Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T01:35:02.722Z Has data issue: false hasContentIssue false

Medical Surge Capacity in Atlanta-Area Hospitals in Response to Tanker Truck Chemical Releases

Published online by Cambridge University Press:  06 November 2015

Curtis Harris*
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
William Bell
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
Edward Rollor
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
Tawny Waltz
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
Pam Blackwell
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
Cham Dallas
Affiliation:
University of Georgia, College of Public Health, Institute for Disaster Management, Athens, Georgia.
*
Correspondence and reprint requests to Curtis Harris, PhD, University of Georgia, College of Public Health, Health Policy and Management, Institute for Disaster Management, Athens, GA (e-mail: [email protected]).

Abstract

Objective

We designed and conducted a regional full-scale exercise in 2007 to test the ability of Atlanta-area hospitals and community partners to respond to a terrorist attack involving the coordinated release of 2 dangerous chemicals (toluene diisocyanate and parathion) that were being transported through the area by tanker truck.

Methods

The exercise was designed to facilitate the activation of hospital emergency response plans and to test applicable triage, decontamination, and communications protocols. Plume modeling was conducted by using the Defense Threat Reduction Agency’s (DTRA) Hazard Prediction and Assessment Capability (HPAC) V4 program. The scenario went through multiple iterations as exercise planners sought to reduce total injuries to a manageable, but stressful, level for Atlanta’s health care infrastructure.

Results

Atlanta-area hospitals rapidly performed multiple casualty triage and were able to take in a surge of victims from the simulated attack. However, health care facilities were reticent to push the perceived manageable numbers of victims, and scenarios were modified significantly to lower the magnitude of the simulated attack. Additional coordination with community response partners and incident command training is recommended. Security at health care facilities and decontamination of arriving victims are two areas that will require continued review.

Conclusion

Atlanta-area hospitals participated in an innovative regional exercise that pushed facilities beyond traditional scopes of practice and brought together numerous health care community response partners. Using lessons learned from this exercise coupled with subsequent real-world events and training exercises, participants have significantly enhanced preparedness levels and increased the metropolitan region’s medical surge capacity in the case of a multiple casualty disaster. (Disaster Med Public Health Preparedness. 2015;9:681–689)

