Decontamination Facilities Research Articles

Fighting fire and fumes: risk awareness and protective practices among Western Australian firefighters

Background In Western Australia, the issue of bushfires (wildfires) poses a persistent health risk to both volunteer and career forestry firefighters, populations that have been historically understudied. Aims This descriptive qualitative study aimed to examine firefighters’ level of understanding concerning hazardous exposures, their Personal Protective Equipment (PPE) protocols and their decontamination practices. Methods Guided by the socioecological model, 23 semi-structured interviews were conducted with firefighters representing both volunteer and forestry sectors. Key results Results indicate a gap in knowledge regarding the health risks associated with bushfire-generated smoke and contaminants among volunteer firefighters. Forestry firefighters, conversely, showed a greater awareness of these risks. Social dynamics, such as peer pressure, were identified as historical deterrents to PPE use, although recent trends indicate positive change. Forestry firefighters also highlighted systemic shortcomings, including inadequate provision of respiratory protection and lack of decontamination facilities for cleaning themselves and their PPE. Conclusion This study underscores the critical need for educational initiatives to address these gaps in understanding, along with organisational reforms to promote a culture encouraging PPE use and to provide essential resources for effective decontamination. Implications This research emphasises that a multi-level approach is essential for safeguarding the health of firefighters in bushfire-prone environments.

The Utilization of Hospital-Based Decontamination Facility for Chemical Incidents

Introduction:The constraints of performing prehospital decontamination in mass casualty incidents involving the release of chemical agents at disaster sites in modern cities are notable. Compounding this are highly built-up urban areas with significantly high population density and traffic congestion. This places the burden of performing such decontamination on nearby healthcare facilities. Based on this need, public hospitals in Singapore have been equipped with decontamination facilities. We present a review of the utilization of this facility at our institution.Method:A retrospective review of the utilization of the hospital decontamination station (HDS) was carried out, noting its frequency, purpose, and outcomes.Results:Since its construction, the HDS has been deployed successfully many times a year for both routine training and disaster preparedness exercises. Despite the lockdown measures due to Covid-19, with concomitant reduction in social and economic activity, the HDS was activated five times for decontamination of chemical contaminated casualties. It is fortunate that, although HDS training activities were curtailed during this period, emergency department (ED) staff were still able to function effectively using prior experience, donning chemical protective suits, and performing decontamination. The semi-automated HDS facilitated rapid deployment which contributed to ease of use of this resource for timely decontamination of casualties with good outcomes.Conclusion:Chemical incidents resulting in contaminated casualties are uncommon events. Nonetheless hospitals must be prepared to deal with this situation in a timely manner. The rapidly deployable HDS has become an important resource and an operationally ready solution for dealing with chemical contaminated casualties presenting at short notice to the ED. Regular training and deployment exercises utilizing the HDS provide staff familiarity critical to overall readiness for chemical incidents. This strategy provides a reliable countermeasure in an all-hazards approach to disaster preparedness at the hospital.

Voices from the frontline: a review of EMS first responders' experience of COVID-19 in Ireland

PurposeThis study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.Design/methodology/approachA systematic literature review (SLR) of research into healthcare workers' and first responders' experiences during the COVID-19 and 2003 SARS pandemics was performed. The SLR informed the content of an online questionnaire distributed via the Irish Pre-Hospital Emergency Care Council to 2,092 first responders on its live register. Data analysis used both descriptive and content analysis.FindingsEMS first responders faced many challenges including PPE quality, training on its use, issues with decontamination facilities, and organisational effectiveness. Emotional challenges included the anxiety experienced, the impact on families, and ethical dilemmas confronted related to patient care. Positive findings also emerged, such as first responders' dedication to working through the pandemic, collegiality, and the community goodwill displayed.Originality/valueWhile investigations of the impact of the COVID-19 pandemic on healthcare workers have been undertaken globally, studies focussing exclusively on the experiences of EMS first responders have been rare. This study addressed this knowledge gap, providing an insight into the challenges and successes experienced by first responders and identifying opportunities for learning that can be applied to future public health emergencies.

