For WMD victims, treatment is related to symptoms that are influenced by exposure, distance, and shielding. The healthcare provider must understand the intentional act and its risk to both the victim and the responder and be prepared to confront multiple victims. The healthcare provider must also be ready to care for victims with detached limbs, burns, significant blood loss, and shock, and be aware of possible internal injuries to solid organs that can spill their contents, resulting in peritonitis, and to hollow organs, causing life-threatening hemorrhage leading to shock. Table 4 presents a list of the types of hollow and solid organs. Table 4: Types of Organs Affected in a WMD Explosion Hollow Organs Solid Organs • Appendix • Bladder • Common bile duct • Fallopian tubes • Gallbladder • Kidneys • Liver • Ovaries • Pancreas • Spleen
Self-Assessment Quiz Question #7 Dirty bombs are also known as: a. Radiological dispersal devices. b. Minor nuclear bombs. c. Explosive devices. d. Secondary explosives.
Self-Assessment Quiz Question #8 A victim of a dirty bomb walks into the local community hospital emergency department. He has not been decontaminated. Which of the following actions should the healthcare provider take? a. Close the emergency department to prevent further contamination of the area. b. Place the victim in an X-ray room set up for emergency patients. c. Cover the victim with a blanket and move him to a private exam area. d. Tell the victim to leave the emergency department immediately and call 911 for help.
• Intestines • Stomach
• Uterus • Ureters
SYNDROMIC SURVEILLANCE AND REPORTING REQUIREMENTS
and generates reports needed to handle larger-scale or more complex events (National Syndromic Surveillance Program BioSense Platform, 2017). The National Retail Data Monitor (NRDM) for public health surveillance tool collects and analyzes daily sales data for over- the-counter healthcare products nationwide and supports the early detection of bioterrorism and naturally occurring disease outbreaks through the anonymous sales reporting of over-the- counter healthcare products by a growing number of retail merchants, such as pharmacies and grocery stores (Real-time Outbreak and Disease Surveillance Laboratory [RODS], 2018). For healthcare providers, because many bioterrorism agents may initially present with nonspecific symptoms, syndromic surveillance provides information involving a cluster of cases versus individual cases, and computerized data signaling an epidemiologic outbreak. Electronic health data and information technologies provide earlier detection of biological events and further collaboration among surveillance organizations addressing the identification of infectious diseases (CDC, 2018f; Fant et al., 2020). Evidence-Based Practice: Understanding the type of explosive device used in a WMD terrorist attack will ensure the healthcare provider is prepared to care for the types of trauma that victims may present. Considerations such as hollow versus solid organ trauma are crucial to the proper care and survival of the victim.
Syndromic surveillance is used to detect outbreaks, monitor disease trends, and provide analysis and feedback, enabling multiple public health agencies to monitor the real-time status of an event and assess the health of a population to select the appropriate public health response. Syndromic surveillance provides for situational awareness, response management, and outbreak recognition to promote and protect an individual’s health during events such as natural disasters (e.g., floods), manmade disasters (e.g., shootings or terrorist attacks), or disease outbreaks (e.g., influenza). For the healthcare provider, syndromic surveillance assists in obtaining information collaboratively from multiple agencies to allocate appropriate resources and provide interventions in support of population health and safety. The National Syndromic Surveillance Program (CDC, 2021b; NSSP, n.d.) promotes and advances the development of a syndromic surveillance system. This provides for the timely exchange of syndromic data used to improve nationwide situational awareness and enhance responsiveness to hazardous events and disease outbreaks to protect America’s health, safety, and security. The NSSP features the cloud-based BioSense Platform, a product of the CDC, launched in 2003 to support national emergency preparedness for early detection and rapid assessment of bioterrorism-related events, as well as the Syndromic Surveillance Community of Practice Portal (n.d.), in which participants collaborate to advance the science and practice of syndromic surveillance. The tools within the BioSense Platform support the Centers for Medicare and Medicaid Services Meaningful Use program, which is intended to expand the use of electronic health records. The NSSP BioSense Platform hosts the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), which provides analytics, data documentation, syndrome classifications,
PERSONAL PROTECTIVE EQUIPMENT
radiological, or other forms of transmission of biological, chemical, or radiological contamination and exposure (USHHS, 2021c). Types of PPE include masks of various designs, gloves, gowns, and foot coverings, as well as dosimeters, hard hats, and oxygen tanks. Each type has a specific function and use with a class of contaminants.
Personal protective equipment (PPE) is specialized equipment used by first responders in an emergency, disaster, or terrorist attack. Anyone who is working at the actual site, in triage, and, in some instances, at a receiving hospital, may be required to use PPE depending on the nature of the response. The PPE can protect the healthcare responder from airborne, dermal,
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