Findings and Recommendations From a Series of Workshops on Hospital Emergency Responses to an Improvised Nuclear Device Detonation.

The New York City Department of Health and Mental Hygiene and the Greater New York Hospital Association held 3 workshops and 2 follow-up meetings with hospital emergency managers and colleagues to determine hospitals' response actions to a scenario of a 10-kiloton improvised nuclear device detonation. The scenario incorporated 3 zones of damage (moderate, light, and beyond damage zones) and covered the period of 0 to 72 hours postdetonation divided into 3 24-hour operational periods. The Joint Commission's critical emergency areas were used to determine the objectives and response actions that would be initiated. The response actions were motivated by the resource-constrained clinical situation demanding the rationing of supplies and the application of crisis standards of care. Actions included seeking situational awareness concerning the incident and maintaining a safe and secure working environment. Due to the severance of the medical material supply chain and the levels of destruction, inner damage zone hospitals considered termination of operations and evacuation. Beyond damage zone hospitals prepared to receive patients from the inner damage zone facilities. However, these plans would not be fully successful without a significant amount of logistical aid from outside local or regional partners. Four broad planning areas with outside partners emerged from the follow-up meetings: staffing, resupply, communications/situational awareness, and guidance. Dwindling resources will require a plan for rationing and implementing crisis standards of care and maintaining staff morale. Communications efforts need to include a formalized plan with scheduled broadcast times and identified sources of authority for hospitals to acquire and disseminate information. Information about fallout radiation, instructions for measuring contamination, and guidance for triaging and diagnosing acute radiation sickness are also needed.