title: Lack of hospital preparedness for chemical terrorism in a major US city: 1996-2000.
abstract: BACKGROUND
  The [US] Nunn-Lugar-Domenici Defense Against Weapons of Mass Destruction (WMD) Act (the WMD Act of 1996) heralded a new wave of spending by the federal government on counter-terrorism efforts. Between 1996 and 2000, the United States of America (US) federal government allocated large sums of funding to the States for bioterrorism preparedness. Distribution of these funds between institutions involved in first-responder care (e.g., fire and safety departments) and hospitals was uneven. It is unknown whether these additional funds had an impact on the level of hospital preparedness for managing mass casualties involving hazardous materials at the local level, including potential terrorist attacks with chemical agents.
  
  
  OBJECTIVE
  (1) To compare 1996 and 2000 measures of preparedness among hospitals of a major US metropolitan area for dealing with hazardous material casualties, including terrorism that involved the use of weapons of mass destruction; and (2) To provide guidance for the improvement of emergency preparedness and response in US hospitals.
  
  
  METHODS
  In July 1996 and again in July 2000,21 hospitals in one major US city were surveyed by questionnaire. A survey was used to assess the amounts of antidote stocks held available for treatment of casualties caused by toxic chemical agents and institutional response capabilities including the number of showers for decontaminating patients, the level of worker protection, and the number of staff trained to decontaminate patients.
  
  
  RESULTS
  Hospital preparedness for treating and decontaminating patients exposed to toxic chemical agents was inadequate in 1996 and in 2000. From 1996 to 2000, there was no statistically significant change in the lack of hospital preparedness for stocking of nerve agent and cyanide antidotes. Capacity for decontamination of patients, which included appropriate hazardous material infrastructure and trained staff, generally was unimproved from 1996 to 2000 with the exception of an increase of nearly 30% in hospitals with at least one decontamination shower facility.
  
  
  CONCLUSIONS
  Hospitals surveyed in this study were poorly prepared to manage chemical emergency incidents, including terrorism. This lack of hospital preparedness did not change significantly between 1996 and 2000 despite increased funds allocated to bioterrorism preparedness at the local level.
authors.affiliation: Department of Emergency Medicine, Emory University of Medicine, Atlanta, Georgia, USA. mkeim@disastercare.net
authors.forename: Mark E
authors.initials: ME
authors.lastname: Keim
authors.forename: Nicki
authors.initials: N
authors.lastname: Pesik
authors.forename: Nana A Y
authors.initials: NA
authors.lastname: Twum-Danso
mesh_terms: D004189:Disaster Planning / Q000458:organization & administration / Q000592:standards*; D015386:Hazardous Substances; D006739:Hospital Administration / Q000592:standards*; D011795:Surveys and Questionnaires; D023481:Terrorism; D017749:Total Quality Management; D014481:United States
chemical_list: D015386:Hazardous Substances