Terrorist attacks careful planning

Decontamination after a chemical terrorist attack needs to be well planned, efficient, and cognizant of the special needs of children. It is well recognized that the unique vulnerabilities of children may lead to a disproportionate number of pediatric victims after a chemical attack. Without proper planning and consideration as to how children will be decontaminated, the potential for preventable pediatric casualties is increased due to time loss and confusion. It is highly recommended for pediatricians to be involved in the development of each hospital s plans for decontamination. Over the last several years, many advances have been made in the management of the critically injured child. In fact, studies have shown that children managed in a pediatric intensive care imit (PICU) have better outcomes than children managed in an adult intensive care unit (Wheeler and Poss, 2003). Not all hospitals have the resources to have their own PICU, but they need to be able to provide the... 

In spite of this and other warnings, most primary care physicians have spent little time planning for terrorism. One reason may be the rarity of these events, especially on US soil. Until recently, the only reported case of bioterrorism in the United States was the 1984 salmonella attack in Oregon. It is unlikely that authors of family medicine textbooks written before September 2001 considered devoting significant space for discussions about how family physicians should respond to terrorist attacks. 

To address the myriad of issues a chemical attack would present to a community, a response template plan with national applicabihfy, referred to as the Off-Site Triage, Treatment and Transport Center, was formulated. The concept was designed to address the non-critical and non-exposed patients who can be expected to seek medical help. This concept requires the set-up of an ancillary medical fadhty to handle the large number of walking wounded and worried well casualties that are expected from a terrorist attack. The facihty would be a temporary site that supplements existing assets, since many of these centers can be set-up as are deemed necessary. The care envisioned to be provided in such a center includes decontamination, initial entry into the medical care system for patients not processed at the scene, care for non-critical patients, transportation to medical facilities for patients in need, and mental health care. 

Terrorists may attempt to use drug resistant organisms in their attack. Obviously, it is imperative to obtain the appropriate specimens, perform antimicrobial susceptibility testing of isolates promptly, and alter mass treatment accordingly (43). All antibiotics useful in treating tularemia are included in the strategic national stockpile. Chapter 6 discusses how public health officials will implement mass treatment plans, and how they will involve primary care physicians. 

In addition to these plans, in October 2001 the French Minister of Health announced Plan Biotox as an immediate response to the terrorist anthrax attacks then taking place in the United States (Plan Biotox, 2001). This plan focused on the provision of specific therapy and early life support to be provided in a contaminated zone with the provision of specially trained and equipped SAMU crews capable of operating in a toxic environment and also provision for the reception of contaminated patients at designated hospitals. A key feature of the new plan was the mass purchase of small portable gas-powered ventilators that can assure a high quality of essential ventilatory care at the scene of the emergency and in hospitals that may receive mass casualties (see Figure 8). 

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