Disaster planning still lacking

North Carolina and the U.S. as a whole still have a long way to go before they can claim to be prepared for a disaster in the post-9/11 world, concludes a study by University of North Carolina at Chapel Hill researchers. The study examined the response system to a devastating explosion at the West Pharmaceutical Services Inc. manufacturing plant in Kinston, N.C., in January, 2003.

The Chemical Safety Board concluded that it was an explosion of fine plastic powder used in the manufacturing of rubber products--and it presented many of the same problems that emergency responders would face in the aftermath of a terrorist bombing. In particular, there were the challenges in terms of quickly assessing the medical care needs of patients with burn and trauma injuries such as broken bones, removing patients from the disaster scene, transporting them to an appropriate medical facility, and providing optimal care to multiple severely injured patients at once.

Soon after the explosion, the response was plagued by communication difficulties and confusion. For example, cell phone networks used by emergency workers became overloaded. Emergency radio operations varied from county to county, so 800-megahertz radios were dispersed to key individuals. "Overall, the communication among the scene, transport systems, and UNC Hospitals has to be characterized as poor," the researchers charge.

Questions also were raised about the actions of the authors themselves and their institution. For instance, the researchers point out that keeping all 10 of the critically injured patients meant that the 21-bed burn center had four more intensive care patients at one time than it was designed to handle. This placed enormous stress on the burn center, igniting doubts about whether some of the patients should have been transferred to another unit.

UNC Hospitals ultimately placed some patients in other units and raised the number of caregivers per shift from eight to 14. However, this resulted in significant costs in overtime pay and added stress on burn center workers. "... The institution's response to the increased workload was ... unsustainable over a long period of time.... A lack of education, communication, and coordination continue to hamper our ability to efficiently and optimally respond to mass casualty events."

Moreover, the study cited the report on Sept. 11 written by the National Commission on Terrorist Attacks to demonstrate that "there is still no comprehensive state, regional, or national disaster plan that incorporates the care of patients with both burns and other serious injuries."

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