Incident Management

Medical Response to WMD Medical Response to Weapons of Mass Destruction

Incident management is an essential factor in saving lives following a weapon of mass destruction event. If first responders follow a conventional incident management plan, more patients will result. When there is a high suspicion of a weapon of mass destruction event, such as a chemical and/or biological attack, first responders must follow an incident management plan of event recognition and activation of the response plan .

Event Recognition

Incident management begins with event recognition. The local first responders must approach incidents with a high level of suspicion. An unannounced event in a civilian population will be extremely difficult to identify as first responders likely have little or no detection equipment and rely on recognition of patient signs and symptoms. A person's senses can provide valuable information. Be aware of unexplained vapor clouds, mists, or plumes and unusual odors. Draw information from the victim's actions. Look for unexplained patterns of sudden onset illnesses or deaths, unexplained signs of skin, eye, or airway irritations, victims twitching, tightness in chest, sweating, pin-point pupils, runny nose, and nausea and vomiting. The environment can provide clues as well. Look for the presence of hazardous materials or equipment that is not relevant to the scene or the occupancy. If the arrangement of a scene or occupancy creates difficult access, or keeps people out, be cautious (Department of Defense, 1998). Prompt recognition will speed the activation of the Metropolitan Medical Response System and the subsequent arrival of additional medical support.

In a weapon of mass destruction event, hospitals should anticipate many patients arriving without medical direction from the first responders. The hospital staff needs to be able to recognize these patients as they arrive. Some of these patients may be contaminated, and if allowed into the medical facility before decontamination, hospital staff may become patients themselves. As a protective measure, personal protective equipment must be readily accessible to any person who encounters a contaminated patient. Training all hospital staff, to include security, administrative and medical professionals, to recognize contaminated patients is paramount to the functionality of the medical facility.

Activation of Response Plan

After confirmation of an event to be a chemical and/or biological incident, the local responders on-scene must request, through internal channels, support from the Metropolitan Medical Response System. Additional support from state emergency service agencies must be notified through the local 911 or local emergency management agency (HHS, 998). It will be difficult for first responders to assess the level of support required to facilitate the incident. For this reason, it is the responsibility of the National Health and Medical Services authority to determine what support is needed and deliver it in a timely manner. The Department of Health and Human Services, Office of Emergency Preparedness, will arrange for alerting the National Disaster Medical System. Within this system the HSS can activate and deploy Disaster Medical Assistance Teams, Disaster Mortuary Teams and other special teams (HHS, 1996). Through proper coordination regional and national medical response teams can be on-scene and provide medical support to the first responders.

With the mass numbers of patients expected, coordination for medical facilit y support is essential. It is primarily the responsibility of the local medical community to provide medical facility support for its citizens. In circumstances where the number of patients exceeds the capabilities of the local medical facilities, local responders will refer requests for additional assistance to state authorities. They in-turn may request for activation of the NDMS hospital support through the Regional Health and Medical Services Support office to the NDMS, Operations Support Center (NDMS/OSC). Once verified by the NDMS/OSC, the Assistant Secretary for Health will review the request for approval. Upon approval, the NDMS/OSC will activate the NDMS patient evacuation system and Federal Coordinating Centers will activate area operations/p atient reception plans (HHS, 1996). Within 12 hours of notification, the HHS can have medical facilities ready to receive patients from the chemical and/or biological incident.