Understanding the Challenges of Hospital Preparedness for CBRNE Incidents

By Marisa Tuszl, Biodefense MS Student

My interest in how well prepared hospitals are to respond to a chemical, biological, radiological, nuclear, or explosive (CBRNE) attack was sparked last fall after I took two different, but equally fascinating courses, on the topic. In October, I attended the US Army’s Medical Management of Chemical and Biological Casualties (MCBC) course and during the fall semester I took a course on building healthcare system resilience with Dr. Saskia Popescu who teaches in the Biodefense program at the Schar School of Policy and Government at George Mason University. While the Army course focused on the threats posed by chemical and biological weapons and managing military casualties in the field caused by these weapons, Dr. Popescu’s course focused on the readiness of civilian hospitals to respond to a range of hazards. My curiosity about the intersection of CBRN weapons and hospital preparedness led me to take Hospital Management of Chemical, Biological, Radiological, Nuclear, or Explosive (HM-CBRNE) Incidents course offered by the United States Army Medical Research Institute of Chemical Defense (USAMRICD) and United States Army Medical Research Institute of Infectious Diseases (USAMRIID). The week-long, virtual HM-CBRNE course presented an opportunity to improve my understanding of how hospitals can manage these types of incidents, the Federal programs and protocols that are in place to provide assistance, and the most common challenges confronting hospital preparedness.

The first day of the course provided a foundation regarding the Federal guidelines for responding to a CBRN incident, such as the National Response Framework (NRF) and National Incident Management System (NIMS), and the response systems in place within healthcare facilities, such as the Hospital Incident Command System (HICS). The subsequent days were focused on the different types of CBRNE threats covered by the course, how the nature of these different threats affected planning, decontamination, triage, and response efforts, and the overall role of the different incident command and management systems in planning and response. Altogether, the buildup of information was designed to prepare us for a capstone exercise at the end of the week in which we utilized a traditional HICS to handle an unknown event in real-time.

The capstone exercise was my favorite part of this course because everyone in our group held a specific role in the HICS organizational chart and we had to work together to triage incoming patients to determine whether they were routine patients, required emergency care, or were victims of the incident and required special medical attention. In addition, the proctors threw curveballs at us during the exercise which required each team to work together to come up with solutions to these new problems. In my role as the Situation Unit Leader, I had to keep track of the patients and available beds in the emergency department to ensure a smooth distribution of patients throughout the hospital and mitigate any surge capacities, if possible, during the incident. Though this was a virtual exercise, it revealed several real issues that hospitals can face as they attempt to handle an unknown public health emergency, such as communicating with other hospitals to ensure that each has adequate resources, making sure that memorandums of understanding (MOUs) are in place before an incident, having a location for families to be directed to avoid confusion and traffic at the hospital, having capabilities to decontaminate patients, and turning over beds in an efficient manner to prevent overfilled emergency departments. The capstone exercise displayed how important it is for localities to have emergency planning committees and perform hazard vulnerability analyses to determine what threats are the most probable for them. The after-action session also allowed the two teams that participated in the capstone exercise to discuss the similarities and differences in their planning and response techniques to the same event. Thus, we were able to learn how others handled the event and gained insight into additional complicating factors such as the possibility of multiple threats or emergencies occurring concurrently and the difficulties in utilizing volunteers and external partners during a major incident.

All in all, the HM-CBRNE program supplied me with an invaluable educational experience for learning about the “ins-and-outs” of hospital emergency management. This course was beneficial in providing myself and the other participants with the tools to identify potential CBRNE incidents and the protocols to respond accordingly. As with the MCBC course, USAMRIID and USAMRICD did a great job in utilizing a virtual platform to provide practical information on hospital preparedness to an array of participants.

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