The AHA's Hospital Readiness Efforts
America Prepared: Disaster Readiness 2001 will be an increasing focus for America's hospitals. Plans and resources essential to a prepared nation, and the need for enhanced community collaboration to strengthen the local alliance of hospitals and emergency response teams, will be critical. There is a lot of work to be done in this area, and hospitals have an important role. As the leading representative of America's hospitals, the AHA is placing a heightened priority on, and more staff resources into, its ongoing effort to address hospitals' preparedness for mass casualties. This effort began more than 18 months ago, and has been intensified in the aftermath of the September 11 tragedies.

An AHA staff working group consisting of five teams is charged with leading the association's efforts to help hospitals prepare for potential use of chemical and biological agents in terrorist attacks.

The Resource Team is charged with identifying readiness resources that are currently available to hospitals and to determine which readiness needs are currently unmet. This includes identifying short-, mid-, and long-term hospital resource needs and existing federal grant programs that may assist hospitals with readiness efforts.

The Insights Team is charged with identifying information on potential incidents and hospital readiness. This includes developing systems for classifying and cataloguing the information that is collected, and developing a strategy to identify and fill in knowledge gaps.

The Relationship Team is charged with identifying agencies, organizations and individuals with which the AHA must establish or enhance relationships in order to most efficiently and effectively ensure that America's hospitals have the most up-to-date materials and resources on mass casualty events.

The Member Pulse and Activities Team is charged with soliciting member input and perceptions on readiness and tracking member activities. This includes identifying opportunities for hospitals to participate in activities to enhance their readiness. This is being accomplished through one-on-one calls with AHA members, through small-group conference calls, and through AHA membership meetings.

The Communications Team is charged with developing materials to help hospitals respond to questions from their communities and the media.

The AHA Staff Working Group on Readiness is just one aspect of the leadership role the AHA has undertaken as the representative for America's hospitals. In addition to the working group's efforts, the AHA continues to represent the interests of its member hospitals before Congress, the administration and federal agencies. This representation includes working with government and elected leaders to ensure that they understand the process of disaster readiness and the resources hospitals need to best ensure the safety of the communities they serve.

We're in regular contact with leaders on Capitol Hill and in the administration to discuss what hospitals need as they update their disaster plans to meet the challenges of a threat that, until recently, seemed hypothetical: an attack using chemical, biological or radiological agents. These are the areas we are promoting:

Medical and pharmaceutical supplies - Hospitals must be properly stocked with antibiotics, antitoxins, antidotes, ventilators, respirators, and other supplies and equipment needed to treat patients in a mass casualty event.

Communication and notification - There is a need for greater coordination of public safety communications, including "interoperability," the ability of different public safety entities to communicate with each other on demand. In addition, alternative and redundant systems will be required in case existing systems fail in an emergency.

Surveillance and detection - Improving hospital laboratory surveillance and the epidemiology infrastructure will be critical to determining whether a cluster of disease is related to the release of a biological or chemical agent. The ability to rapidly identify the agent involved is vital.

Personal protection - Hospital supplies of gloves, gowns, masks, etc. would quickly be used up during an attack; and equipment like self-contained breathing apparatus is rarely kept in adequate numbers to meet demands of an attack.

Hospital facility - Among the capabilities hospitals will need in the event of an attack: lockdown ability; auxiliary power; extra security; increased fuel storage capacity; large volume water purification equipment.

Dedicated decontamination facilities - Hospitals need a minimal level for small events; the ability to ramp-up quickly for a medium-level event; and access to a regional decontamination facility for a large-scale event.

Training and drills - Staff training is needed at all levels for all types of potential disasters. Additional disaster drills beyond the two per year required by JCAHO, particularly community-wide drills, would enhance the level of hospital readiness.

Mental health resources - Mass casualty events trigger escalated emotional responses. Hospitals must be ready to treat not only patients exhibiting these symptoms, but others, such as family members, emergency personnel and staff.

Talking to Your Community and the Media
The following talking points were developed to help you and your hospital team respond to questions from your community, your staff, and the media about the readiness efforts of hospitals.

  • Hospitals are committed to caring for their communities in ordinary and extraordinary times.

  • We were ready for the foreseeable; now we're planning for the previously inconceivable.

  • Hospitals have always had disaster plans in place. But the events of September 11 raised the bar and redefined the meaning of disaster.

  • Hospitals are now upgrading their existing readiness plans to meet the challenges of a new reality. The American Hospital Association recommends that hospitals:
    Maintain disaster plans that, while flexible enough to respond to a wide range of events, are tailored to the specific needs of their communities.
    Increase coordination with local agencies such as police, fire and emergency medical systems.
    Expand training of nurses, doctors and other caregivers in chemical/biological incident response.
    Review inventory levels and sources of drugs and other supplies, to ensure that adequate amounts are available if a disaster occurs.

  • Our nation's nurses, doctors and health care workers are caring, committed people who are devoted to providing the care their communities need. They answered the call on September 11. They stand ready to do so again.

A Chemical/Biological Agent Checklist
The following lists contain the chemical and biological agents often identified as the most likely to be used in a terrorist attack.

Chemical agents Effects Onset First aid
Nerve Agents
Tabun (GA)
Sarin (GB)
Soman (GD)
Seconds to minutes Decontamination,
(blister agents):

eye irritation,
Minutes to hours Decontamination,
topical antibiotics,
British antiLewisite
Blood agents:
Hydrocyanic acid
Cyanogen chloride
Methyl isocyanate
loss of consciousness,
Minutes Nitrites,
sodium thiosulfate
Choking agents:
Tightness in the chest,
Minutes to hours Oxygen,

Biological agents Effects of inhalation Incubation Communicability Treatment
Anthrax Fever,
death if untreated
1-5 days None, but spores can survive outside host for years Intravenous antibiotics for 30 days, plus vaccination, effective only if begun before symptoms appear
Botulism Blurred vision,
difficulty speaking,
progressive paralysis,
respiratory failure,
1-5 days None Supportive therapy, antitoxin available only through CDC
Hemorrhagic fever High fever,
low blood pressure,
bleeding from
   mucous membranes,
organ failure,
4-21 days From patient fluids Supportive therapy, ribivirin for some viruses
Plague Fever,
pneumonia and
  bloody sputum,
2-3 days Highly contagious via aerosol route Prophylaxis for seven days. Vaccine is no longer available.
Smallpox Fever,
abdominal pain,
death in 20-30%
7-17 days Highly contagious via aerosol or contact with pox scabs Symptomatic treatment only; vaccine only through CDC
Tularemia Fever,
prolonged weight loss;
seldom fatal
2-10 days None Antibiotic twice daily for 10-14 days



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