Improving Civilian Medical Response to Chemical or Biological Terrorist Incidents Interim Report on Current Capabilities (1998) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-8
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Traditional military approaches to battlefield detection of chemical and biological weapons and the protection and treatment of young healthy soldiers are not necessarily suitable or easily adapted for use by civilian health providers dealing with a heterogeneous population of casualties in an urban environment. For these reasons, the Institute of Medicine (IOM)
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This interim report describes current preparedness at each of four levels of medical intervention local first responders, initial treatment facilities, state departments of emergency services and public health, and a variety of federal agencies. The specific capabilities assessed are preincident intelligence; detection of agents in the environment, personal protective equipment; safe and effective patient extraction; recognition of signs and symptoms in patients; detection of agent exposure in clinical samples; detection of covert exposures of a population; mass-casualty triage procedures; decontamination of exposed individuals; availability, safety, and efficacy of drugs and other therapeutics; and prevention and treatment of psychological effects.
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Detection of Agent Exposure in Clinicali Samples Laboratory assays indicating exposure to nerve agents and cyanide are known and available at many hospitals, but there is no current clinical test for mustard agents or other vesicants. However, for all of these agents except mustard, individuals receiving significant doses usually develop signs and symptoms within a matter of minutes after exposure.
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Despite loins Commission on Accreditation of Healthcare Organizations standards calling for hospitals to have Hazmat plans and conduct Hazmat training, two recent reviews have suggested that most hospitals in the United States are ill prepared to treat chemically contaminated patients. Treatment Emergency medical personnel, both at the scene of hazardous materials incidents and in hospital emergency departments have a wide selection of reference materials to call upon for guidance in patient management.
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One technique, Critical Incident Stress Debriefing (CT SD) , has gained wide acceptance among field emergency workers and is increasingly used by hospital-based emergency personnel, the military, public safety personnel, volunteers, victims, unwilling witnesses, and even schoolmates of victims.
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A major mission of public health departments is prompt identification and suppression of infectious disease outbreaks, and poison control centers deal with poisonings from both chemical and biological sources on a daily basis. it would be a serious tactical and strategic mistake to ignore (and possibly undermine)
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The report, therefore, concludes with the following eight recommendations involving potentially simpler, faster, or less expensive mechanisms than research arid development of new technology: Recommendation I: Provide federal financial support for improvements in state and local surveillance infrastructure- namely poison control centers and communicable disease programs, including expansion of the CDC Emerging Infections Initiatives. Recommendation 2: Survey major metropolitan hospitals on supplies of antidotes, drugs, ventilators, personal protective equipment, decontamination capacity, mass-casualty planning and training, isolation rooms for infectious disease, and familiarity of staff with the effects and treatment of chemical and biological weapons.
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Recommendation 6: Develop incentives for hospitals to be ambulancereceiving hospitals, to stockpile nerve agent antidotes and selected antitoxins and put them in the hancIs of first responders (this may require changes to existing laws or regulations in some states) , and to purchase appropriate personal protective equipment and expandable decontamination facilities and train emergency department personnel in their use.
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