Preparedness for terrorist attacks,national geographic viewing schedule,business continuity plan in financial organization - Good Point

Drawing upon decades of experience, RAND provides research services, systematic analysis, and innovative thinking to a global clientele that includes government agencies, foundations, and private-sector firms. The magnitude and character of recent terrorist events have called into question the readiness of the nation's state and local emergency response and health and medical personnel to respond effectively to future incidents, to correctly identify hazards as they occur, and to mitigate damage to persons and property. The research described in this report was performed under the auspices of RAND's Office of External Affairs.This report is part of the RAND Corporation issue paper series. Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.
The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous.
Subscribe to the weekly Policy Currents newsletter to receive updates on the issues that matter most. Information for preppers on all aspects of emergency preparedness, prepping and food storage. Preparing Your Home, Family, and Business for TERRORIST ATTACKS is the name of a new publication put out by Rep Robert Pittenger, the Chairman of the Congressional Task Force on Terrorism and Unconventional Warfare. For a small book this manual has a lot of good information on Terrorist attacks, share it with your family and friends. This entry was posted in bioterrorism, nuclear, Operational Secrecy and tagged terrorist attacks. Department of Health Policy & Management, School of Public Health, College of Public Service, Jackson State University, Jackson Medical Mall, 350 W. The possibility of a terrorist attack employing the use of chemical or biological weapons of mass destruction (WMD) on American soil is no longer an empty threat, it has become a reality. IntroductionThe possibility of a terrorist attack employing the use of weapons of mass destruction (WMD) on American soil is no longer an empty threat, it has become a reality. Mississippi Trauma Care System – Trauma Care RegionSource: Mississippi State Department of Health, Division of Emergency Medical Service (2000).
This issue paper discusses the challenges of measuring preparedness for chemical and biological weapons of mass destruction (WMD) incidents and illustrates the difficulties using detailed, nationally representative data from local response organizations on the existence and exercise of plans to address these types of incidents.
The issue paper was a product of the RAND Corporation from 1993 to 2003 that contained early data analysis, an informed perspective on a topic, or a discussion of research directions, not necessarily based on published research.
RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. A WMD is defined as any weapon with the capacity to inflict death and destruction on such a massive scale that its very presence in the hands of hostile forces is a grievous threat.
It uses a RAND survey conducted from March to September 2001 about domestic terrorism involving WMD to a national cross-section of more than 1,000 state and local organizations. The issue paper was meant to be a vehicle for quick dissemination intended to stimulate discussion in a policy community. The survey results show that few organizations have a plan in place sufficient to address a moderately sized chemical and biological incident.
In light of these actions, hospitals have been working vigorously to ensure that they would be “ready” in the event of another terrorist attack to provide appropriate medical care to victims.
In light of these incidents and the continued threat of future attacks, hospitals have been working vigorously to ensure that they would be prepared to adequately care for victims in the event of another terrorist attack.
For information on reprint and linking permissions, please visit the RAND Permissions page. However, according to a recent United States General Accounting Office (GAO) nationwide survey, our nation’s hospitals still are not prepared to manage mass causalities resulting from chemical or biological WMD. Therefore, there is a clear need for information about current hospital preparedness in order to provide a foundation for systematic planning and broader discussions about relative cost, probable effectiveness, environmental impact and overall societal priorities. Hence, the aim of this research was to examine the current preparedness of hospitals in the State of Mississippi to manage victims of terrorist attacks involving chemical or biological WMD.
Additionally, the President stated that although the United States has taken the lead in disarming and decreasing terrorists’ capacity, a number of “terrorist cells” still exist. In a June 2004 news conference entitled “New Terrorist Threats,” Attorney General John Ashcroft announced that “terrorists are planning another attack on U. Ashcroft and Mueller also believe that the recent railway bombing in Madrid has strengthened the resolve of some terrorist groups, motivating them to attack the U.S.
