Weapons Of Mass Destruction Incidents Research Articles

General Visualization Abstraction Algorithm for Geographic Map-based Directable Interfaces

Emergency incident response, including Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) a.k.a. weapons of mass destruction incidents, is evolving from a response involving humans with equipment to a response system combining humans and thinking machines (e.g. robots). The robots, along with possibly other deployed sensors, will generate and capture volumes of information that will be presented in directable visualizations. This paper presents a novel approach to performing information abstraction (i.e., selection and grouping) and determining how each information item should be presented (i.e., its shape) in directable visualizations. This new approach employs the General Visualization Abstraction (GVA) algorithm to make salient and direct attention to the most relevant information items by determining an importance value for each information item based on the item's relationship with two classes of information: historically relevant and currently relevant information, and novel and emerging information.

Training Retention of Level C Personal Protective Equipment Use by Emergency Medical Services Personnel

Objectives: To assess the six-month training retention for out-of-hospital providers donning and doffing Level C personal protective equipment (PPE). Methods: In this prospective observational study, 36 out-of-hospital providers enrolled in a paramedic program were trained in Level C (chemical-resistant coverall, butyl gloves, and boots and an air-purifying respirator) PPE use. A standardized training module and checklist of critical actions developed by a hazardous materials (hazmat) technician were used to evaluate donning and doffing. Students were trained until they were able to correctly don and doff the Level C PPE. An investigator used the checklist accompanying the training module to assess proficiency and remediate mistakes. Six months after initial training, the subjects were reassessed using the same investigator and checklist. Errors were designated as either critical (resulted in major self-contamination of the airway, such as early removal of the respirator) or noncritical (potentially resulted in minor self-contamination not involving the airway). Results: Only five subjects (14.3%) were able to don and doff PPE without committing a critical error. The most common critical errors were premature removal of the respirator (65.7%; n= 23) and actions allowing the contaminated suit to touch the body (54.3%; n= 19). The most common noncritical error was possible self-contamination due to the boots not being removed before exposing other body parts (37.1%; n= 13). Of the seven subjects (20%) with additional prior hazmat training, only two donned and doffed PPE without committing a critical error. Conclusions: Retention of proper donning and doffing techniques in paramedic students is poor at six months after initial training. Even in subjects with previous hazmat, firefighter, and emergency medical services training, critical errors were common, suggesting that current training may be inadequate to prevent harmful exposures in emergency medical services personnel working at a hazmat or weapons of mass destruction incident.

Training Retention of Level C Personal Protective Equipment Use by Emergency Medical Services Personnel

To assess the six-month training retention for out-of-hospital providers donning and doffing Level C personal protective equipment (PPE). In this prospective observational study, 36 out-of-hospital providers enrolled in a paramedic program were trained in Level C (chemical-resistant coverall, butyl gloves, and boots and an air-purifying respirator) PPE use. A standardized training module and checklist of critical actions developed by a hazardous materials (hazmat) technician were used to evaluate donning and doffing. Students were trained until they were able to correctly don and doff the Level C PPE. An investigator used the checklist accompanying the training module to assess proficiency and remediate mistakes. Six months after initial training, the subjects were reassessed using the same investigator and checklist. Errors were designated as either critical (resulted in major self-contamination of the airway, such as early removal of the respirator) or noncritical (potentially resulted in minor self-contamination not involving the airway). Only five subjects (14.3%) were able to don and doff PPE without committing a critical error. The most common critical errors were premature removal of the respirator (65.7%; n = 23) and actions allowing the contaminated suit to touch the body (54.3%; n = 19). The most common noncritical error was possible self-contamination due to the boots not being removed before exposing other body parts (37.1%; n = 13). Of the seven subjects (20%) with additional prior hazmat training, only two donned and doffed PPE without committing a critical error. Retention of proper donning and doffing techniques in paramedic students is poor at six months after initial training. Even in subjects with previous hazmat, firefighter, and emergency medical services training, critical errors were common, suggesting that current training may be inadequate to prevent harmful exposures in emergency medical services personnel working at a hazmat or weapons of mass destruction incident.

Integrated Decision-Making in Response to Weapons of Mass Destruction Incidents: Development and Initial Evaluation of a Course for Healthcare Professionals

Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (WMD) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center. This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to WMD events. Course participants were healthcare professionals, including physicians, nurses, emergency medical services administrators, hospital administrators, and public health officials. Each course included three modified tabletop and/or real-time functional exercises. A total of 441 participants attended one of the eight course offerings between March and August 2003. An intervention group only, pre-post design was used to evaluate change in perceived capabilities related to administrative decision-making for WMD incidents. Paired evaluation data were available on 339 participants (81.9%). Self-ratings for each of 21 capability statements were compared before and after the course. A 19-item total scale score for each participant was calculated from the pre-course and post-course evaluations. Paired t-tests on pre- and post-course total scores were conducted separately for each course. There was consistent improvement in self-rated capabilities after course completion for all 21 capability statements. Paired t-tests of pre- and post-course total scale scores indicated a significant increase in mean ratings for each course (all p < 0.001). The tabletop/real-time-exercise format was effective in increasing healthcare administrators' self-rated capabilities related to WMD disaster management and response. Integrating the competencies into training interventions designed for a specific target audience and deploying them into an interactive learning environment allowed the competency-based training objectives to be accomplished.