The listing of new persistent organic pollutants in the stockholm convention: Its burden on developing countries

The Stockholm convention aims to protect the environment and human health by eliminating or restricting the production, use, and distribution of persistent organic pollutants (POPs). With an initial focus on twelve POPs, the list has been expanding over the years, with 28 POPs listed in the annexes of the convention as of December 2019. Currently, there are new substances under assessment for enlistment as POPs in the Stockholm convention. The addition of new POPs has, however, not kept its pace with monitoring capacity, management of stockpiles and wastes, remediation of contaminated sites, and financial resources disbursed to implement POPs related activities, especially in developing countries. Here, the authors suggest strengthening the capacity of laboratories in developing countries to enable them to test for legacy and new POPs. Most developing countries lack the infrastructure and know-how to manage POPs stockpiles and wastes. It is, therefore, necessary to establish regional POPs decontamination and destruction facilities to help some of those developing countries manage their POP stockpiles and wastes. It is also important to improve the capacity and competence in managing and remediating POPs contaminated sites, since most of them are poorly managed across developing countries. Besides, there is a need for more POPs mitigation and abatement funding schemes in developing countries, as most cannot generate enough domestic funds to implement POPs projects and as such are struggling to meet their obligations under the convention.

COVID-19 threat and frontline paediatric care professionals.

COVID-19 threat and frontline paediatric care professionals.

A robust optimization approach for decontamination planning of emergency planning zone: Facility location and assignment plan

Establishing a robust facility location and assignment plan to improve the efficiency of the decontamination process is critical to alleviating the physical impact of the radiation leakage that occurs in a nuclear accident. This study develops an approach for optimizing the locations of decontamination facilities and assignments of affected villages. The approach is a robust optimization model that optimizes the worst-case performance. The system dynamic model is integrated into the robust optimization model to simulate the decontamination process and compute the decontamination time. A case study is conducted of the Plume Emergency Planning Zone in China. The results indicate that (1) a decontamination site location plan can be obtained in which each site is located in a different direction, (2) no evacuee will be allowed to travel across the downwind area in an assignment plan, and (3) a larger financial investment does not imply an increased decontamination efficiency. An appropriate budget exists that can balance the decontamination time and cost. The proposed model can assist decision makers in (i) better understanding the effects of decontamination site location and village assignment and (ii) deciding which location and assignment plans should be applied to cope with disruptive nuclear accidents.

Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study.

A descriptive, cross-sectional study was performed. All 93 Dutch hospitals with an emergency department (ED) were sent a link to an online survey on different aspects of CBRN preparedness. Besides specific hospital information, information was obtained on the hospital's disaster planning; risk perception; and availability of decontamination units, personal protective equipment (PPE), antidotes, radiation detection, infectiologists, isolation measures, and staff training. Response rate was 67%. Sixty-two percent of participating hospitals were estimated to be at-risk for CBRN incidents. Only 40% had decontamination facilities and 32% had appropriate PPE available for triage and decontamination teams. Atropine was available in high doses in all hospitals, but specific antidotes that could be used for treating victims of CBRN incidents, such as hydroxycobolamine, thiosulphate, Prussian blue, Diethylenetriaminepentaacetic acid (DTPA), or pralidoxime, were less frequently available (74%, 65%, 18%, 14%, and 42%, respectively). Six percent of hospitals had radioactive detection equipment with an alarm function and 22.5% had a nuclear specialist available 24/7 in case of disasters. Infectiologists were continuously available in 60% of the hospitals. Collective isolation facilities were present in 15% of the hospitals. There is a serious lack of hospital preparedness for CBRN incidents in The Netherlands. Mortelmans LJM , Gaakeer MI , Dieltiens G , Anseeuw K , Sabbe MB . Are Dutch hospitals prepared for chemical, biological, or radionuclear incidents? A survey study. Prehosp Disaster Med. 2017;32(5):483-491.

