Weapons of mass destruction events with contaminated casualties - Effective planning for health care facilities

Biological and chemical terrorism is a growing concern for the emergency pr eparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prep ared for such incidents. The greatest challenge for HCFs may be the sudden presentation of large numbers of contaminated individuals. Guidelines for m anaging contaminated patients have been based on traditional hazardous mate rial response or military experience, neither of which is directly applicab le to the civilian HCF. We discuss HCF planning for terrorist events that e xpose large numbers of people to contamination. Key elements of an effectiv e HCF response plan include prompt recognition of the incident, staff and f acility protection, patient decontamination and triage, medical therapy, an d coordination with external emergency response and public health agencies. Controversial aspects include the optimal choice of personal protective eq uipment, establishment of patient decontamination procedures, the role of c hemical and biological agent detectors, and potential environmental impacts on water treatment systems. These and other areas require further investig ation to improve response strategies.