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5/17/2003

Seattle Health Care Workers Participate in Disaster Drill

Donna Young

Cindi Brennan, assistant director of ambulatory care pharmacy for Harborview Medical Center in Seattle, got an unusual phone call on May 12 from a pharmacist at nearby Children’s Hospital and Regional Medical Center inquiring if her pharmacy had any Prussian blue, a mineral compound known as ferric hexacyanoferrate.

Prussian blue, according to the Food and Drug Administration (FDA), has been shown to be safe and effective in treating people exposed to radioactive elements such as cesium-137, a product found in the fallout from the detonation of nuclear weapons and in the waste from nuclear power plants.

FDA in January called for manufacturers to submit new drug applications for Prussian blue as a treatment for thallium or radioactive cesium contamination.

Prussian blue is the first therapy that would be available to immediately help reduce the body’s burden of exposure to radioactive particles, FDA stated.

The phone call to Brennan from the pharmacist at Children’s Hospital was in response to a simulated disaster that involved the explosion of a radiological dispersal device, commonly known as a dirty bomb.

The staged incident was part of TopOff 2, the largest counterterrorism drill since the September 11, 2001, terrorist attacks on New York and the Pentagon, according to a statement from the Department of Homeland Security.

Harborview, a 380-bed level-1 trauma center, was the coordinating hospital in Seattle and King County for the national drill, which also included a simulated release of a biological agent in Chicago from the fictitious terrorist organization identified as GLODO.

At about 11:45 a.m. (PST) on May 12, Brennan said, she heard a loud explosion, and about 30 minutes later her hospital initiated a Delta-60 alert, meaning there had been a disaster in the area and the hospital should expect to receive some 60 patients.

Soon thereafter, the local emergency management and fire departments notified the hospital that the disaster involved patients who might have been exposed to radioactive material, she said.

Harborview pharmacists had to refocus their workload, Brennan noted, and quickly complete their scheduled discharge medication counseling for patients to make room for an unknown number of emergency patients.

The pharmacy had to evaluate its inventory to ensure it had potassium iodide and other essential drug products in stock to treat victims of a nuclear weapon attack, she added.

Harborview pharmacists are also responsible for monitoring the city’s local stockpile of drug products, which is stored across the street from the hospital at the local emergency management agency’s headquarters, noted Brennan.

About an hour into the drill, she said, the hospital began receiving patients, who had volunteered to participate in the exercise and were wearing stage makeup to simulate burns, broken bones, and other wounds.

According to the Homeland Security Department, dirty bombs are used to spread radioactive contamination and any immediate deaths or serious injuries would result from the explosion itself and not from radiation exposure.

A dirty bomb, however, could cause fear, panic, and disruption, and result in other types of illness or injury.

Brennan said some of the volunteer victims were imitating symptoms of a heart attack.

To decontaminate volunteer victims who were close to the simulated exploding bomb, she said, Harborview health care workers used a special portable decontamination tent that hospital workers quickly set up outside the hospital.Seattle Drill

Patients were placed on backboards and rolled under gentle water sprayers to remove radioactive contamination, Brennan said.

The hospital purchased the tent for about $60,000 with funds provided by the federal government, she said, adding that an additional $10,000 was spent by Harborview for special protective biohazard suits and gear for health care workers.

Seattle received $2.5 million from the federal government to cover costs and purchase equipment and supplies needed to participate in the drill.

The government spent a total of $16 million for the exercise, according to the Homeland Security Department.

The major test for Harborview health care workers during TopOff 2, Brennan said, was the use of the decontamination tents; communications with local, state, and federal agencies; and coordination of care for emergency patients between hospitals in a disaster situation.

In preparing for the drill, Brennan said, Harborview relied on emergency preparedness lessons it gleaned from the February 28, 2001, earthquake that shook Seattle and the Northwest and was of magnitude 6.8.

Even though the hospital received very few patients who were injured from the earthquake’s effects, Brennan said, that event aided the hospital in identifying its vulnerabilities.

The hospital provided care to 25 volunteer patients during TopOff2, she added.