Disaster Planning

By Marcia Hartman, MS

Four years after the transformative events of Sept. 11, 2001, the natural disasters of 2005 hit home the fact that domestic disaster preparedness isn't where we thought it would be. Not a day passes without a media article or news program mentioning disaster preparedness by the business community or government agencies.

The media frequently mentions radioactive "dirty bombs" as an ongoing threat. If a terrorist event occurs where you live (or even within 100 miles of your location), your hospital could receive victims. Typically only tertiary medical centers have on-staff health physicists to assist their emergency department (ED) in planning for this threat. The ED staff at most hospitals look to their diagnostic radiology, nuclear medicine and radiation oncology professionals to provide advice for hospital policies and procedures and to guide them through the initial response.

Jerrold T. Bushberg, PhD, a clinical professor of radiology and radiation oncology at the University of California Davis Medical Center who has responded to radiological medical emergencies and provided response training to hospital staff, suggests several ways for medical professionals to increase their knowledge of disaster preparedness and aid the ED in planning. "Read and understand your hospital's radiological emergency management plan," says Dr. Bushberg, who also advises the California and federal Departments of Homeland Security and the International Atomic Energy Agency (IAEA) on radiological response issues. "If one does not exist or lacks appropriate guidance or detail, participate in revising the plan."

He also suggests getting to know the person at your institution who handles emergency preparedness (EP)-one of seven "Environment of Care" areas evaluated by the Joint Commission on Accreditation of Healthcare Organizations. Recently, JCAHO designated EP as an area of special emphasis during its inspections, with the commission requiring institutions to conduct at least two drills per year. "Suggest that one of the drills in the next few years center around a radiological emergency," says Dr. Bushberg. "Then participate in the development and execution of drills and/or tabletop exercises."

He urges staff to acquaint themselves with ED personnel and their environment to enable them to feel more comfortable should they participate in an emergency setting. "Beyond whatever technical assistance you may offer in the ED, one of your most important functions is to explain the radiation risks in a way that raises their level of comfort and lowers their level of anxiety," he says, "so that they can effectively focus on their primary mission of critical care."

Another option: participating in a "noon educational conference" on ED management of radiological emergencies. The Medical Response Subcommittee of the Health Physics Society's Homeland Security Committee, which Dr. Bushberg chairs, has prepared a 45-minute PowerPoint presentation on the subject (available at www.hps.org/hsc/responsemed.html) that includes talking points in the "notes section" and can be edited to suit your application.

Dr. Bushberg suggests developing your responses to questions that would likely arise during a radiological emergency event or drill (many of these answers should be in the plan or supporting educational material). Consider the examples below.

ED staff may ask:

Must all patients be decontaminated before treatment in the ED?

How do I know it's safe to treat a contaminated patient?

What dose of radiation can I receive and what is the associated risk?

How can I reduce my dose?

Should I treat contaminated patients if I'm pregnant?

Should I wear a lead apron?

Do we have to close the ED if it's contaminated with radioactive material?

Other clinical care staff such as surgical or pulmonary services may ask:

What special precautions are necessary for us to treat these patients?

What will be required before we're able to treat other patients in these areas?

Evaluate your role in response to a radiological emergency and ask yourself:

Am I fully prepared to provide the services described in the plan?

Could I offer more assistance beyond what is called for in the plan?

Evaluate the radiation safety aspects of the plan and ask yourself:

Are the other radiation experts (e.g., health physicists, radiologists, radiation oncologists, nuclear medicine physicians and technologists) effectively incorporated into the plan?

Does the radiation safety portion of the plan contain redundancies or gaps?

Finally, Dr. Bushberg recommends keeping abreast of consensus documents that provide recommendations on managing radiological emergencies from authoritative sources such as the National Council on Radiation Protection and Measurements, International Commission on Radiation Protection, the Centers for Disease Control and Prevention (CDC) and the IAEA. Then, make recommendations to modify your hospital's existing plans as necessary. The CDC and IAEA Web sites have considerable reference material available as portable document files.

A terrorist event is, without question, a profoundly disturbing event that no one is eager to contemplate. But response to such a disaster is less stressful if you discuss policies and make decisions before such an event occurs. After policies and procedures are in place, the hospital staff can train and drill with confidence and competence. The alternative involves trying to respond to an event for which no plan is in place, or with a plan that has insufficient detail. Inadequate preparation can needlessly delay patient care and cause avoidable loss of life. The time to act is now.

Marcia Hartman, MS, is a health physicist at the University of California Davis Medical Center and a member of the Medical Response Subcommittee of the Health Physics Society's Homeland Security Committee.