In addition, both agree that although a number of planned major events occur often all over the U.S. In general, hospitals in the State of Mississippi, like a number of hospitals throughout the United States, are still not adequately prepared to manage victims of terrorist attacks involving chemical or biological WMD which consequently may result in the loss of hundreds or even thousands of lives. Therefore, hospitals continue to require substantial resources at the local, State, and national levels in order to be “truly” prepared. The report pointed out that over the next fifteen years, successes in the global war on terrorism and advances in information technology are likely to result in an increasingly decentralized terrorist threat, consisting of an eclectic array of terrorist groups, cells and individuals.


The report also suggested that acts of biological terrorism would be particularly suited for these smaller and better informed terrorists and that their laboratories need be only the size of a household kitchen and their weapons built smaller than a toaster. For example, Presidential Directive 39, created in 1995, triggered a number of actions among many national agencies to develop strategies that would better position the U.S. In 1996, Congress enacted the Defense Against Weapons of Mass Destruction Act, requiring each State to develop a Domestic Preparedness Program and other efforts to improve the capabilities of local emergency response agencies. This program recognized that hospitals and other public health infrastructure are an essential component of the preparedness for terrorist attacks and other hazards both natural and manmade. But despite these general preparedness efforts within the health care industry, hospitals typically are a weak link in the preparedness infrastructure, particularly for those incidents involving chemically or biologically contaminated patients [8].Since the mid 1990s, approximately 120 of the largest United States cities have received tens of millions of dollars annually in federal funding for training, practice exercises, and equipment to respond to chemical or biological attacks. The Department of Health and Human Services (HHS) has established the Office of Public Health Preparedness to address the preparedness needs of Public Health agencies. In January 2002, President Bush approved $1 billion for preparedness to be administered by the Department of Health and Human Services, to help States prepare their public health infrastructures. In November 2002, Congress approved the development of the Department of Homeland Security, designed to consolidate several U.S. In December 2002, the Bush administration announced plans to start inoculating some 10 million healthcare, emergency service, law enforcement, and military personnel against smallpox before making the smallpox vaccine available to the general public on a voluntary basis in 2004. In President Bush’s January 2003 State of the Union address, he proposed spending an additional $6 billion for research and production of vaccines and other treatments against chemical and biological weapons of mass destruction (CBWMD) [10].
Also in January 2003, the Bush administration created a surveillance system designed to detect the release of such deadly germs as anthrax and smallpox within 24 hours by adapting many of the Environmental Protection Agency’s 3,000 air-quality monitor stations nationwide.
The Bioterrorism Hospital Preparedness Program, administrated by HHS’s Health Resources and Services Administration (HRSA), provided funding in the fiscal year 2002 in the amount of approximately $125 million through cooperative agreements to States and eligible municipalities to enhance the capacity of hospitals and healthcare entities to manage victims exposed to CBWMD.Additionally, agencies such as the American Hospital Association, American College of Emergency Physicians, Centers for Disease Control and Prevention, Center for Civil Biodefense Strategies, Joint Commission on Accreditation of Healthcare Organizations and others have established guidelines for the preparedness of hospitals for managing patients exposed to CBWMD [11]. Donald Henderson suggest that it is common for hospitals to not be fully prepared to respond to mass casualty disasters of any kind, neither in their capacity to care for large numbers of victims or in their ability to provide care in coordination with regional or federal incident command structures. Several surveys of hospital emergency departments have also found broadly prevalent deficits in knowledge, plans, and resources for responding to hazardous materials incidents [13].
James Burgess agrees with Henderson and contends that even relatively small-scale hazardous materials incidents have overwhelmed the response capacities at many hospitals and often resulting in secondary exposure among emergency department staff n ecessitating hospital evacuations [14].In support of Burgess’ contentions, a national survey of hospitals by the General Accounting Office (GAO) reported recently to a Congressional Committee that hospitals and their emergency departments would require far greater resources than those needed for everyday performance to respond to a large-scale chemical or biological weapons attack [15]. Other findings included in the report were that specific preparedness equipment, supplies, and facilities needed during and after an attack involving CBWMD could vary depending upon what type of terrorist attack. The report also suggested that the demand for healthcare services could quickly outweigh the ability and capacity of hospitals to effectively and efficiently respond to the needs of attack victims.Several practice scenarios have also been presented to assess the preparedness and response of healthcare systems in the event of a terrorist attack. One such scenario, “TOPOFF 2000”, simulated a terrorist attack using pneumonic plague released at a public event in a single location in one city [16]. In this exercise, officials found that by the third day following the covert release of the toxin, 500 persons with symptoms had been reported and antibiotic shortages were beginning to occur. By the end of this day, nearly 800 cases had been identified and over 100 persons had died. In each of the succeeding two days, the situation worsened and shortage of medical care within the city was described as critical, with insufficient hospital staff, beds, ventilators, and medications.
At the conclusion of the exercise one week after the attack, an estimated 3,700 cases of plague had been identified and 2,000 death s reported.
In the early stages of the epidemic, hospitals were seeing two to three times their normal volume of patients and later in the exercise up to ten times the normal volume were arriving at hospitals.
Alarmingly, hospitals were not able to effectively isolate patients to prevent the spread of the disease to hospital staff.Another practice scenario to test the nation’s healthcare systems for managing victims of terrorist attacks was conducted on June 22–23, 2001 by the John Hopkins Center for Civilian Biodefense Strategies [17]. In collaboration with the Center for Strategic and International Studies, Analytic Services Institute for Homeland Security, and Oklahoma National Memorial Institute for the Prevention of Terrorism, the scenario, “Dark Winter,” simulated a covert smallpox attack on the U.S. Dark Winter was constructed to examine the challenges that senior-level policy makers would face if confronted with a biological terrorist threat that initiated outbreaks of a highly contagious disease. Hospital influx systems across the country were flooded with demands for patient care which consisted of clients who had contracted smallpox, those with common illness and feared they had smallpox, and those who were not ill but worried that they might become infected.
The challenges of distinguishing the infected or exposed from those who were not, rationing of scarce resources, and the shortages of health care professionals, who were themselves worried about becoming infected or transmitting the disease to their families, imposed a major burden on all hospitals and other healthcare systems in the nation.Since September 11, 2001, significant resources have been focused on chemical and biological terrorism planning and preparedness. As indicated by several scholars, these resources have dramatically improved the nation’s ability to confront an attack involving smallpox or other insidious chemical or biological agents.
However, according to Victoria Elliott, gaps in the preparedness of hospitals to manage victims resulting from chemical or biological exposure in the long-neglected health care sector still exist [18].
It is these gaps that continue to trigger uncomfortable doubts about the health care system’s surge capacity and other preparedness elements should a worst-case scenario occur. In addition, most health care agencies would not have the capacity to provide large-scale vaccinations or care in the event of a major infectious incident.
Representative Barney Frank of Massachusetts was recently asked by the Massachusetts Nursing Association if he believed that hospitals were ready for a terrorist attack.
He responded by saying that “hospitals are not ready for Saturday night, let alone a terrorist attack [19].” According to Barney, many hospitals are finding it hard just to keep their doors open which unfortunately could not have happen at a more critical time in our nation’s history. He indicated that hospitals now are faced with the need to prepare themselves to be on the receiving end of the fallout from terrorist attacks thereby serving as the core of the community’s plans to receive, identify and treat contaminated victims.


Representative Barney argues that this expectation will be difficult to meet given that most hospitals do not have the proper financial resources to meet such need.
The Trust for America’s Public Health, a nonpartisan public health watchdog, recently provided a similar report that supports Representative Barney’s contentions. In December 2004, the Trust reported that the nation’s public health system is still woefully unprepared to handle a biological terrorist attack and that federal policies are still ill-defined and inconsistent [20].Clearly, there is a need for more information about the current state of hospitals’ preparedness for managing victims of terrorist attack(s) in an effort to provide a broader foundation for systematic planning and discussions about the necessary resources needed to be truly prepared.
To provide such information, this research examined six critical elements of preparedness necessary for hospitals to be truly prepared to manage victims of terrorist attacks involving chemical or biological weapons of mass destruction. Acute care hospital refers to the hospital category that best describe the type of services provided to the majority of its patient admissions. This reference is also consistent with the designation of acute care hospital provided by the Mississippi State Department of Health, Health Facilities Licensure and Certification Division. Additionally, this population selection methodology allowed for the inclusion of hospitals that were located throughout the 82 counties in the State of Mississippi.This population of hospitals also represents seventy-percent of all hospitals in the State. In addition, these hospitals represent diverse perspectives on the issues of the preparedness of hospitals for managing victims of terrorist attacks involving CBWMD. Hence, it may be concluded that accurate generalizations may be made about the preparedness of hospitals in general related to their ability to manage victims of terrorist attacks in the State of Mississippi. The closer the values were to ± 1.00, the greater the associations were between the variables.
The critical values table for Pearson correlation coefficient was used at the .05 level of significance to reflect the probability of an alpha error [21].
Additionally, Guilford’s Guideline for Interpreting the Strength for Values of r was utilized as a reference point to interpret the strength of an association, if any, between the dependent variable and independent variables [22]. Demographic data were also analyzed to provide a detailed description of the population under investigation.
The questionnaire survey contained eighteen items that measured documented and functional preparedness plans.
All but three measures were identified as significantly correlated to the preparedness of hospitals.
However, the majority of the hospitals were not able to identify an alternate point of care individual, augment their security forces, or provide offsite information systems backup. All of the respondents had one or more dedicated decontamination areas, were able to decontaminate multiple contaminated victims simultaneously, and provided decontamination training to their staff within the past twelve months.
The findings from these measures revealed that less than half (40.5%) of the hospitals in this study could increase their surge capacity. In addition, hospitals in this study reported that they would not have rapid access to appropriate respiratory protective equipment such as air purifying masks. However, many of the hospitals do have at least some of the critical elements of preparedness. Unfortunately, a number of hospitals reported that they could not increase their surge capacity or have diagnostic laboratory services capable of analyzing and identifying chemical or biological warfare agents.Although hospitals in urban areas were generally better prepared than rural hospitals in Mississippi, only a few of these hospitals fully met the specific criteria used in this study to measure “true” preparedness. More urban than rural hospitals participated in this study which may be due to there being almost twice as many urban hospitals in the State than rural. The majority of the hospitals had 100 to 300 inpatient beds and between 10 to 20 emergency department beds.The majority of hospitals was not part of a larger health system and had not received any federal funding for preparedness efforts. It is conceivable that these factors may indicate that hospitals are constrained by the availability and capacity of existing resources required for the preparedness of hospitals for managing victims exposed to chemical or biological warfare agents. However, the majority of the hospitals were accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Hence, it is likely that a number of hospitals in this study, in light of reports that they were not prepared based on the study’s measurement criteria, may be better prepared than indicated.
In line with being fully accredited by the JCAHO, these hospitals have achieved a predetermined set of standards for preparedness. These standards indicate a desired level of preparedness for being capable of managing victims of a disaster such as one resulting from a CBWMD.Though most of the hospitals had preparedness plans, many reported that they had not designated an alternate point of care individual, augmented their security forces and had not secured an offsite information systems backup.
This would suggest that many of the hospitals in the State must develop better assessment tools that would allow them to assess and provide appropriate education to all levels of their staff in order to be “truly” prepared.The findings in this study also indicate that an ability to increase surge capacity was a major issue for the majority of hospitals in the State of Mississippi. Most of them reported that they were not able to increase their current capacity (staff, supplies, equipment, number of beds, etc.) to care for mass casualties in the event of a chemical or biological disaster. Even in light of having appropriate decontamination facilities primarily for chemical exposure, a terrorist deployment of a biological warfare agent may result in mass casualties and fatalities by the time it is diagnosed.Overall, the findings in this research revealed that acute care hospitals, which represent over seventy-percent of all hospitals in the State of Mississippi, are not “truly” prepared to manage victims of terrorist attacks involving CBWMD. Although these study findings are based entirely on self-administered questionnaire surveys that can carry an inherent risk of reporting bias, the individuals that completed the surveys were professionals who should have been well informed and had ready access to the necessary information to appropriately answer the survey questions.



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