CHEMICAL, BIOLOGICAL AND RADIOLOGICAL WARFARE
Disaster Management
N Edwards
Royal Adelaide Hospital, Adelaide, SA
In recent times, Australia has been increasingly mentioned by terrorist groups as a potential target. The detonation of explosive devices in Bali on 12 October 2002 resulted in the deaths of 202 people, of whom 88 were Australian. The following month, BBC Monitoring intercepted a statement believed to have been made by Osama Bin Laden, which claimed that Australians had been directly targeted. On 9 September 2004, the Australian embassy in Djakarta was bombed, killing 9 Indonesians, and wounding over 180. Further bombings in Bali in October 2005 wounded over 130 and killed 23, including two Australians. Of note, the online military journal attributed to al-Qaeda, Mu’askar al-Battar, now lists Australians as the fourth highest priority Christian target.
The health care system, including hospitals, will clearly play a pivotal role in the response to a mass casualty incident from any cause. Incidents involving one of the CBR agents differ significantly from conventional incidents, in that they have they potential to leave both the people and the environment exposed to the agent contaminated. Hospitals therefore need to develop Chemical, Biological and Radiological (CBR) annexes to their major incident plans (MIP) that address issues such as decontamination, antidotes, and the avoidance of secondary contamination of the hospital, its staff, and decontaminated patients. If hospital staff become exposed to the agent in their attempts to render assistance to contaminated patients, they too may become casualties, further compounding the disaster. If security is breached, the ability of the hospital to continue to function may also be severely impaired, or force its closure.
Accordingly, there are enormous issues for hospitals that need to be addressed in their planning, such as
- Crowd control and traffic control
- Organising and triaging mass casualties
- Mass decontamination
- Protection of staff from exposure
- Is it appropriate for hospital staff (wearing appropriate personal protective equipment (PPE)) to manage contaminated patients?
- What is an appropriate level of PPE?
- Are hospital staff adequately trained to wear that PPE safely?
- Managing resources (eg stockpiling)
- Reliance on other emergency services turning up on the day to support hospitals – or will they be required at the scene?
Despite these issues, there have been repeated claims that hospitals are well prepared for mass casualty events, including those involving one of the CBR agents. Accordingly, we have looked for evidence to support such claims.
In 2003, by far the largest hospital-based mass casualty field exercise to be held in Australia, was conducted in Adelaide. It involved the mock exposure of 120 people to a nerve agent at a racecourse on the outskirts of the Central Business District. Named Exercise Supreme Truth (the English translation for ‘Aum Shinrikyo’, the religious cult responsible for the Tokyo subway sarin attacks in 1995), and with the involvement of all State emergency services, it was primarily designed to examine the response of the largest tertiary-referral hospital (Royal Adelaide Hospital) in Adelaide to such an incident. A major goal of the exercise was to make it as ‘realistic’ as possible, in order for it to be a true test of current planning. Despite extensive work on the hospital plans over a number of years, tabletop exercises and a significant increase in resources (including a permanently deployed mass decontamination facility), numerous deficiencies were identified in areas such as crowd control, hospital security, secondary contamination of staff and the hospital, and interagency communication.
To further examine hospital preparedness, in December 2003 we mailed a questionnaire to the directors of the 86 emergency departments in Australia that are accredited for training by the Australasian College for Emergency Medicine, examining issues such as perceived risk, planning, education and available resources.
Responses were received from 86%, and results included
- 96% had a disaster / major incident plan
- 70-80% had a contingency for chemical, biological or radiological incidents<
- 32% had no training of staff for CBR incidents
- 59% had not had a practical (field) CBR exercise in the past 5 years
Over 70% believed that the maximum number of patients from a CBR incident with which their department would be able to cope in the first 2 hours, was 20 or less
In light of these results, we believe there is little evidence to support claims that Australian hospitals are well prepared to deal with anything but small numbers of patients from a CBR incident. If hospitals are to effectively plan, train and resource, they need to know with what they are reasonably expected to be able to cope. At present, there are no minimum standards of preparedness for hospitals, and so we will present a set of standards during this presentation for consideration.
Time of Presentation
Saturday 13 May 2006 - 1030-1200
