Biological and chemical terrorism is a growing concern for the emergency
preparedness community. While health care facilities (HCFs) are an essential
component of the emergency response system, at present they are poorly prepared
for such incidents. The greatest challenge for HCFs may be the sudden presentation
of large numbers of contaminated individuals. Guidelines for managing contaminated
patients have been based on traditional hazardous material response or military
experience, neither of which is directly applicable to the civilian HCF. We
discuss HCF planning for terrorist events that expose large numbers of people
to contamination. Key elements of an effective HCF response plan include prompt
recognition of the incident, staff and facility protection, patient decontamination
and triage, medical therapy, and coordination with external emergency response
and public health agencies. Controversial aspects include the optimal choice
of personal protective equipment, establishment of patient decontamination
procedures, the role of chemical and biological agent detectors, and potential
environmental impacts on water treatment systems. These and other areas require
further investigation to improve response strategies.
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