New CDC bioterrorism guidelines:Take steps to update your disaster plan
If a bioterrorism or chemical terrorist attack occurred in your community today, would you have a strategic plan to decontaminate large numbers of patients? If you’re like most ED nurses, your answer is "no," according to Jeffrey Doucette, RN, MS, CEN, director of emergency services at Medical Center of Arlington (TX).
"The majority of EDs are not prepared for this type of event should it happen today," Doucette warns.
With the ever-increasing threat of domestic terrorism and the increase in state, local, and federal funding for education and training, you should have policies and procedures in place to address nuclear, biological, and chemical (NBC) incidents, says Doucette. (See chart that lists treatments for biological agent exposure and sample Bioterrorism Readiness Plan, inserted in this issue.)
New guidelines from the Atlanta-based Centers for Disease Control and Prevention (CDC), titled Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response, offer specific recommendations that emphasize the ED’s role, says Ali S. Khan, MD, MPH, deputy director for the CDC’s Bioterrorism Preparedness and Response Program.
"Key points for EDs are early recognition of suspect cases and having established plans to deal with large volumes of patients that are well-exercised," Khan says. (See excerpt of CDC guidelines, inserted in this issue, and Resources for information for obtaining complete copies of the guidelines, p. 108.)
Don’t ignore threat of bioterrorism
The threat of encountering a domestic terrorist attack involving biologic or chemical agents in your ED is real, emphasizes Robert Suter, DO, MHA, FACEP, medical director for the North Texas region at Questcare Emergency Services in Plano, TX. Suter also serves on the faculty of the department of military and emergency medicine at the Uniform Services University of Health Sciences in Bethesda, MD.
Be familiar with the CDC guidelines and use them to implement a disaster plan, stresses Suter. "Universal ED knowledge and compliance with these guidelines is vitally important to our role of protecting our communities," he urges. "An ED that does not incorporate the CDC recommendations is doing its community a disservice in preparedness."
The biggest misconception about disaster planning is the false belief that "it will never happen to us," says Doucette. As a result, many staffs don’t take preparation seriously, he says.
"It’s true that the best thought-out plans may never be utilized," Doucette says. "But when the time comes, EDs that are well-prepared report a much smoother response to a true disaster situation." (See related story on what to include in your ED bioterrorism plan, p. 107.)
Here are ways to prepare for a bioterrorism incident:
• Include plans for a biological or chemical attack in your disaster plan.
Although your ED may have a detailed external disaster plan, biologic and chemical attacks must be specifically addressed, says Doucette.
"With the sheer number of actual exposures and worried well,’ you may treat hundreds or even thousands of patients over a short period of time," he says. "That consumes a great deal of resources and manpower." (See story on stockpiling of antidotes for a bioterrorism incident, p. 111.)
Disaster plans should address the resources needed for a mass casualty situation, Doucette says. "In the ED, we tend to focus on short-term [two to 24 hours] disaster situations," he says. "But if a biological or chemical attack occurs, our resources may be stretched for seven to 10 days or more."
• Drill for terrorism scenarios.
Drills are absolutely essential, because you need to discover flaws in your planning, says Suter. Perform drills at least on a limited scale, he advises. "You will always identify practical issues with large-scale decontamination that need to be addressed, and your plan will need to be modified," he says.
Combine scenarios for the maximum educational impact, suggests Suter. For example, you might have a drill with a combination of an explosion and chemical release, he advises. "That results in both traumatic wounds and chemical exposure and allows you to test both your decontamination and trauma components simultaneously," Suter says.
• Participate in hospitalwide planning.
Involvement of ED nurses in the hospitalwide planning process is key, says Khan. "Such participation could include providing information on triaging patients."
• Get advice from bioterrorism experts.
Medical Center of Arlington’s ED staff have benefited from national training sponsored by the Department of Defense’s Domestic Preparedness program. The ED will participate in a citywide terrorism drill to be held this month, along with local, state, and federal agencies. "These drills are best handled by experts in the bioterrorism field since the actual event is so complex," Doucette says.
The ED held an eight-hour class on recognition of symptoms and presentation, managing patients from arrival to decontamination to discharge, protecting the caregiver and the facility, and specific treatments for chemical and biological agents, says Doucette. Bioterrorism experts from the Department of Defense taught the class and provided the materials, he adds.
"We had a significant need to improve our decontamination process, and through the education and consultation with bioterrorism experts, we are better prepared for this type of incident," says Doucette.
The drill will help the ED to prepare for a significant number of patients over an extended period of time, says Doucette. "We will receive between 50 and 100 patients in a two-hour window during the initial phase of the drill," he says.
If your ED doesn’t have access to this type of training program, contact the Department of Defense for a list of hospitals that are planning to participate in drills, so you can send a representative to observe a drill in a nearby city, Doucette recommends. (See Resources for contact information, p. 108.)
• Consider community resources.
Assess the resources available in your community before drawing up plans of action, Doucette suggests. "For example, we have a very close collaborative relationship with the HazMat team at the city fire department. We can focus more closely on patient management rather than decontamination in our plan since our mutual aid agreement moves some of the initial care management to the HazMat group," he says.
This type of planning is crucial because the entire medical response system will be taxed, says Doucette. "The elimination of rework or duplicative processes will be key to maximizing resources and efficiency in a response of this scale."
• Realize that with preparation, you can save lives.
The concept of a terrorist attack might seem overwhelming, but avoid taking a fatalistic approach, says Suter. "You cannot throw up your hands and say Everybody’s going to die anyway, so what is the point?’ These instances are survivable for patients, if people are prepared to take the right steps if and when they occur."
A biological or chemical attack is like any other disaster, except it has a couple of twists that make it more challenging, says Suter. "If you think of it that way, you will approach it with more confidence than if you say, This is a chemical catastrophe, and we’ve never done anything like this before,’" he says.
Remember that the basic principles of disaster management are the same, no matter what the cause of the disaster, Suter notes. "Realize that you already have the basic skills and problem-solving approach to care for patients," he says.
For more information about preparing for a bioterrorism incident, contact:
• Jeffrey Doucette, RN, MS, CEN, Emergency Services, Medical Center of Arlington, 3301 Matlock Road, Arlington, TX 76015. Telephone: (817) 472-4870. Fax: (817) 472-4878. E-mail: [email protected].
• Ali S. Khan, MD, MPH, Bioterrorism Preparedness and Response Program, Mail Stop C-18, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Telephone: (404) 639-1724. Fax: (404) 639-0382. E-mail: [email protected].
• Robert Suter, MD, FACEP, QuestCare,101 E. Park Blvd., Suite 921, Plano, TX 75074. Telephone: (972) 881-8353. Fax: (972) 422-2208. E-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content