Type
Original Research
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Vale, A. What lessons can we learn from the Japanese sarin attacks? Przegl Lek. 2005;62:528-532.Google Scholar
2. Public health consequences from hazardous substances acutely released during rail transit--south Carolina, 2005; selected states, 1999-2004. MMWR Morb Mortal Wkly Rep. 2005;54:64-67.Google Scholar
3. Disasters: Chemical accidents and spills. Pollution Issues website. www.pollutionissues.com/Co-Ea/Disasters-Chemical-Accidents-and-Spills.html. Accessed July 14, 2011.Google Scholar
4. Mishra, PK, Samarth, RM, Pathak, N, et al. Bhopal gas tragedy: review of clinical and experimental findings after 25 years. Int J Occup Med Environ Health. 2009;22(3):193-202.Google Scholar
5. Bucher, JR. Methyl isocyanate: a review of health effects research since Bhopal. Fundam Appl Toxicol. 1987;9(3):367-379.CrossRefGoogle ScholarPubMed
6. Mehta, PS, Mehta, AS, Mehta, SJ, et al. Bhopal tragedy’s health effects. A review of methyl isocyanate toxicity. JAMA. 1990;264(21):2781-2787.Google Scholar
7. Jasanoff, S. The Bhopal disaster and the right to know. Soc Sci Med. 1988;27(10):1113-1123.Google Scholar
8. Lepkowski, W. Bhopal, Indian city begins to heal but conflict remains. Chem Eng News. 1985;63(48):18-32.Google Scholar
9. Broughton, E. The Bhopal disaster and its aftermath. Rev Environ Health. 2005;4(1):6.CrossRefGoogle ScholarPubMed
10. Chander, J. Water contamination: a legacy of the union carbide disaster in Bhopal, India. Int J Occup Environ Health. 2001;7(1):72-73.Google ScholarPubMed
11. Shrivastava, P. Bhopal: Anatomy of a Crisis. Cambridge, MA: Ballinger Publishing; 1987:184.Google Scholar
12. About HSE. Health and Safety Executive website. http://www.hse.gov.uk/aboutus/index.htm. Accessed October 6, 2015.Google Scholar
13. Belke, JC, Dietrich, DY. The post-Bhopal and post-9/11 transformations in chemical emergency prevention and response policy in the United States. J Loss Prev Process Ind. 2005;18(4-6):375-379.Google Scholar
14. LaForte, JM. The vulnerability of transporting hazardous chemicals specific to the semiconductor industry. https://www.researchgate.net/publication/237679412_The_Vulnerability_of_Transporting_Hazardous_Chemicals_Specific_to_the_Semiconductor_Industry.Google Scholar
15. Bjerklie, DG. Diagnosing the risks. Time. http://www.time.com/time/magazine/article/0,9171,1000931,00.html. Published October 8, 2001. Accessed July 14, 2011.Google Scholar
16. United States Congress. O.o.T.A. Transportation of hazardous materials, OTA-set 304. Congress of the US. Washington, DC: Office of Technology Assessment; 1986.Google Scholar
17. Fleet Owner. DOT and railroads take aim at D.C. HazMat ban. http://fleetowner.com/news/dc_hazmat_ban_dot_csx_021705.Google Scholar
18. Hazmat rail ban could have ripple effect. DC Velocity. http://www.dcvelocity.com/articles/20060701newsworthy_hazmat_rail_ban_could_have/. Published July 1, 2006. Accessed June 9, 2010.Google Scholar
19. Office of the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs/Nuclear Matters. Specialized radiological monitoring and hazard assessment capabilities. 2.a DTRA HPAC. http://www.acq.osd.mil/ncbdp/narp/Radiation_Data/Specialized_Radiological.htm. Accessed October 6, 2015.Google Scholar
20. Oak Ridge National Laboratories. LandScan Global Population Database. Oak Ridge, TN: Oak Ridge National Laboratories. Google Scholar
21. Basic questions regarding acute exposure guideline levels. OSHA website. http://www.osha.gov/SLTC/emergencypreparedness/chemical/pdf/tier_2-aegls_basic_usachppm1_03.pdf. Accessed July 13, 2011.Google Scholar
22. Bonnett, CJ, Peery, BN, Cantrill, SV, et al. Surge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25(3):297-306.Google Scholar
23. Burkle, FM Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20(2):409-436.Google Scholar
24. Smith, GP II. Triage: endgame realities. J Contemp Health Law Policy. 1985;1:143-151.Google Scholar
25. Kosashvili, Y, Daniel, LA, Peleg, K, et al. Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted? Injury. 2009;40(7):727-731.Google Scholar
26. DeLia, D, Wood, E. The dwindling supply of empty beds: implications for hospital surge capacity. Health Aff (Millwood). 2008;27(6):1688-1694.Google Scholar
27. Hick, JL, Hanfling, D, Burstein, JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44(3):253-261.CrossRefGoogle ScholarPubMed
28. Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, part 1: Community emergency response. Acad Emerg Med. 1998;5:613-617.Google Scholar
29. Bell, WC, Dallas, CE. Vulnerability of populations and the urban health care systems to nuclear weapon attack--examples from four American cities. Int J Health Geogr. 2007;6(1):5.Google Scholar
30. Dallas, CE, Bell, WC. Prediction modeling to determine the adequacy of medical response to urban nuclear attack. Disaster Med Public Health Prep. 2007;1(02):80-89.Google Scholar
31. Peleg, K, Kellermann, AL. Enhancing hospital surge capacity for mass casualty events. JAMA. 2009;302(5):565-567.Google Scholar
32. Kaji, AH, Koenig, KL, Lewis, RJ. Current hospital disaster preparedness. JAMA. 2007;298(18):2188-2190.Google Scholar
33. Hick, JL, Barbera, JA, Kelen, GD. Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(S1):S59-S67.Google Scholar
34. Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, part 2: Hospital response. Acad Emerg Med. 1998;5:618-624.Google Scholar
35. US Department of Labor. OSHA best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substances. OSHA website. Published January 2005. https://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html. Accessed October 6, 2015.Google Scholar
36. Horton, DK, Berkowitz, Z, Kaye, WE. Secondary contamination of ED personnel from hazardous materials events, 1995-2001. Am J Emerg Med. 2003;21(3):199-204.Google Scholar
37. Quarantelli, EL. The future is not the past repeated: projecting disasters in the 21st century from current trends. J Contingencies Crisis Manage. 1996;4(4):228-240.Google Scholar
38. Assistant Secretary for Preparedness and Response. Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response; 2012:1-72.Google Scholar
39. Thompson, J, Rehn, M, Lossius, HM, et al. Risks to emergency medical responders at terrorist incidents: A narrative review of the medical literature. Crit Care. 2014;18(5):521.Google Scholar
40. Horton, DK, Orr, M, Tsongas, T, et al. Secondary contamination of medical personnel, equipment, and facilities resulting from hazardous materials events, 2003-2006. Disaster Med Public Health Prep. 2008;2(02):104-113.Google Scholar
41. Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: A conceptual framework. Acad Emerg Med. 2006;13:1157-1159.Google Scholar
42. Schultz, CH, Koenig, KL. State of research in high-consequence hospital surge capacity. Acad Emerg Med. 2006;13:1153-1156.Google ScholarPubMed