Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

y private physicians. Approximately 85% of the 592 survivors sustained non-life-threatening
soft-tissue injuries (including lacerations, abrasions, contusions, and puncture wounds), and 35%
sustained musculoskeletal injuries (including fracture/dislocations and sprains). The 66 children
who were injured in the Oklahoma City blast showed a similar pattern of soft-tissue and
musculoskeletal injury.
The first wave of patients from the Oklahoma City blast arrived either by ambulance or some
other means of transportation within 15 to 30 minutes of the event. Medical systems were
overloaded with minimally injured patients. As would be expected, hospitals closest to the attack
were overwhelmed first. More seriously ill, non-ambulatory patients tended to arrive later
because of the delay associated with field triage and transport via EMS. The experience after the
World Trade Center attacks in 2001 was similar in that the vast majority of patients seen in
emergency departments were ambulatory and were treated for minor soft-tissue injuries and
released. However, hospital overload was mitigated somewhat due to the large number of
fatalities, which decreased the number of survivors presenting for treatment. The main lesson to
be learned from these experiences is that casualty profiles are event specific, but an effective
triage system can better direct attention toward the critically ill.
Regional coordination. The objective of risk assessment is to estimate the likelihood that an
incident will have an impact on the hospital, as well as the size of that impact. Considerations in
risk assessment include the following:
• Attack has the potential to generate large number of causalities.
• Effects may be immediate or delayed.
• Response will require specialized equipment, procedures (decontamination), and
medications, all adapted to pediatric needs.
• Hospitals may be targets of secondary attacks to amplify effect.
Situations with both high probability and the potential for high impact (e.g., an earthquake in
California, or a tornado in the Midwest) should receive more attention in preparedness planning
than either situations of low probability with the potential for high impact (e.g., industrial plant
chemical leak) or situations of high probability and the potential for low impact (e.g., community
outbreak of infectious gastroenteritis).
Hazard vulnerability analysis (HVA) is an aspect of risk analysis that considers the hospital’s
capabilities regarding the traditional elements of risk. This analysis allows a comparison between
the potential risk factor (hazard) and the hospital’s ability to cope. The action plan resulting from
this type of risk analysis should be directed toward those hazards against which the hospital is
less able to cope (i.e., vulnerabilities). Areas of vulnerability may include attack on hospital
information systems, inadequate ventilation systems (negative pressure, contained exhaust) for
decontamination procedures in toxic exposures, hospital staff untrained in the proper use of
personal protective equipment (PPE), and so on.
The key benefit of HVA analysis is the ability to prioritize planning for the hospital in any given
situation. The key to effective HVA is a good, frequently updated inventory of the resources and
capabilities (within both the hospital and the community) that are available for dealing with a
particular hazard-related emergency.
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