Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 2001 May;91(5):710–716. doi: 10.2105/ajph.91.5.710

Hospital preparedness for victims of chemical or biological terrorism.

D C Wetter, W E Daniell, C D Treser
PMCID: PMC1446687  PMID: 11344876

Abstract

OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective.

Full Text

The Full Text of this article is available as a PDF (104.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Auf der Heide E. Disaster planning, Part II. Disaster problems, issues, and challenges identified in the research literature. Emerg Med Clin North Am. 1996 May;14(2):453–480. doi: 10.1016/s0733-8627(05)70262-5. [DOI] [PubMed] [Google Scholar]
  2. Brennan R. J., Waeckerle J. F., Sharp T. W., Lillibridge S. R. Chemical warfare agents: emergency medical and emergency public health issues. Ann Emerg Med. 1999 Aug;34(2):191–204. doi: 10.1016/s0196-0644(99)70229-5. [DOI] [PubMed] [Google Scholar]
  3. Burgess J. L., Blackmon G. M., Brodkin C. A., Robertson W. O. Hospital preparedness for hazardous materials incidents and treatment of contaminated patients. West J Med. 1997 Dec;167(6):387–391. [PMC free article] [PubMed] [Google Scholar]
  4. Burgess J. L. Hospital evacuations due to hazardous materials incidents. Am J Emerg Med. 1999 Jan;17(1):50–52. doi: 10.1016/s0735-6757(99)90016-5. [DOI] [PubMed] [Google Scholar]
  5. Cohen H. W., Gould R. M., Sidel V. W. Bioterrorism initiatives: public health in reverse? Am J Public Health. 1999 Nov;89(11):1629–1631. doi: 10.2105/ajph.89.11.1629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cone D. C., Davidson S. J. Hazardous materials preparedness in the emergency department. Prehosp Emerg Care. 1997 Apr-Jun;1(2):85–90. doi: 10.1080/10903129708958794. [DOI] [PubMed] [Google Scholar]
  7. Dart R. C., Stark Y., Fulton B., Koziol-McLain J., Lowenstein S. R. Insufficient stocking of poisoning antidotes in hospital pharmacies. JAMA. 1996 Nov 13;276(18):1508–1510. [PubMed] [Google Scholar]
  8. Edgell M., James M. R. Contaminated casualties: are we prepared to receive them? J Accid Emerg Med. 1994 Sep;11(3):172–177. doi: 10.1136/emj.11.3.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gough A. R., Markus K. Hazardous materials protections in ED practice: laws and logistics. J Emerg Nurs. 1989 Nov-Dec;15(6):477–480. [PubMed] [Google Scholar]
  10. Henderson D. A. The looming threat of bioterrorism. Science. 1999 Feb 26;283(5406):1279–1282. doi: 10.1126/science.283.5406.1279. [DOI] [PubMed] [Google Scholar]
  11. Inglesby T. V., Henderson D. A., Bartlett J. G., Ascher M. S., Eitzen E., Friedlander A. M., Hauer J., McDade J., Osterholm M. T., O'Toole T. Anthrax as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. 1999 May 12;281(18):1735–1745. doi: 10.1001/jama.281.18.1735. [DOI] [PubMed] [Google Scholar]
  12. Kaufmann A. F., Meltzer M. I., Schmid G. P. The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable? Emerg Infect Dis. 1997 Apr-Jun;3(2):83–94. doi: 10.3201/eid0302.970201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Keim M., Kaufmann A. F. Principles for emergency response to bioterrorism. Ann Emerg Med. 1999 Aug;34(2):177–182. doi: 10.1016/s0196-0644(99)70227-1. [DOI] [PubMed] [Google Scholar]
  14. Landesman L. Y., Leonard R. B. SARA three years later. Emergency physician's knowledge, beliefs, and actions. Prehosp Disaster Med. 1993 Jan-Mar;8(1):39–44. doi: 10.1017/s1049023x00039996. [DOI] [PubMed] [Google Scholar]
  15. Levitin H. W., Siegelson H. J. Hazardous materials. Disaster medical planning and response. Emerg Med Clin North Am. 1996 May;14(2):327–348. doi: 10.1016/s0733-8627(05)70254-6. [DOI] [PubMed] [Google Scholar]