Descriptive survey of personal hygiene and knowledge of exposure factors of zoonotic diseases among poultry workers in Ogun state, Nigeria

A cross sectional survey was conducted using questionnaire as a tool from March to July, 2011 to determine the personal hygiene and safety status of some selected poultry workers in Ogun State, Nigeria. The questionnaire was also to determine the knowledge of poultry workers on various factors that can exposure them to zoonotic diseases. A total of 143 questionnaires were administered. Sizeable number of poultry workers (74.8%), were not provided with personal protective equipment (PPE) during work. Majority of the poultry workers have adequate personal hygiene while use of antiseptics as part of hand washing practices is relatively low. Forty-three percent of poultry workers have some knowledge of occupational exposure factors and 27.3% have some knowledge of non-occupational exposure factors to zoonotic diseases. It was concluded that, there is a need for provision of adequate personal protective equipment, adequate decontamination and hygienic facilities for poultry workers as well as awareness creation and education of poultry workers on various exposure factors of zoonotic diseases. Keywords : Personal hygiene, Knowledge of risk factors, Poultry workers, Zoonotic diseases

Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents

As one of Europe's most densely populated countries with multiple nuclear installations and a prominent petrochemical industry, Belgium is at some reasonable risk for terrorist attacks or accidental chemical, biological, radiation, and nuclear (CBRN) incidents. We hypothesize that local hospitals are not sufficiently prepared to deal with these incidents. All 138 Belgian hospitals with an emergency department (ED) were sent a survey on their preparedness. Data on hospital disaster planning, risk perception, availability of decontamination units, personal protective equipment, antidotes, radiation detection, infectiologists, isolation measures, and staff training were collected. The response rate was 72%. Although 71% of hospitals reported being at risk for CBRN incidents, only 53% planned for the same in their disaster plans. Only 11% of hospitals had decontamination facilities in front of or at the ED entrance and only 6% had appropriate personal protective equipment for triage and decontaminating teams. Atropine was available at all centers, but more specific antidotes such as hydroxycobolamine, thiosulphate, or pralidoxime were less available (47, 47, and 19%, respectively). Six percent of hospitals had radiodetection equipment with an alarm function and 14% had a nuclear specialist available 24/7. Infectiologists were continuously available in 26% of the total EDs surveyed. Individual isolation facilities were present in 36% of the EDs, and isolation facilities capable of housing larger groups were present in 9%. University hospitals were significantly better prepared than community hospitals. There are serious gaps in hospital preparedness for CBRN incidents in Belgium. Lack of financial resources is a major obstacle in achieving sufficient preparedness.

(P2-95) Pre-Decontamination Triage for Hazmat Casualties Involving an Unknown Chemical

Pre-decontamination triage aims to prioritize the use of decontamination facilities for casualties based on their severity of injuries. Pre-decontamination triage aims to: (1) ensure severe casualties undergo early decontamination, in order for them to receive early definitive medical treatment post-decontamination; (2) provide basic life support measures, e.g., stopping external hemorrhage, use of bag valve mask ventilation, even before decontamination; (3) early administration of antidotes for organophosphate poisoning (if present). Triage during the pre-decontamination takes place in the warm zone. Triage personnel must don personnel protective equipment (PPE) of level C or above. Donning PPE will decrease the visual, aural and tactile senses of triage personnel, adversely affecting their ability to carry out effective triage. With these limitations in mind, a pre-decontamination triage system was devised, modified from the Simple Triage and Rapid Treatment (START) protocol. Assessment will be based on the presence of airway, breathing, or circulatory compromises, or changes in mental status, similar to the START protocol. Recognition of organophosphate poisoning prior to decontamination is emphasized, as the toxidrome is recognizable and specific. Once organophosphate poisoning is diagnosed, the severity of the poisoning is graded and antidote administration is carried out using the Mark I Kits. The need to be certain of the diagnosis of organophosphate poisoning before administration of Mark I Kits is emphasized. The diagnosis may not be apparent initially to the triage personnel till a spectrum of patients with toxidromes suggestive of organophosphate poisoning has been seen.

Evaluation of admissions to the Major Incident Hospital based on a standardized protocol

