Almost half of EDs don’t have a nuclear attack disaster plan
When you heard about the recent "dirty bomb" threat, was your first thought that your ED lacks a specific plan for a nuclear attack? If so, you have plenty of company. According to a recent survey of 5,000 hospitals by the Chicago-based American Hospital Association, only 54% of hospitals have a nuclear terrorism component in their disaster plans, and 27% plan to add one to their plans within this next year.
"We are a lot more cognizant of the threat than even a year ago," says Joseph Ornato, MD, FACP, FACC, FACEP, professor and chairman of the department of emergency medicine at Virginia Commonwealth University’s Medical College of Virginia Hospitals in Richmond. "I don’t think anyone needs to be convinced any longer. This is a capability that each facility needs to have."
Unfortunately, many hospitals trying to bring disaster plans up to date only considered biochemical terrorism and forgot the nuclear threat, says Robert Suter, DO, FACEP, senior consultant for Dallas-based Texas Emergency Physicians, and director of physician practice development for Greater Houston Emergency Physicians, both ED physician practice groups. "This may have been due to a sense of fatality rooted in the mistaken belief that the only nuclear threat would be a total destruction scenario, resulting from the diversion of a military warhead," Suter says.
Suter stresses that it’s a mistake to assume there would be no survivors from such an attack. "Disaster committees need to understand that the effects of a nuclear terrorist attack can be survivable," he says. "The victims will include many individuals remote from the epicenter."
If you are a manager of a rural or community ED, you probably didn’t seriously consider the possibility of a nuclear terrorist attack until 9/11, Ornato says. "Smaller facilities assumed that if that ever happened, the bigger guys down the street would deal with it," he adds. Ornato says it’s a mistake to assume that large facilities will bear the burden of a nuclear disaster, and he points to the victims who went to community hospitals after the terrorist attacks at the World Trade Center and the Pentagon.
Even if you don’t currently have a nuclear component to your disaster plan, you can develop one quickly, says Richard B. Schwartz, MD, FACEP, vice chairman of the department of emergency medicine at Medical College of Georgia in Augusta. Here are effective ways to increase your preparedness for nuclear terrorism:
• Add radiation injuries to your disaster plan.
Val Gokenbach, RN, MBA, CAN, director of emergency services and observation at William Beaumont Hospital in Royal Oak, MI, reports that radiation disasters are part of her facility’s overall disaster plan. "The essential component for that particular scenario is inclusion of the hospital radiation safety officer. The rest is a variation on other scenarios," she says. (See the facility’s radiation exposure/decontamination plan.)
Begin by integrating your facility’s medical radiation incident protocol into the disaster plan and expanding it, Suter says. He says your plan should address decontamination, security, radiologic monitoring, and decorporation (removing materials before they have become permanently incorporated into the body). "The principles are the same for all facilities, regardless of where you are located," he says.
Schwartz recommends addressing the following three items:
1. Radiation monitoring. Schwartz adds that decontamination follows the same guidelines as for other hazardous materials, with the addition of radiation monitoring. Most radiation safety personnel will have access to dosimeters and Geiger-Mueller counters for monitoring the adequacy of decontamination, he says.
2. Use of personal protective equipment. The personal protective equipment involved is surgical gowns with all seams taped, Schwartz says. "The use of lead aprons that are used for X-ray shielding are not recommended," he says. "They give a false sense of security, as gamma radiation will pass through them."
3. Availability of iodine tablets. These should be given to radiation-exposed patients to prevent future thyroid cancer, Schwartz says.
• Screen patients if disasters involve explosives.
Dan Hanfling, MD, FACEP, director of emergency management and disaster medicine at Inova Health System in Fairfax, VA, recommends screening all incoming patients from the scene of any disaster event involving the use of explosives. "This may be performed by the responding fire and rescue units," he says. However, Hanfling adds that many patients will not use fire and rescue units to arrive at the ED. "So it would be prudent to implement a similar strategy by the ED staff, until you can be certain that there is no risk of radiological contamination," he says.
• Have a realistic plan for decontamination.
It’s a mistake to expect the fire department to handle decontamination after a dirty bomb attack or nuclear attack, stresses Roy Alson, PhD, MD, FACEP, assistant professor of emergency medicine at Wake Forest University School of Medicine in Winston-Salem, NC. "You are in for a rude awakening when you find they are all tied up at the scene, and no one is there to decontaminate the patients who are arriving at your ED now," he says. Alson warns that you must have a lockdown plan to control access. "Otherwise your facility will be contaminated. Do not assume that all your victims will arrive by EMS and have been decontaminated first," he says.
