Evacuate the Seriously Injured
The U.S. medical system is poorly equipped to treat the mass casualties that might result from a chemical attack. In the age of managed care, most urban hospitals are privately owned entities that are under strong pressure from insurance companies to keep costs down and run at full or excess capacity under normal conditions. As a result, most hospitals have little "surge capacity" to accept an influx of casualties from a terrorist attack. In the event of a major incident of chemical terrorism, the local supply of hospital beds would rapidly be used up.

To avoid chaos and overcrowding, cities should plan for satellite treatment centers in sports arenas, schools, armories, and other public buildings equipped with central heating, hot and cold running water, and telephones. Another challenge is to find enough healthcare personnel to care for the injured. Call-up lists should be prepared in advance so that local healthcare workers can be mobilized rapidly in an emergency.

In the event of a major chemical attack, the federal government would activate the National Disaster Medical System (NDMS). More than 70 disaster medical assistance teams (DMATs) have volunteered to deploy to a range of disasters. These teams would probably take several hours to mobilize, however. The NDMS can transfer overflow patients, by medical airlift if necessary, to veterans' hospitals and some 2,000 participating private hospitals nationwide.

Reassure the Public
During an incident of chemical terrorism, a large number of people will experience symptoms or extreme anxiety and, believing themselves to have been exposed to the toxic agent, will self-report to hospitals and doctors' offices for treatment. During the 1995 Tokyo subway attack, for example, roughly 80 percent of the 5,000 casualties who arrived at hospitals had no chemical injuries but still demanded medical attention. This influx of "worried well" swamped the available medical resources. Thus, after an incident of chemical terrorism, physicians and other healthcare providers will need to distinguish real victims from those suffering from anxiety and psychosomatic symptoms and deliver priority treatment to those needing it most urgently.

In the interest of preventing widespread confusion and panic, local, state, and federal authorities must have a unified public affairs strategy and be prepared to inform the public and the news media immediately and continuously after a chemical incident has occurred. In particular, credible and reassuring officials must be available to explain the cause of the disaster, what the victims should do, how to avoid exposure, how long the crisis will last, and where to find information about missing family members.

For a more detailed description of responses to chemical attacks, see  Responses to CW Terror Incidents  in the multimedia section.

This material is produced independently for NTI by the Center for Nonproliferation Studies at the Monterey Institute of International Studies and does not necessarily reflect the opinions of and has not been independently verified by NTI or its directors, officers, employees, agents.
Copyright © 2004 by MIIS.