IntroductionThe Major Incident Hospital (MIH) is a unique facility strictly reserved to provide immediate large-scale emergency care for victims of disasters and major incidents. We evaluated the implemented organization to identify strengths and weaknesses, and provide knowledge essential for further improvement of preparedness.MethodAccording to the Protocol for Reports from Major accidents and Disasters (PRMD) and along with our five scenarios for activation, we analyzed all the data from evaluation reports of all our deployments since the MIH was founded in 1991.ResultsThe MIH was able to provide group-wise emergency care to military (29 admissions) as well as civilian victims of major incidents and disasters, both national (260) and international (226). Group-wise treatment was advantageous for quarantine, logistics, registration, emotional support and (pre)arrangements for family, media and security. Strong points are preparedness and availability of a dedicated facility, including ICU, X-ray and OR facilities, irrespective of MRSA status and prearranged cooperation, e.g., with a trauma centre, poison centre and the military. Evaluation, research and training resulted in a barcode registration system and continuous adaptations to improve preparedness. Shortage of resources did not occur; use of the MIH’s available resources for national incidents though, could be further optimized.ConclusionsRecommendations for the future are: improvement of imbedding in regional and national procedures, continued dedicated time and staff for training, research and development, improvement of nuclear/biological/chemical decontamination facilities and preparedness, implementation of standardized scoring systems and expansion of registration systems to the prehospital setting.Electronic supplementary materialThe online version of this article (doi:10.1007/s00068-010-0067-0) contains supplementary material, which is available to authorized users.

Hospital-based special needs patient decontamination: Lessons from the shower

A hospital-based decontamination team tested whether it could (1) perform effective technical decontamination while maintaining safety of staff and patients; (2) safely accommodate unique needs in the showers, including guide dogs and motorized wheelchairs; (3) identify needs of special needs populations by patient type, including blindness, hearing loss, and cognitive learning disabilities; (4) outline effective use of federal preparedness funds to support planning and execution of tabletop and mock victim drills; and (5) demonstrate the ability of a community hospital to act as a catalyst for community-wide disaster response improvements. A series of five disaster exercises were used to test hypotheses and to generate quality improvement results. Fixed emergency department decontamination facilities. A total of 39 hospital-based decontamination team members, 40 other drill staff and 35 mock victims were included. Three priority decontamination operations changes resulted from each of the five completed drills. Formulated prioritized list of decontamination team procedural changes to improve patient safety and technical decontamination and to generate a table of best practices to share. With enhanced training, disaster drills participation of community response agencies and special needs patients, community hospitals can improve safety while accommodating unique patient needs.

Design of dental surgeries in relation to instrument decontamination

Recent guidelines advise that the decontamination of dental instruments should be undertaken outwith the treatment area. The aim of this study was to determine the physical area of rooms in dental surgeries that decontaminate instruments within and outwith the treatment area respectively, and other factors relating to practice layout and ventilation. Data were collected by interview and observation of dental healthcare workers in dental practice in Scotland, UK. Room layouts were recorded and measured at floor, benchtop and above benchtop heights. Thirteen surgeries with instrument decontamination processes occurring in the treatment area and seven surgeries with instrument decontamination outwith the treatment area were selected at random for detailed analysis of room dimensions. Of the 179 dental surgeries surveyed, 55% were located in converted residential premises and most practitioners (91%) did not share premises with other healthcare providers. The median number of rooms in the practices was 8 (range: 2-21) and the median number of surgeries present was 3 (range: 1-6). Regardless of whether instrument decontamination facilities were housed within the treatment area or not, the average treatment area room size for both was 15.8m(2) (range: 7.3-23.9) (P=0.862), with 20% of the room area available as work surfaces. The median size of the seven instrument decontamination rooms (local decontamination units) was 7.6m(2) (range: 2.9-16.0), with, on average, 63% of the room used for work surfaces. This survey suggests that the historical location of dental surgeries in converted residential properties places many restrictions on appropriate design for healthcare premises.

University of North Carolina's Experience With State Medical Assistance Teams

Events in the last several years have shown a clear need for better preparation regarding disaster management. In an effort to improve this preparation, North Carolina implemented state medical assistant teams to provide alternative care facilities, decontamination facilities, and shelter assistance during times of disaster. This article explores these teams from the perspective of the University of North Carolina, which serves as a lead agency for one of these teams. Key components of the team, training provided, and lessons learned will be discussed.

