There are a few major problems in the area of "Bio-Terrorism" preparation for hospitals in the US. First, is the term: "Bio-Terrorism". If hospitals plan EXCLUSIVELY to prepare for "Bio-Terrorism" (thus ignoring preparation for nuclear and chemical events and patients), do we honestly believe that terrorists are going to initiate a "Bio-terrorist" event because we are prepared (only) for "Bio-terrorism"?.
Second is the philosophy and belief by some pre-hospital and hospital personnel that all patients will be decontamianted prior to being tranported to a medical facility. In some events (due to the nature, scale, and location), many patients may result. Depending on the proximity of the event, at least some of these patients may self refer to local hospitals, completely bypassing the EMS system, and/or any on - scene decontamination effort. The prospect of patient "field" decontamination is a presumption that is made, but historically, does not always occur in (worldwide) actual events or in WMD drills. The end result is a hospital Emergency Department being presented with a patient, or worse yet, many patients who may be in need of emergency decontamination.
There are NO REGULATIONS (nor requirements) for hospitals to be prepared for WMD/NBC (not OSHA, not FEMA, not NRC, etc.) (believe me, I teach this material, I have contacted these agencies and have done research....it is very confusing and GREATLY MISINTERPRETED). In the US, if any (including NY City!!) hospital does not want to, can't afford ($$) to, or doesn't have the resources to prepare for WMD/NBC....they don't have to!! What incentive do hospitals have (besides self preservation?)
Since 1997 the US federal government has been "preparing" the 140 + largest cities/urban areas for their response to WMD (weapons of mass destruction events). This has included tens of millions of dollars, which are appropriated for government sponsored WMD training (until recently, had been under the control and management of the US Dept. of Defense, and more recently has been transferred to the US Dept. of Justice, Office of Justice Programs, Office for State and Local Domestic Preparedness Support), and preparation (through agencies such as FEMA, FBI, and US Dept. of Health and Human Services).
Despite the existence of this program, MANY PROBLEMS AND DEFICIENCES STILL EXIST:
1) An extremely large percentage of hospitals in the US have no training, plan, or equipment to manage a Nuclear, Biological or Chemical (NBC) event.
2) The current federal training programs have been designed and taught by private, subcontracted companies, does not address the preparatory issues (i.e., "how do we handle 150 patients at once?") AND seem to confuse Pre-hospital response with Hospital response.
3) There is no ONE federal standard for this type of hospital training or procedures for these events.
4) The federal money (tens of millions of dollars), which has been appropriated and spent on "terrorism", is directed ONLY to large cities (not ALL large cities, however; only those who we think the terrorists will attack).
5) This mechanism of distribution of this federal money (specifically earmarked for terrorism) is being further channeled exclusively into either the city's Fire Departments and or city Emergency Management Agencies. They have the responsibility and total control to "disseminate, distribute, and to further appropriate" this money (millions of dollars in each city - 140 cities to date) to whatever agency, department or institution as they see fit, but unfortunately, the only "department" that is getting the money (in many cases is theirs). What is happening is "the buck stops here". Again, hospitals for the most part, even in large cities, don't have a clue how to manage these NBC events and patients.
My analogy of the current state of preparedness for WMD/NBC in the US is as follows:
What if we removed all of the fire extinguishers and sprinkler systeme in all buildings in the US, did away with training medical personnel in burn care and treatment, and removed all of the Burn Centers in the US, but just kept fire departments intact....and furthermore, poured more money and training into fire departments. (My note: Pre-hospital EMS, Fire, and Law Enforcement agencies ARE on the front line and indeed DO need funding and assistance.....although hospitals do as well)
Gil Cosnett, Principal
Gilbert H. Cosnett and Associates
Nuclear, Biological, and Chemical - Medical Preparedness