Hospitals response

In March 1944, I was severely ill with diphtheria and was sent to the camp hospital barracks. My mother had asked to be transferred to stay with me in the hospital. [Response not stated]... Nurses, doctors, and patients survived... ... 

Okumura, T., Suzuki, K., Fukuda, A. (1998). The Tokyo subway sarin attack Disaster management. Part 2 Hospital response. Academic Emergency Medicine, 5, 625-628. 

ENA supports emergency nurses participation in planning a hospital response to a mass casualty incident. Emergency nurses are a critical element of a hospital planning effort due to their skills in triage and rapid prioritization of needs within a rapidly changing scenario. 

Okumura T, Suzuki K, Fukuda A et al. (1998). The Tokyo subway Sarin attack. Disaster management, part 2 hospital response. Acad Emerg, 5, 618-624. 

Georgopoulas PG, Fedele P, Shade P et al. (2004). Hospital response to chemical terrorism personal protective equipment, training, and operations planning. Am J Indust Med, 46, 432-445. 

Emergency medical personnel managing toxic trauma in hospitals may be involved in the incident itself either as part of the pre-hospital response teams, as is the case in France and other European countries, or because of the need to manage contaminated casualties who arrive at the emergency department without having been processed through a chemical incident management system (HAZMAT). Such contaminated casualties may pose a serious risk to the hospital personnel and their activities. 

Recovery This deals with reviewing the incident and auditing the response, legal proceedings and feedback on processes (lessons learned). It can be invaluable in determining any risk to the responders and in improving plans for the future. Clinicians should be directly involved with this process to provide information about the effectiveness of the hospital response and identify potential weak points. 

For many years, the identification of specific collections of signs and symptoms following exposure to toxic agents has formed the basis of early medical responses in diagnosis and treatment. This has particularly been the case in the military world for the management of chemical warfare agent exposure. In the civil setting where identification of the released substance may not be immediate, toxidromes have assumed an equal importance and are part of established paramedical pre-hospital response to HAZMAT incidents. 

Appropriate surge capacity must be incorporated into hospital response plans to deal with multiple cases of infection by the most highly contagious organisms. This may involve preparation of a specific zone or ward as an isolation area. Multiple critically ill casualties will require the coordination of a regional, or even national, response to provide adequate numbers of high-dependency beds. 

Key elements of the hospital response to a biological release incident... 

An appropriate coordinator should be identified to collect details of casualties and ensure that the correct documentation is maintained. In normal circumstances the senior clinician on duty for the Emergency Department should be responsible for ensuring that aU necessary PPE and decontamination resources are made available. Other hospital departments such as the general wards, intensive care or high dependency units will need to be informed so that they can prepare to receive patients. Infection control teams will need to be informed to ensure adequate numbers of isolation bed spaces are made available. Off-duty personnel may need to be called in and the responsibihty for this will need to be given to a previously nominated individual. Figure 4.2 illustrates a generic information cascade for the hospital response. 

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