Your bioterrorism plan must include 10 items
Does your ED have a comprehensive bioterrorism plan with which all staff are familiar? If not, develop one now, emphasizes Richard S. Roman, MHSA, senior epidemic support coordinator for the Bioterrorism Preparedness and Response Program at the Centers for Disease Control and Prevention (CDC) in Atlanta.
"The importance of this cannot be stressed enough," he says. "During mass-casualty events, normal emergency room care goes out the window."
When developing your ED plan, work with a committee of key hospital individuals, advises Roman. "You definitely need to get top-level management buy-into this process," he says. "Otherwise, you will never get the cooperation and input you need from other departments."
Here are key components to include in your mass casualty disaster plan:
1. Emergency procedures for triaging. Include a system, such as a tagging system, for identifying the most critically injured needing immediate care and patients who can wait, says Roman.
2. Use of barrier protection. Medical staff safety and health issues are of paramount importance, stresses Roman. "You need to have barrier protection recommendations, depending on the agent used and prophylaxis recommendation to prevent sickness," he says.
3. Emergency call-down rosters for recalling personnel. Those rosters should be updated at least quarterly and kept handy for emergency purposes, recommends Roman.
4. Instructions for whom to contact. When a bioterrorism incident occurs, your plan should include contact names and phone number for the following, he says:
Inside the hospital:
• your infection control staff;
• your hospital epidemiologist, if you have one;
• your hospital administrator;
• the chief of your ED;
• your public information officer.
Outside the hospital:
• your local health department infection control bureau;
• your state health department epidemiologist;
• the FBI field office closest to your hospital;
• the CDC.
5. Infection control practices. Isolation precautions must include hand washing, gloves, masks/eye protection, and gowns, says Roman.
"The plan should address patient placement considerations, especially for overwhelming numbers of victims who will flood the ED," he advises. "The worried well will be extremely costly in terms of medical resource use for nonpriority persons."
6. Patient transport. Address patient transport for moving massive numbers of patients to other hospitals if needed, Roman says. "For example, do you use National Guard vehicles or police cars?"
Don’t assume you can rely on your EMS system, because they will be busy responding to incident calls, Roman cautions. "Your plan should include recommendations for patient transport, and your mutual aid agreements with other area hospitals for receiving and transporting patients," he says.
7. Cleaning, disinfecting, and sterilization procedures. Include recommendations for contaminated equipment and the ED environment, says Roman. "Does your hospital have a plan describing how patients are decontaminated before being allowed into an ED for treatment? If not, you need to develop one," he urges.
8. Post-mortem disposition. Roman advises that EDs address several issues regarding large numbers of deceased patients:
• How many corpses can your hospital morgue hold at any one time?
• If you don’t have a hospital morgue, where do you store the deceased until the medical examiner arrives?
• What are your procedures and policies for holding massive numbers of deceased that could present after a large bioterrorism attack?
• How will the deceased be prepared without infecting staff members?
• How will the deceased with infectious diseases be dispositioned?
Establish lab protocols
9. Hospital laboratory procedures. The hospital lab will probably be doing the initial testing of human samples once symptomatic individuals begin presenting, Roman says. Your plan must include specific instructions for the following issues, he says:
• What protocols does the laboratory have in notifying the state public health laboratory once a presumptive diagnosis is found in your laboratories?
• Who confirms your findings?
• What procedures are in place to transport samples to various reference laboratories to confirm your hospital’s findings?
• If you suspect bioterrorism, law enforcement requires maintaining the chain of custody of the evidence, which are your hospital laboratory samples. Do you have proper handling and transport procedures in place for this?
10. Disease-specific information. Address specific diseases that are the highest concern from a public health standpoint, recommends Roman. These include anthrax, smallpox, tularemia, botulism, plague (pneumonic), and the viral hemorrhagic fevers (Marburgh, filoviruses, arenaviruses, and Ebola), he says.
"Information regarding these can be obtained from your local or state health department or from the CDC directly," Roman says.
A complete copy of the Center for Disease Control and Prevention (CDC) guidelines titled Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response, which were published in the April 21, 2000, issue of Morbidity and Mortality Weekly Report (MMWR), can be downloaded at the CDC Web site: www.cdc.gov (click on "MMWR"). A hard copy of the guidelines can be purchased for $2.50. Ask for stock number 717-016-01094-2. Contact:
• Superintendent of Documents, U.S. Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250. Telephone: (202) 512-1800. Fax: (202) 512-2250. E-mail: [email protected]. Web site: http://bookstore.gpo.gov.
The Domestic Preparedness training programs are a federal initiative managed by the Department of Defense to improve the capability of local, state, and federal emergency responders in incidents involving nuclear, biological, or chemical terrorism. For more information on training programs, contact:
• Department of Defense, U.S. Army, SBC-COM — Domestic Preparedness Office. Web site: www.nbc-prepare.org.
For technical assistance in nonemergency cases, call the Domestic Preparedness program’s Chemical/Biological HelpLine at (800) 368-6498. For technical assistance during a chemical or biological incident, call the Chemical/Biological HotLine, which is staffed 24 hours a day, seven days a week, at (800) 424-8802.
For more information about bioterrorism and mass casualty plans, contact:
• Richard S. Roman, MHSA, Bioterrorism Preparedness and Response Program, Mail Stop C-18, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Telephone: (404) 639-0393. Fax: (404) 639-0382. E-mail: [email protected].
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