It's the Network

Viewed in traditional Amateur Radio terms, the average cellular telephone handset is not very impressive. It has limited RF power output, a fixed, built in antenna, and you can’t even select the operating frequency. These devices do though leverage billions of dollars in worldwide network investment. Until Amateur Radio starts to think beyond just home stations and at more fixed infrastructure and networking, our emergency communications capabilities, particularly in the digital arena, will be limited. One evening in mid 2002 I checked into the Minnesota Section Phone Net. It was one of those days when we had some traffica periodic military Divisional Reunion, and about five messages were being held for us. It took quite a while for these to be sent and for operators in each of the areas to be rounded up. I think we got all five or maybe four of the five messages handled in the half hour the net normally runs. Later that week, in June 2002, there was an article in the Wall Street Journal talking about how hospitals would have to improvise a response to a “dirty bomb” attack (1). While the article focused on the notion of limited emergency room capacity and shortages of decontamination facilities, the point was that we were not prepared for many types of terrorist incidents or accidents. This was before the massive build-up in Federal and other funding for terrorism response, and the widespread adoption of the Incident Command System. If there had been an incident, say in Minneapolis, it is likely Amateur Radio would have played a role. So the question was, if we had to help with a mass evacuation as an example, would we have the tools to do the job? The short answer is no. We could probably handle the message volumes needed for internal Amateur radio purposes; we would not have much if any spare capacity to provide for served agencies, which is of course a key mission for us. I have stopped showing our 1920 era radiogram form to served agencies, who have not appreciated the historical context here in light of their serious mission objectives. Most agencies are besieged with proposals from vendors and consultants for state of the art digital emergency response technology. As was stated in the Editorial in QST in September 2007, (2) the emergency management community is pushing toward a digital response, and we can either fight that and be left behind, or return, as the FCC rules suggest, to a leadership position. Home Stations There are some things we can do at an individual home station to get more digital ready. Having Internet is a start, as that is pretty universal, and is also the source of most news and software updates. If the Internet is up, being able to relay messages that way and look up information is perfectly fine. Internet linked repeaters can be accessed, and you have a range of available services. Winlink/Airmail is another good tool, which can provide in and out of region mail services. These can use the Internet, or HF. HF is great, as you can reach out of region mail servers, who may not be impacted by local Internet outages as an example. One issue though with Airmailyou are capacity constrained, and have to seek permission to send large volumes of messages. And the system is Internet basedit may be impacted by Internet issues, such as in a Pandemic Flu scenario. In Pandemic Flu, it is anticipated there will be a gradual deterioration of fixed utility infrastructure, depending on the length and severity of the infection outbreak. There is a very low cost Airmail option still available – Pactor 1.

Fifteen Years since the Tokyo Subway Attack and Development of Chemical, Biological, Radiological, Nuclear, or Explosive Terrorist Countermeasures in Japan

Introduction:Although 15 years have passed since the Tokyo subway attack, it was the preparations for the Kyushu-Okinawa G8 summit (2000) five years thereafter that catalyzed the development of countermeasures and policy against chemical, biological, radioactive, nuclear, or explosive (CBRNE) threats in Japan.Report: No substantial progress was made for five years after the subway attack. Preparedness for the Kyushu-Okinawa G8 Summit included promulgation of the Civil Protection Law (2004), which codified the responses to CBRNE terrorist attacks, and consequendy, the effectiveness with which the countermeasures against CBRNE terrorism acts could be deployed at a national level. Countermeasures included the establishment of a CBRNE task force, syndromie surveillance programs, and the stockpiling of antidotes, antitoxins, and antibiotics. Decontamination facilities were introduced throughout Japan.Conclusions:Preparedness for the summit facilitated recognition of the need for medical countermeasures against CBRNE threats to protect healthcare providers in Japan. In the 15 years since the Tokyo Subway Attack, the measures implemented in the last five years have been most effective. However, future challenges include the promotion of civilian awareness, inter-agency collaboration, and increasing the mutual-aid capacity of local communities.

