Front Cover -- Title Page -- Copyright Page -- Table of Contents -- Contributor list -- Preface -- Acknowledgments -- 1. Recurring Pitfalls in Hospital Preparedness and Response -- 1.1 Introduction -- 1.2 Hospital Challenges and Constraints -- 1.3 Hospital Requirements -- 1.4 Observations -- 1.5 Communications -- 1.6 Security -- 1.7 Decontamination -- 1.8 Staff Training -- 1.9 Staff Protection -- 1.10 Exercise Design and Conduct -- 1.11 Suggestions -- 1.12 Communications -- 1.13 Security -- 1.14 Decontamination -- 1.15 Staff Training -- 1.16 Staff Protection -- 1.17 Exercises -- 1.18 Critical Steps -- References -- 2. The History and Threat of Biological Weapons and Bioterrorism -- 2.1 Introduction -- 2.2 Biological Weapons in the Ancient World -- 2.3 Battlefield Use of Infectious Diseases, or "Giving The Gift That Keeps On Giving" -- 2.4 Biological Contamination of Water Supplies -- 2.5 Biological Contamination of Food -- 2.6 Toxin Weapons -- 2.7 World War I-German Saboteurs -- 2.8 World War I-US Research -- 2.9 World War II-Japan -- 2.10 World War II-Germany -- 2.11 World War II-United States -- 2.12 Post-WWII to Modern Era -- 2.13 Soviet Biological Weapons Program -- 2.14 US Biological Weapons Program -- 2.15 Aum Shinrikyo -- 2.16 Rajneeshees -- 2.17 St. Paul Medical Center, Dallas -- 2.18 Other Recent Bioterrorism Incidents -- 2.19 Biological Weapons and Countries Thought to Possess Them -- References -- 3. Hospital Syndromic Surveillance -- 3.1 Hospital Inpatient Data -- 3.2 Hospital Emergency Department Data -- 3.3 Other Data Streams -- 3.4 Confirmatory Clinical Data -- 3.5 Pre-Diagnostic Clinical Data -- 3.6 Non-Traditional Health Indicator Data -- 3.7 Selection of Data Elements -- 3.8 Data Acquisition and Presentation -- 3.9 Data Analysis: Algorithms for Aberration Detection -- 3.10 Control Chart Usage.

3.11 Issues in Aberration Detection -- 3.12 Upcoming Challenges in Hospital-Based Aberration Detection -- 3.13 Summary -- References -- 4. Biological Agents, Effects, Treatment, and Differential Diagnosis -- 4.1 Disease: Anthrax -- 4.2 Disease: Botulism Intoxication -- 4.3 Disease: Plague -- 4.4 Disease: Smallpox -- 4.5 Disease: Tularemia -- 4.6 Disease: Viral Hemorrhagic Fever -- 4.7 Disease: Brucellosis -- 4.8 Disease: Glanders -- 4.9 Disease: Q Fever -- 4.10 Disease: Ricin Intoxication -- 4.11 Disease: Staphylococcal Enterotoxin B Intoxication -- 4.12 Disease: Trichothecene Mycotoxin (T2) Intoxication -- References -- 5. Medical Considerations for Radiological Terrorism -- Disclaimer -- 5.1 Introduction -- 5.2 Physics -- 5.3 Decontamination, Diagnosis, and Management -- References -- Radiological Casualty Related Websites -- Appendix: Terrorism with Ionizing Radiation General Guidance Pocket Guide -- 6. Nerve and Chemical Agents -- Disclaimer -- 6.1 Introduction -- 6.2 Nerve Agents -- 6.3 Cyanide -- 6.4 Vesicants -- References -- Suggested Comprehensive Resources -- 7. Decontamination and Personal Protection -- 7.1 Removal of Clothing -- 7.2 Skin Contamination -- 7.3 Training -- 7.4 Surgical Wound Decontamination -- 7.5 Site Security -- 7.6 Site Layout -- 7.7 Patient Identification -- 7.8 Certification of Decontamination -- 7.9 Personal Protection Equipment -- 7.10 Skin Protection -- 7.11 Conclusion -- Appendix 7.1 -- Example 1. Vital Signs and PPE Checklist -- Example 2. Vital Signs Monitoring Checklist -- Appendix 7.2 Example of Patient Decontamination Procedure -- Appendix 7.3 PPE Donning and Doffing Sequence -- Appendix 7.4 Example of Technical Decontamination Process for Hospital Personnel -- Appendix 7.5 Example of Integrated Procedures for First Receivers -- References -- 8. EMS Preparation for Terrorist Events -- 8.1 Introduction.

8.2 Preparation -- 8.3 Urban vs. Rural Preparation -- 8.4 Personnel and Training -- 8.5 Treatment Protocols -- 8.6 Patient Decontamination -- 8.7 Planning -- 8.8 Patient Transportation -- 8.9 Return to Service -- Department of EMS Education, Hartford Hospital - Terrorism Protocols -- References -- 9. Emergency Department Preparation -- 9.1 Introduction -- 9.2 Preparation -- 9.3 Planning -- 9.4 Patient Flow -- 9.5 Security -- 9.6 Notification of an Incident and Preparation to Receive Patients -- 9.7 Additional Preparation -- 9.8 Decontamination -- 9.9 Staff Needs -- 9.10 Post Incident Return to Normal Operations -- References -- 10. Pediatrics: Special Considerations for Children -- 10.1 Introduction -- 10.2 Children: Special Vulnerabilities -- 10.3 Children and Agent-specific Vulnerabilities -- 10.4 Mental Health Considerations in Pediatric Victims of Terrorism -- References -- 11. The Role of Psychiatry and Social Services in the Hospital Response to Bioterrorism -- 11.1 Introduction The Psychological Dimension of "Terror" in Bioterrorism -- 11.2 Management of Acute Traumatic Stress and Grief Reactions in Patients and Staff -- 11.3 Longterm Psychiatric Services in the Wake of Bioterrorism: After the Heroic/Honeymoon Phases -- 11.4 Conclusion -- Acknowledgments -- References -- Appendix 11.1 For the Healthcare Professional: When Disaster Strikes -- Appendix 11.2 Coping Effectively with Extreme Stress: Focusing -- 12. Bioterrorism and Obstetrics The Exposed Pregnant Patient -- 12.1 Introduction -- 12.2 Obstetrics Staff Training -- 12.3 Management of the Exposed Pregnant Woman -- 13. Operating Room Preparation for Mass Casualties -- 13.1 Introduction -- 13.2 Individual Preparation -- 13.3 Departmental Plan -- 13.4 Expansion of Capacity -- 13.5 Patient Flow and Infectious Considerations -- 13.6 Training Drills -- 13.7 Communications.

13.8 Security/Crowd Control -- 13.9 Conclusion -- References -- 14. Bioterrorism and Implications for Nurses and Nursing -- 14.1 Vulnerable Groups -- 14.2 Triage -- 14.3 Hospital Expansion -- 14.4 Summary -- References -- 15. The Role of Pharmacy in Emergency Preparedness -- 15.1 Strategic National Stockpile -- 15.2 Staffing Concerns in a Crisis -- 15.3 Training and Participation of the Pharmacy Staff in Community Preparedness Efforts -- 15.4 Conclusion -- References -- 16. The Clinical Engineering Department Role in Emergency Preparedness -- 16.1 Lessons Learned -- 16.2 Priorities -- 16.3 Incident Command System -- 16.4 Communications -- 16.5 Departmental Staff Care -- 16.6 Individual Preparedness -- 16.7 Departmental Preparedness -- 16.8 Vendor Preparedness -- 16.9 Business Resumption Planning -- 16.10 Departmental Response -- 16.11 Putting it all Together -- Appendix: Disaster Action Sheet Normal Work Hours Hospital Clinical Engineering -- References -- 17. Amateur Radio Support for Hospitals -- Executive Summary -- 17.1 What is Amateur Radio? -- 17.2 What Motivates "hams" to Volunteer their Time, Skills, and Equipment? -- 17.3 External Hospital Communications -- 17.4 Redundant Systems and Pathways -- 17.5 Where can a Hospital or Healthcare System Find Amateur Radio Resources? -- 17.6 Hospital Disaster Plan -- 17.7 Summary and Conclusions -- References -- Additional Resources -- 18. Hospital Power: Critical Care -- 18.1 Code Required Systems -- 18.2 Recommended Systems -- 18.3 HVAC System Impact on Generator Size -- 18.4 What can Happen during the Loss of Normal Power -- 18.5 Alternate Cooling Strategies -- 18.6 Emergency Generator Coordination -- 18.7 Commissioning -- 18.8 Conclusion -- 19. Electromagnetic Interference -- 19.1 Overview of EMI -- 19.2 Intentional EMI -- 19.3 Mitigation -- 19.4 Summary -- References.

20. Chapter for Simulation for Bioterrorism -- 20.1 Introduction to Simulation -- 20.2 History of Simulation -- 20.3 Adaptation of Simulation to Medicine -- 20.4 Basic Elements of Simulation Education -- 20.5 Post-Simulation Period: Debriefing and Reflection -- 20.6 Crew Resource Management -- 20.7 Moulage vs. Mannequin Training -- 20.8 Medical Professionals: Little Things Mean a Lot -- 20.9 Simulation Drills for Bioterrorism -- 20.10 Conclusion -- References -- 21. Simulation II: Preparing for Biodisasters -- Disclaimer -- Objectives for the Reader -- Key Words -- 21.1 Audience -- 21.2 Premise -- 21.3 Unique Contribution of Simulation -- 21.4 Scenario Resources -- 21.5 Scenario Creation -- 21.6 Scenario Examples -- 21.7 Example 1: Clinical Students -- 21.8 Example 2: Non-clinical Students -- 21.9 Example 3: Clinical and Non-clinical Students -- 21.10 Summary -- Reference -- Resources -- 22. Hospital Large-Scale Drills -- 22.1 Introduction -- 22.2 Hospital Drill Planning -- 22.3 Decontamination -- 22.4 Drills -- 22.5 Conclusion -- References -- 23. Response to SARS as a prototype for bioterrorism: Lessons in a Regional Hospital in Hong Kong -- 23.1 Introduction -- 23.2 Recognition of an Impending Outbreak in Hong Kong -- 23.3 Recognition of the Outbreak in PYNEH -- 23.4 Response at the Emergency Room Level -- 23.5 Response at Ward and Department Levels -- 23.6 Response at Hospital Management Level -- 23.7 Further Response at Hospital Authority Head Office (HAHO) Level With Direct Impact on the Department -- 23.8 Outbreak Resolution -- 23.9 Aftermath -- 23.10 Conclusion -- References -- Appendix A: Emergency Preparedness, Response & Recovery Checklist Beyond the Emergency Management Plan -- I. Introduction -- II. Incident Command (Orange) -- III. Operations (Red) -- IV. Planning (Blue) -- V. Logistics (Yellow) -- VI. Finance (Green).

VII. Recovery: Ending Emergency Operations.