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Hospital Planning For Terrorist Disasters: A Community-Wide Program

EB Medicine, Dec 2009


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Terrorist attacks may be less likely to occur than other types of disasters, but they can have far greater impacts on hospital operations. Historically, hospital emergency preparedness programs have not included provisions for terrorism events. September 11, 2001 was the catalyst that convinced many emergency management officials of the need for such plans.

The US Centers for Disease Control and Prevention (CDC) began focusing intensely on emergency operations systems for public health facilities after the anthrax bioterrorism attacks in late September 2001. Despite the limited number of direct victims (22 people) in that attack, the public health effects were widespread, with large numbers of people receiving antibiotic prophylaxis. Psychological effects were also felt across the nation.1,2 The fact that anthrax had been dispersed as a biological weapon through the US mail system also heightened the need for preparedness.

In order to develop a robust and effective emergency preparedness plan, hospital leaders should build on previous experiences with disaster management, especially with respect to human behavior, as well as on published research. This article is intended to complement resources such as the US Department of Health and Human Services’ Public Health Emergency Response Guide and assist hospital planners in preparing for terrorism events and other disasters.3

The goal of terrorism is to induce fear in order to disrupt society or create a change in behavior. However, unless terrorists announce an attack or use a weapon with an immediate effect (eg, high explosives or chemical weapons), it may be unclear in the initial assessment that an act of terrorism has occurred. Once this fact has been established, management of a terrorist event is similar to that for other disasters. All potential scenarios and hazards (eg, explosions, chemical events, biological events, and shootings) should be considered. In addition, the medical and health response to terrorism will always be accompanied by a law enforcement response. Evidence collection in the ED as well as in out-of-hospital crime scenes will be a priority for law enforcement officials, including those with the Federal Bureau of Investigation (FBI), and must be accommodated.

Integration and coordination with the community is also vital to avoid operating in isolation, to minimize the negative effects on society, and to ensure a robust plan that addresses the 4 phases of emergency management: mitigation, preparedness, response, and recovery.4,5

In “Hospital Planning For Terrorist Disasters: A Community-Wide Approach,” expert authors discuss information to assist emergency physicians and hospital leaders in preparing for terrorism events and other disasters. Integration and coordination with the community as well as the 4 phases of emergency management (mitigation, preparedness, response, and recovery) is also discussed.



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