Skin and Surface Lead Contamination, Hygiene Programs, and Work Practices of Bridge Surface Preparation and Painting Contractors

A 2005 regulatory review of the lead in construction standard by the Occupational Safety and Health Administration (OSHA) noted that alternative pathways of exposure can be as significant as inhalation exposure and that noncompliance with the standard pertaining to hygiene facilities and practices was the second most commonly violated section of the standard. Noncompliance with provisions of the standard and unhealthy work and hygiene practices likely increase the likelihood of take-home lead via contaminated clothing, automobiles, and skin, thus contributing to elevated blood lead levels (BLL) among construction workers and their family members. We performed a cross-sectional study of bridge painters working for small contractors in Massachusetts to investigate causes of persistent elevated BLLs and to assess lead exposures. Thirteen work sites were evaluated for a 2-week period during which surface and skin wipe samples were collected and qualitative information was obtained on personal hygiene practices, decontamination and hand wash facilities, and respiratory protection programs. Results showed lead contamination on workers' skin, respirators, personal automobiles, and the decontamination unit, indicating a significant potential for take-home lead exposure. Overall, the geometric mean (GM) skin lead levels ranged from 373 μg on workers' faces at end of shift to 814 μg on hands at break time. The overall GM lead level inside respirators was 143 μg before work and 286 μg after work. Lead contamination was also present inside workers' personal vehicles as well as on surfaces inside the clean side of the decontamination unit. Review of the respiratory protection programs, work site decontamination and hand wash facilities, and personal hygiene practices indicated that these factors had significant impact on skin and surface contamination levels and identified significant opportunities for improving work site facilities and personal practices. Elevated lead exposure and BLL can be minimized by strict adherence to the OSHA provisions for functioning decontamination and hygiene facilities and healthy personal hygiene practices.

Surveying instrument decontamination procedures

Objective This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities. Materials and methods The study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there was more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specific training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries. Results A methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from five sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises. Conclusion The use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities.

A method for surveying instrument decontamination procedures in general dental practice

This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities. The study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there were more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specific training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries. A methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from five sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises. The use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities.

Chemical or Biological Terrorist Attacks: An Analysis of the Preparedness of Hospitals for Managing Victims Affected by Chemical or Biological Weapons of Mass Destruction

The possibility of a terrorist attack employing the use of chemical or biological weapons of mass destruction (WMD) on American soil is no longer an empty threat, it has become a reality. A WMD is defined as any weapon with the capacity to inflict death and destruction on such a massive scale that its very presence in the hands of hostile forces is a grievous threat. Events of the past few years including the bombing of the World Trade Center in 1993, the Murrah Federal Building in Oklahoma City in 1995 and the use of planes as guided missiles directed into the Pentagon and New York's Twin Towers in 2001 (9/11) and the tragic incidents involving twentythree people who were infected and five who died as a result of contact with anthrax-laced mail in the Fall of 2001, have well established that the United States can be attacked by both domestic and international terrorists without warning or provocation. In light of these actions, hospitals have been working vigorously to ensure that they would be "ready" in the event of another terrorist attack to provide appropriate medical care to victims. However, according to a recent United States General Accounting Office (GAO) nationwide survey, our nation's hospitals still are not prepared to manage mass causalities resulting from chemical or biological WMD. Therefore, there is a clear need for information about current hospital preparedness in order to provide a foundation for systematic planning and broader discussions about relative cost, probable effectiveness, environmental impact and overall societal priorities. Hence, the aim of this research was to examine the current preparedness of hospitals in the State of Mississippi to manage victims of terrorist attacks involving chemical or biological WMD. All acute care hospitals in the State were selected for inclusion in this study. Both quantitative and qualitative methods were utilized for data collection and analysis. Six hypotheses were tested. Using a questionnaire survey, the availability of functional preparedness plans, specific preparedness education/training, decontamination facilities, surge capacity, pharmaceutical supplies, and laboratory diagnostic capabilities of hospitals were examined. The findings revealed that a majority (89.2%) of hospitals in the State of Mississippi have documented preparedness plans, provided specific preparedness education/training (89.2%), have dedicated facilities for decontamination (75.7%), and pharmaceutical plans and supplies (56.8%) for the treatment of victims in the event of a disaster involving chemical or biological WMD. However, over half (59.5%) of the hospitals could not increase surge capacity (supplies, equipment, staff, patient beds, etc.) and lack appropriate laboratory diagnostic services (91.9%) capable of analyzing and identifying WMD. In general, hospitals in the State of Mississippi, like a number of hospitals throughout the United States, are still not adequately prepared to manage victims of terrorist attacks involving chemical or biological WMD which consequently may result in the loss of hundreds or even thousands of lives. Therefore, hospitals continue to require substantial resources at the local, State, and national levels in order to be "truly" prepared.