Preparing hospitals for toxicological mass casualties events

Objective: For most hospital staffs, treatment of chemical casualties prese nts an obscure and even frightening situation. We report our unique experie nce from hospital drills in order to improve hospital preparedness for pati ent management under mass casualty conditions involving hazardous chemicals . Setting: Twenty one major hospitals in Israel. Interventions: A unique hospital deployment plan for the management of chem ical casualties was developed, and hospitals were required to have a full c hemical practice drill every 3 to 5 yrs. These drills were designed as realistically as poss ible, and all included the use of personal protective equipment, decontamin ation, and treatment of simulated patients. Twenty-five percent of these pa tients, simulating children and adults, required intensive care and ventila tion support. Hospitals were inspected and reviewed on the quality of treat ment given and the overall continuity of care as well as on their administr ative performance. Results: Between 1986 to 1994, 30 full chemical practice drills were conduc ted in 21 major hospitals. Each drill included treatment of 100 to 400 simu lated patients. The lessons from the hospital drills are described and were incorporated in the proposed revised hospital deployment plan. All hospita ls significantly im proved their ability to respond appropriately to these incidents. Conclusions: The level of preparedness for a chemical mass casualty scenari o should be established according to the existing threat and the available resources. The proposed plan can serve as a basis for hospital planning and staff training worldwide, thus facilitating optimal care in the event of a n incident involving toxic chemicals. A cost-effective scale for hospital p reparation levels according to the existing threat is suggested.