Responding to a Terrorist Attack: Hospital Emergency Rooms

This publication is now archived.

What role do hospital emergency rooms play in responding to terrorist attacks?

Emergency room teams treat those injured in conventional terrorist attacks—such as a car bomb—in much the same way they treat victims of car accidents. Emergency rooms would also be on the front lines after terrorist attacks involving weapons of mass destruction. After an attack with a biological weapon such as anthrax or smallpox, emergency room physicians and nurses would likely be the first to detect exposure, identify the agent used, and treat the victims. Most victims of chemical or radiation attacks would be decontaminated by firefighters and emergency medical services ( EMS ) workers at the scene and then be rushed to local emergency rooms. But U.S. emergency room teams don’t have much experience in handling large terrorist attacks and don’t always know what to expect.

Could emergency rooms be overwhelmed by the casualties of a large terrorist attack?

Perhaps. Hospitals could probably handle many types of smaller-scale attacks such as bus bombings, but experts say most U.S. emergency medical personnel aren’t properly trained or equipped to deal with a large number of victims of a chemical, biological, or radiation attack. Even a “Level-1” trauma center like Boston Medical Center, which is certified to treat the most serious injuries around the clock, can only decontaminate about twenty patients at a time.

Moreover, after a biological, chemical, or radiation attack in a U.S. city, thousands of people—both actual victims and panicked bystanders—would flood local emergency rooms for testing, decontamination, and treatment. In the 1995 sarin gas attack on the Tokyo subway system by the doomsday cult Aum Shinrikyo, about 4,000 people who were not affected by the gas rushed to nearby hospitals, overwhelming staff and facilities.

To test hospital and emergency room capabilities, the Department of Homeland Security held the largest ever nationwide anti-terrorism drill in April 2005 to expose weak spots in the U.S.’s emergency response. Hospitals and law enforcement officials took part in the $16 million, five-day exercise, which involved simulated biological and chemical attacks, and required emergency responders to treat and assess mock patients.

Do hospitals have to meet federal standards of preparedness for terrorist attacks?

Not exactly. The federal government requires every U.S. hospital to have an “all-hazards plan”—a flexible set of procedures to follow in case of a disaster.  A recent study done by the Centers for Disease Control, found that 97 percent of hospitals have plans for natural disasters; about 85 percent have plans for responding the chemical and biological attacks and 77 percent have plans for responding to nuclear or radiological attacks and explosive incidents.

In 2002, the Department of Health and Human Services created the National Bioterrorism Hospital Preparedness Program (NBHPP) to “prepare hospitals and supporting healthcare systems to deliver coordinated and effective care to victims of terrorism and other public health emergencies.” Since 2003, the program’s budget has been a nearly half a billion dollars, but the money has been slow to reach individual hospitals.

Are some emergency rooms better prepared than others to handle victims of a terrorist attack?

Yes. One of the best prepared is St. Vincent’s Medical Center in Manhattan, which treated victims of the 1993 and 2001 attacks on the World Trade Center and has had a committee devoted to nuclear, biological, and chemical threats since 1997. (In fact, after the September 11 attacks on the World Trade Center, doctors at St. Vincent ’s and other nearby trauma centers treated far fewer patients than they had anticipated because of the high percentage of fatalities.) Small-town facilities tend to be less prepared, with the odd exception: the only hospital emergency room in the country dedicated to treating patients for radiation exposure is located in Oak Ridge, Tennessee (population 26,700), near a major nuclear facility.