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Could your hospital safely treat a single victim of a chemical poisoning without endangering emergency department staff? Could you handle 50 or more victims? If hospitals can cope with hazardous material spills or poisonings, they are on track to develop readiness for chemical or biological terrorist events, preparedness experts say.
That capability must be available 24 hours a day, seven days a week, and must be backed up by updated policies and periodic training, says Henry Siegelson, MD, FACEP, an emergency physician based in Atlanta and an expert on hospital disaster preparedness. "Unless there are policies and procedures in place for the management of a victim exposed to a chemical, then the health care worker can very rapidly become a victim," says Siegelson, who has provided consulting worldwide through Disaster Planning International, based in Indianapolis.
"It’s much more than just training. It’s more than equipment," he says. "It’s also policies and procedures and exercises. I believe that every single hospital that has an emergency department must be able to, without exception, manage at least one or two victims of a hazardous material exposure on a 24-hour basis, any time day or night. You cannot depend on the fire department. You cannot depend on any other agency to help. This must be an internal capability. This is a community responsibility for the hospital."
Siegelson recommends these steps toward preparedness:
1. chemical preparedness, including proper decontamination and protective equipment and awareness and operations-level training;
2. incident command systems, which enable the hospital to organize resources to respond during disasters;
3. syndromic surveillance, which allows the hospital to recognize patterns of patient complaints that might suggest a biological attack;
4. reporting to the health department of data collected from syndromic surveillance;
5. exercises and drills in the community;
6. responding to an actual event.
Preparedness doesn’t have to be a budget-buster, Siegelson says. For example, an outdoor decontamination unit costs far less than an internal one that requires new construction or remodeling. If the hospital is flooded with the "worried well" who have minimal, if any, exposure, the hospital can use simple decontamination kits that allow people to remove their clothing even in a public place. The kit, manufactured by Haz/Mat DQE in Indianapolis, leaves the patient draped in a poncho-like garment.