An assessment of regional preparedness of volunteer firefighters for weapons of mass destruction incidents

Study objectives: We assess the training and preparedness of the volunteer fire departments in western New York to deal with incidents involving weapons of mass destruction (WMDs). Methods: A survey was developed and mailed to the 238 volunteer fire companies of the 8 counties of western New York (Erie, Niagara, Chautauqua, Cattaraugus, Allegany, Genesee, Orleans, and Wyoming). The surveys were number coded to protect the identity of the responding company and were sent to the attention of the fire company chief. Three separate mailings were sent consecutively at 1-month intervals. The remaining fire chiefs who did not reply were contacted by telephone, at which time they were asked to verbally respond to the survey. The data was entered into a spreadsheet for analysis. A point system was applied to the objective portion of the study to assign a training level score of 0 to 5 points, 5 points signifying that more than 50% of the company took specified New York State Fire Academy courses, performed a general disaster drill, a WMD drill, recently reviewed their disaster plan, or purchased WMD-related equipment. The subjective portion of the study consisted of a scale ranging from 1 to 5 that assessed the company's preparedness as indicated by the fire chief, 1 point being completely unprepared to 5 points equaling complete preparedness. Results: The response rate to the survey was 184 companies of 238, or 77% total response. This number represents 5,784 volunteer firefighters. There was a direct correlation between training level scores to the fire chief's perceived preparedness score. A Pearson correlation coefficient of 0.428 was obtained, with a P value less than .01. Conclusion: Preparedness for weapons of mass destruction incidents is directly related to the amount of training activity performed. Despite receiving training, the companies who achieved the highest training score still only felt moderately prepared, which supports the need for more training opportunities to be provided to volunteer firefighters.

Chemical weapon functional exercise--Cincinnati: observations and lessons learned from a "typical medium-sized" city's response to simulated terrorism utilizing Weapons of Mass Destruction.

In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks.

Are the Psychosocial Aspects of Weapons of Mass Destruction Incidents Addressed in the Federal Response Plan: Summary of an Expert Panel

Within the domestic preparedness community, there is a growing recognition of the importance of psychosocial issues in weapons of mass destruction (WMD) incidents. Whereas social and behavioral issues were only infrequently considered just a few years ago, they are now coming to be seen as central to consequence management efforts. As a result, discussions in the domestic preparedness community are beginning to consider the extent to which psychosocial effects are addressed in the Federal Response Plan and the degree to which additional preparedness and response steps may be needed. To grapple with this crucial issue, an expert panel was brought together at the International Conference on the Operational Impact of Psychological Casualties from Weapons of Mass Destruction. The panel brought together a wide range of specialists from federal agencies, the armed services, and the academic community. This article summarizes the views and assessments of the panelists as well as their policy recommendations for enhancing preparedness.

Nuclear, Biological, and Chemical Training in the U.S. Army Reserves: Mitigating Psychological Consequences of Weapons of Mass Destruction

Weapons of mass destruction (WMD) and their associated delivery systems pose a major threat to the national security of the United States. The Department of Defense is pursuing a number of activities to counter paramilitary and terrorist threats from nuclear, biological, and chemical (NBC) agents. These efforts include supporting, training, and equipping the U.S. Army Reserves (USAR) for the medical management of physical injuries and psychological trauma resulting from the use of NBC weapons both in the United States and overseas. The USAR will play an important role in responding to a WMD incident because most of the Army's support assets are in the USAR. The USAR is training to perform its mission in an NBC-contaminated environment by engaging in realistic WMD exercises using state-of-the-art protective equipment and medical support. Realistic training builds confidence in medical defenses and in NBC protective equipment. This translates into accomplishing the mission while minimizing the psychological and physical casualties in an NBC-contaminated battlefield or in support of a WMD terrorist incident.

Hospital preparedness for weapons of mass destruction incidents: An initial assessment

Study Objective: We performed an assessment of hospital preparedness for weapons of mass destruction (WMD) incidents in Federal Emergency Management Agency (FEMA) Region III. Methods: Interviews of hospital personnel were completed in 30 hospitals. Data collected included level of preparedness, mass decontamination capabilities, training of hospital staff, and facility security capabilities. Results: No respondents believed their sites were fully prepared to handle a biologic incident, 73% (22/30) believed they were not prepared to manage a chemical weapons incident, and 73% believed they were unprepared to handle a nuclear event. If a WMD incident were to occur, 73% of respondents stated a single-room decontamination process would be set up. Four (13%) hospitals (all rural) reported no decontamination plans. WMD preparedness had been incorporated into hospital disaster plans by 27% (8/30) of facilities. Eighty-seven percent (26/30) believed their emergency department could manage 10 to 50 casualties at once. Only 1 facility had stockpiled any medications for WMD treatment. All facilities had established networks of communication. No hospital had preprepared media statements specific to WMD. Nearly one fourth (7/30) stated that their hospital staff had some training in WMD event management. All reported need for WMD-specific training but identified obstacles to achieving this. Seventy-seven percent (23/30) of hospitals had a facility security plan in place, and half were able to perform a hospital-wide lock down. Ninety-six percent (29/30) reported no awareness regarding the threat of a secondary device. Conclusion: Hospitals in this sample do not appear to be prepared to handle WMD events, especially in areas such as mass decontamination, mass medical response, awareness among health care professionals, health communications, and facility security. Further research is warranted, including a detailed assessment of WMD preparedness using a statistically valid sample representative of hospital emergency personnel at the national level. [Treat KN, Williams JM, Furbee PM, Manley WG, Russell FK, Stamper CD Jr. Hospital preparedness for weapons of mass destruction incidents: an initial assessment. Ann Emerg Med. November 2001;38:562-565.]

Y2K medical disaster preparedness in New York City: confidence of emergency department directors in their ability to respond.

To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model. Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness. The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management. Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

H EALTH C ARE F ACILITY P REPARATION FOR W EAPONS OF M ASS D ESTRUCTION

Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night.