• Become knowledgeable about dirty bombs.
Schwartz says that the actual threat of a dirty bomb attack is much less than the "fear factor. We have a little bit of mystique about nuclear threats and need to know what the threats actually are," he says. The majority of patients would present with burns and conventional traumatic injuries, Schwartz explains.
Hanfling notes that "dirty bombs" are nothing more than conventional explosives laced with radiological contaminants. He says that dirty bombs would be easier to respond to than chemical weapons, because radiological elements leave physical signs of contamination that can be detected with a radiation detector, whereas chemical weapons use is primarily determined by clinical syndrome presentation.
Suter recommends asking your hospital’s radiation safety officer to give you a list of local courses so staff can be trained in radiologic monitoring. (For information on training courses, see resources at end of article.)
• Use a dirty bomb scenario for a disaster drill.
Suter advises you to use a dirty bomb scenario for your next drill, since it addresses both conventional trauma and radiation injuries. "Use an Oklahoma City-type incident where the terrorist puts radioactive waste in the truck," he says. "When the bomb explodes, it does all the usual trauma damage, plus now everything is contaminated with radioactive waste. It’s as simple as that."
Gokenbach reports that her facility’s next disaster drill will involve a dirty bomb explosion at a community office. "This will include about 50 live victims and involvement by Royal Oak Fire Department and other private agencies," she says.
However, Suter advises against limiting your plan to dirty bomb scenarios. "If the unthinkable happens and a diverted nuclear warhead is detonated, it will cause a significant radiation disaster at the fringes of the blast and downwind," he says. "Your hospital could be in one of these areas and need to react to save lives."
Sources and resources
For more information, contact:
• Roy Alson, PhD, MD, FACEP, Assistant Professor of Emergency Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1089. Telephone: (336) 716-2193. Fax: (336) 716-5438. E-mail: [email protected].
• Val Gokenbach, RN, MBA, CAN, Director of Emergency Services and Observation, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073. Tele-phone: (248) 551-1995. Fax: (248) 551-2017. E-mail: [email protected].
• Dan Hanfling, MD, FACEP, Director, Emergency Management and Disaster Medicine, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042. Telephone: (703) 698-3002. Fax: (703) 698-2893. E-mail: [email protected].
• Joseph P. Ornato, MD, FACP, FACC, FACEP, Department of Emergency Medicine, Medical College of Virginia Hospitals, 401 N. 12th St., P.O. Box 980525, Richmond, VA 23298-0525. Telephone: (804) 828-5250. Fax: (804) 828-8597. E-mail: [email protected].
• Richard Schwartz, MD, FACEP, Vice Chairman, Depart-ment of Emergency Medicine, Medical College of Georgia, 1120 15th St., AF2037, Augusta, GA 30912. Telephone: (706) 721-3548. Fax: (706) 721-9081. E-mail: [email protected].
• Robert E. Suter, DO, FACEP, Senior Consultant, Texas Emergency Physicians, 5926 Saint Marks Circle, Dallas, TX 75230-4048. Telephone (214) 739-2776. Fax (214) 739-0658. E-mail: [email protected].
The American College of Radiology offers a quick reference guide for health care professionals responding to a radiation disaster. The guide summarizes current information on preparation for a radiation emergency, how to handle contaminated persons, and radiation exposure health effects. It is available on-line at no charge at www.acr.org/dyna/?id=educ. Click on "Radiation Disasters: Preparedness and Response for Radiology," "ACR Primer (PDF)," "Access the Primer." Single paper copies are free of charge. Contact: Connie Potter, Administrative Assistant, American College of Radiology, Education Department, 1891 Preston White Drive, Reston, VA 20191-4397. Telephone: (800) 227-5463, ext. 4245 or (703) 648-8900. E-mail: [email protected].
The Oak Ridge Institute for Science and Education’s Radiation Emergency Assistance Center/Training Site (REAC/TS) offers several courses in handling radiation accidents, including Handling of Radiation Accidents by Emergency Personnel. This is a 3½-day course intended for physicians, nurses, and physicians’ assistants who may be called upon to provide emergency medical service to a radiation accident victim. It includes handling a contaminated victim, preventing the spread of contamination, and reducing the radiation dose to the victim and attending personnel. Cost of the course is $75. For more information, contact: L. Gail Mack, Registrar, REAC/TS, Oak Ridge Institute for Science and Education, P.O. Box 117, MS39, Oak Ridge, TN 37831-0117. Telephone: (865) 576-3132. Fax: (865) 576-9522. E-mail: [email protected]. Web: www.orau.gov/reacts.
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