Managing Bioterrorism Mass Casualties in an Emergency Department: Lessons Learned From a Rural Community Hospital Disaster Drill

Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks.