Are U.S. Hospitals Prepared for an Attack?

July 3, 2007 — -- Last week's news of the foiled car bombings in London was a reminder that such scenarios are not unique to the Middle East. Sept. 11, of course, saw American hospitals dealing with a terrorist attack. But how prepared are emergency departments for a similar or even smaller attack?

If a terrorist's bomb detonates in New York City, causing an untold number of casualties and sending citizens into a panic, will emergency departments be prepared to respond?

Located in two separate buildings on the West Side of Manhattan, St. Luke's-Roosevelt Hospital expects to deal with victims of a potential terrorist attack in America's largest city.

While doctors there say they have plans in place, whether they can actually deal with an attack depends on the details.

"We can't write an 'if' for every possible scenario," said Eileen Yost, the emergency medicine nurse manager for St. Luke's-Roosevelt.

"I think we're as prepared as we can be," she said.

But then she added, "I think, depending on the situation, anything can happen."

As Prepared as We Can Be?

Doctors at the hospital say they feel the staff has done all they can under the circumstances, but question whether that will be enough.

"It would be a lie to say we're totally prepared and can withstand anything that can happen. I don't think we'll ever be at that level," said Dr. Patricia Carey, medical director of the St. Luke's-Roosevelt emergency department.

But Carey stressed that the hospital has planned for a significant disaster.

"We've always had a disaster plan in place, and since 9/11 we've had a more elaborate disaster plan in place," she said.

Carey said that the hospital had planned for many eventualities but "there are always some peculiarities not planned for."

A car bombing or suicide bomber would be easier to deal with than many other scenarios, she said, because the resulting injuries would be similar to the traumatic injuries that St. Luke's-Roosevelt takes care of on a daily basis.

The hospital has several other measures in place in the event of a disaster. They have a system to evacuate all but the sickest patients from the emergency room to clear it for attack victims.

They have also implemented a phone tree to ensure that medical personnel are available at the hospital, but that they don't arrive all at once. This would ensure that the hospital's staff doesn't exhaust their ability to deal with a prolonged disaster.

St. Luke's-Roosevelt will also provide a location to keep the "worried well" -- bystanders who are not injured but who may panic and seek help following an emergency situation. This is also where staff will accommodate the needs of pregnant women and people with long-term illnesses, who often will come to hospitals in an emergency as a precautionary measure.

In the event of a biological attack, the rules change; the hospital will require that anyone coming in pass through a decontamination room to avoid having an agent spread in the hospital.

Overseas Hospitals Provide Model for U.S.

Dr. Stephan Lynn, director of emergency medical services at St. Luke's-Roosevelt, thinks his and other American hospitals could improve their emergency preparedness significantly.

"Although they are ready, there's a lot more they could be doing," he said.

One scenario St. Luke's-Roosevelt personnel said they may not be prepared for is a multiple bomb attack, where a second bomb detonates, injuring medical personnel on the scene. They also worry about the possibility the hospital itself will be attacked following a bombing.

Lynn points to Hadassah Hospital in Jerusalem, which he recently visited, as the model to which American emergency departments should aspire.

"When I see ones like that, I know where we should be," he said.

Lynn cites the use of certain safeguards within the hospital as reasons for the hospital's superior preparedness, including protection for windows and means of locking off certain wings of the hospital.

Hospitals in Israel have additional security measures. All ambulances entering the hospital must be checked twice before going in -- a precaution followed in light of the theft of several ambulances that some fear would be used in a terror attack.

Todd Zalut heads the emergency department at Shaare Zedek Hospital in Jerusalem. He attended medical school at the University of Illinois and did his residency at various Chicago hospitals before moving to Israel in 1990, just a few years before the first suicide bombers struck there.

Zalut is skeptical of the preparedness of American hospitals for a terrorist attack.

One of the primary issues he pointed to was that of training. American hospitals are required to have a few disaster drills each year. Most of these involve 20-25 students who act as casualties to test the hospital's emergency readiness.

Zalut explained that, unlike the small U.S. drills, those at Shaare Zedek involve 350-500 soldiers acting as patients to simulate a major attack.

"For better or worse, we have to be ready for it because it is more likely to occur in Israel than it is anywhere else in the world," he said.

Preparedness, Zalut explained, involves not only having safeguards in place, but having the public understand the need for them.

"It's a matter of education and it's a matter of communication," he said. "If you would have said to yourself 10 years ago you'd need to take off your shoes [before boarding an airplane], you would have said it was preposterous."

Zalut pointed to several security measures taken in Israel that do not exist in the United States, including bag checks before entering crowded places like shopping malls and sporting events.

"I hope I'm wrong, but it's only a matter of time [before an attack occurs in the U.S.]," said Zalut. "Once it starts happening in America, they're going to be forced into making those changes."

While she remains confident that her emergency department is prepared for an attack on U.S. soil, St. Luke's-Roosevelt's Yost remains concerned that something completely unexpected could still overwhelm them.

"We've done the best that we can in terms of trying to prepare for almost anything," Yost said. "[But] there's going to come a time where something we didn't anticipate could happen."