  16. Macintyre A. G., Christopher G. W., Eitzen E., Jr, Gum R., Weir S., DeAtley C., Tonat K., Barbera J. A. Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. JAMA. 2000 Jan 12;283(2):242–249. doi: 10.1001/jama.283.2.242. [DOI] [PubMed] [Google Scholar]
  17. Merritt N. L., Anderson M. J. Malathion overdose: when one patient creates a departmental hazard. J Emerg Nurs. 1989 Nov-Dec;15(6):463–465. [PubMed] [Google Scholar]
  18. Meselson M., Guillemin J., Hugh-Jones M., Langmuir A., Popova I., Shelokov A., Yampolskaya O. The Sverdlovsk anthrax outbreak of 1979. Science. 1994 Nov 18;266(5188):1202–1208. doi: 10.1126/science.7973702. [DOI] [PubMed] [Google Scholar]
  19. Nozaki H., Hori S., Shinozawa Y., Fujishima S., Takuma K., Sagoh M., Kimura H., Ohki T., Suzuki M., Aikawa N. Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med. 1995 Dec;21(12):1032–1035. doi: 10.1007/BF01700667. [DOI] [PubMed] [Google Scholar]
  20. Okumura T., Suzuki K., Fukuda A., Kohama A., Takasu N., Ishimatsu S., Hinohara S. The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998 Jun;5(6):613–617. doi: 10.1111/j.1553-2712.1998.tb02470.x. [DOI] [PubMed] [Google Scholar]
  21. Okumura T., Suzuki K., Fukuda A., Kohama A., Takasu N., Ishimatsu S., Hinohara S. The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med. 1998 Jun;5(6):618–624. doi: 10.1111/j.1553-2712.1998.tb02471.x. [DOI] [PubMed] [Google Scholar]
  22. Okumura T., Takasu N., Ishimatsu S., Miyanoki S., Mitsuhashi A., Kumada K., Tanaka K., Hinohara S. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996 Aug;28(2):129–135. doi: 10.1016/s0196-0644(96)70052-5. [DOI] [PubMed] [Google Scholar]
  23. Pile J. C., Malone J. D., Eitzen E. M., Friedlander A. M. Anthrax as a potential biological warfare agent. Arch Intern Med. 1998 Mar 9;158(5):429–434. doi: 10.1001/archinte.158.5.429. [DOI] [PubMed] [Google Scholar]
  24. Richards C. F., Burstein J. L., Waeckerle J. F., Hutson H. R. Emergency physicians and biological terrorism. Ann Emerg Med. 1999 Aug;34(2):183–190. doi: 10.1016/s0196-0644(99)70228-3. [DOI] [PubMed] [Google Scholar]
  25. Sharp T. W., Brennan R. J., Keim M., Williams R. J., Eitzen E., Lillibridge S. Medical preparedness for a terrorist incident involving chemical or biological agents during the 1996 Atlanta Olympic Games. Ann Emerg Med. 1998 Aug;32(2):214–223. doi: 10.1016/s0196-0644(98)70139-8. [DOI] [PubMed] [Google Scholar]
  26. Simon J. D. Biological terrorism. Preparing to meet the threat. JAMA. 1997 Aug 6;278(5):428–430. doi: 10.1001/jama.278.5.428. [DOI] [PubMed] [Google Scholar]
  27. Thanabalasingham T., Beckett M. W., Murray V. Hospital response to a chemical incident: report on casualties of an ethyldichlorosilane spill. BMJ. 1991 Jan 12;302(6768):101–102. doi: 10.1136/bmj.302.6768.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Tucker J. B. National health and medical services response to incidents of chemical and biological terrorism. JAMA. 1997 Aug 6;278(5):362–368. [PubMed] [Google Scholar]
  29. Török T. J., Tauxe R. V., Wise R. P., Livengood J. R., Sokolow R., Mauvais S., Birkness K. A., Skeels M. R., Horan J. M., Foster L. R. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. JAMA. 1997 Aug 6;278(5):389–395. doi: 10.1001/jama.1997.03550050051033. [DOI] [PubMed] [Google Scholar]
  30. Waeckerle J. F. Domestic preparedness for events involving weapons of mass destruction. JAMA. 2000 Jan 12;283(2):252–254. doi: 10.1001/jama.283.2.252. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES