How Would Military Hospitals Cope with a Nuclear, Biological, or Chemical Disaster?
In any nuclear, biological, or chemical (NBC) attack, it is clear that the hospitals may be overwhelmed with casualties. In these deliberate accidents, there will be an additional problem of contamination. Military hospitals must be prepared for NBC disasters with a detailed incident plan. Within this plan, decontamination facilities and shower systems are needed primarily to protect the hospital from self-contamination. Physical and collective protection measures of the staff should be taken into account, with evacuation routes under such an attack. Within this conjunction, the required equipment, including protective suits, detection means, drugs, antidotes, and vaccines, should be provided and stored properly. Qualified personnel should be assigned to the NBC first-aid and rescue team organized within the hospital, equipped, and trained according to such a possible task. Medical staff must be aware of the effects of the agents, and must be experienced in decontamination and first-aid to victims exposed to these agents. Therefore, this information must be put into practice by giving attack scenarios and responses to the hospital administration. It can be conclusively pointed out that military hospitals especially should be better prepared than any other civilian health unit to such attacks of weapons of mass destruction.
The threat from unconventional warfare agents, including radiological, chemical, and biological agents, has traditionally been considered a military issue.1″3 However, several recent events have shown that civilians may also be exposed to these agents. Potential sources of exposure for civilian populations include acts of terrorism, direct military attacks, and industrial accidents. The intentional release of nuclear, biological, and chemical (NBC) so-called weapons of mass destruction (WMD) might lead to thousands of casualties, thereby overwhelming local health and medical resources, particularly military medical facilities.4 Accordingly, setting up medical defense and firstaid systems, especially in military hospitals, should be carried out against a possible NBC attack. Although medical defense elements against each of NBC weapons has some common countermeasures that need to be taken, medical care, triage, treatment, and decontamination are all different from each other.5 There are many shared points among NBC agents in terms of medical care and defense. From this point of view, military hospitals, which may also be one of the main targets of such weapons, must be prepared against NBC disasters with a detailed preparedness plan. The aim of this article was to present the importance of the function of military hospitals against a NBC attack rather than that of civilian medical facilities and to discuss the elementary issues concerning planning, preparedness, and response to a NBC disaster.
Background
The NBC agents carrying the potential for use in a deliberate release are listed in Table I. The impact of the attack depends on a number of factors such as the agent type used, the method of dispersal, and the responsiveness of the health system.6″9 In cases involving the intentional release of chemical-biological agents, and nuclear or radioactivity events, effective management has to include a rapid and coordinated response among states and local and military foundations. From the perspective of disaster planning and preparedness, these should cover the training of medical care providers, the establishment of first-aid and rescue teams, emergency department preparedness, providing a pharmaceutical stockpile containing antibiotics, antidotes, vaccines, and personal protective equipment, setting up medical care and decontamination units, including a shower system, analytical and detection laboratories, linkage with other military health care facilities, and a surveillance system of longterm medical sequelae.10
What is important in the emergency response is to organize and coordinate all of these elements. In the aftermath of a NBC incident, the medical leader has to be an expert communicator to allow for the distribution of information. Based on protocols, this communication should not only be with other military commanders, but also with medical staff, other military personnel, and the public, to provide useful guidance. Cooperation and consultation should be maintained with other medical centers close to the incident site to attract their health care efforts to the task at hand. It must be reminded that the required information be issued to the public through the news media and bulletins. Therefore, effective emergency management in NBC defense would be possible, particularly in military hospitals, if each of the tasks summarized above was performed effectively among the disciplines responsible for functioning against such an attack.
Fundamentals of a Hospital Response against NBC Exposure
It is a fact that most hospitals or medical facilities, even in developed countries, are insufficiently and poorly prepared regarding an effective medical defense to NBC exposure, including decontamination, treatment, and laboratory services.11,12 Thus, in particular, military hospitals should have a plan that includes medical treatment and service units, with specialized staff experienced in the medical care of NBC casualties, other than analytical laboratories and decontamination units. Taking different medical management for intervention in NBC casualties into consideration, different facilities may be required for each group of casualties that show generally different signs and symptoms. Military hospitals have the capability at various levels in terms of medical care, treatment, laboratory support, and mobilized rescue teams. Among them, military medical academies are the places that are better organized and have more capabilities compared with other peripheral hospitals.