitals to deal with the medical implications of a radioactive dirty bomb or other terrorist attacks involving radioactive materials, according to a new study. Experts say the findings should be a warning to risk managers that action is needed.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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