Hazard

During mass casualty emergencies, such as a terrorist attack or chemical plant explosion, patients may be exposed to biological agents, chemical agents, or radioactive materials. Hospitals can anticipate little or no warning before victims begin arriving. Additionally, first receivers, which in these events typically include Emergency Department (ED) staff, should anticipate that information regarding the hazardous agent(s) would not be available immediately. Hospitals also can anticipate a large number of self-referred victims (as many as 80 percent of the total number of victims) and victims may not have been decontaminated prior to arriving at the hospital. ED staff could be exposed to whatever hazardous agents or materials accompany the patient into the hospital.

Recognized Controls and Work Practices

Provide and plan for emergency response for ED staff. OSHA standards, including Hazardous Waste Operations and Emergency Response (HAZWOPER, 29 CFR 1910.120), require training for workers who will be involved in certain activities during responses to mass casualty incidents. ED staff must be equipped with PPE that could effectively protect first receivers assisting victims contaminated with unknown substances (see examples in OSHAs best practices document cited below). A higher level of protection also may be necessary for any hospital that anticipates depoloying ED staff to provide specialized services (such as Hazardous Materials Response Team at the incident site). The U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the American Hospital Association (AHA), the Department of Defense (DOD), and OSHA have several resources available on how hospitals can plan and prepare for terrorist events:

• Follow OSHA's "Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances," to plan for and respond to mass casualty incidents.
• Additional preparedness and response resources include:
  • Emergency Preparedness and Response. OSHA Safety and Health Topics Page.
  • Hospitals and Community Emergency Response. OSHA Publication 3152-3R, (2008).
  • Horton D. K., Z. Berkowitz, W.E. Kaye. 2003. Secondary contamination of ED personnel from hazardous materials events, 1995-2001. Am J Emerg Med 21:199-204. May.
  • Guidance on Emergency Responder Personal Protective Equipment (PPE) for Response to Chemical, Biological, Radiological, and Nuclear (CBRN) Terrorism Incidents. Centers for Disease Control and Prevention (CDC).
  • Biological Agents. OSHA Safety and Health Topics Page.
    • Anthrax. OSHA Safety and Health Topics Page.
    • Anthrax in the Workplace. OSHA.
  • Radiation emergencies
    • Radiological Dispersal Devices (RDD)/Dirty Bombs. OSHA Safety and Health Topics Page.
      • See How will health care workers be protected?
  • Radiological Dispersion Devices. National Institute of Environmental Health Sciences (NIEHS).