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Medical Surge Capacity in Atlanta-Area Hospitals in Response to Tanker Truck Chemical Releases

  • Curtis Harris (a1), William Bell (a1), Edward Rollor (a1), Tawny Waltz (a1), Pam Blackwell (a1) and Cham Dallas (a1)...



We designed and conducted a regional full-scale exercise in 2007 to test the ability of Atlanta-area hospitals and community partners to respond to a terrorist attack involving the coordinated release of 2 dangerous chemicals (toluene diisocyanate and parathion) that were being transported through the area by tanker truck.


The exercise was designed to facilitate the activation of hospital emergency response plans and to test applicable triage, decontamination, and communications protocols. Plume modeling was conducted by using the Defense Threat Reduction Agency’s (DTRA) Hazard Prediction and Assessment Capability (HPAC) V4 program. The scenario went through multiple iterations as exercise planners sought to reduce total injuries to a manageable, but stressful, level for Atlanta’s health care infrastructure.


Atlanta-area hospitals rapidly performed multiple casualty triage and were able to take in a surge of victims from the simulated attack. However, health care facilities were reticent to push the perceived manageable numbers of victims, and scenarios were modified significantly to lower the magnitude of the simulated attack. Additional coordination with community response partners and incident command training is recommended. Security at health care facilities and decontamination of arriving victims are two areas that will require continued review.


Atlanta-area hospitals participated in an innovative regional exercise that pushed facilities beyond traditional scopes of practice and brought together numerous health care community response partners. Using lessons learned from this exercise coupled with subsequent real-world events and training exercises, participants have significantly enhanced preparedness levels and increased the metropolitan region’s medical surge capacity in the case of a multiple casualty disaster. (Disaster Med Public Health Preparedness. 2015;9:681–689)


Corresponding author

Correspondence and reprint requests to Curtis Harris, PhD, University of Georgia, College of Public Health, Health Policy and Management, Institute for Disaster Management, Athens, GA (e-mail:


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1. Vale, A. What lessons can we learn from the Japanese sarin attacks? Przegl Lek. 2005;62:528-532.
2. Public health consequences from hazardous substances acutely released during rail transit--south Carolina, 2005; selected states, 1999-2004. MMWR Morb Mortal Wkly Rep. 2005;54:64-67.
3. Disasters: Chemical accidents and spills. Pollution Issues website. Accessed July 14, 2011.
4. Mishra, PK, Samarth, RM, Pathak, N, et al. Bhopal gas tragedy: review of clinical and experimental findings after 25 years. Int J Occup Med Environ Health. 2009;22(3):193-202.
5. Bucher, JR. Methyl isocyanate: a review of health effects research since Bhopal. Fundam Appl Toxicol. 1987;9(3):367-379.
6. Mehta, PS, Mehta, AS, Mehta, SJ, et al. Bhopal tragedy’s health effects. A review of methyl isocyanate toxicity. JAMA. 1990;264(21):2781-2787.
7. Jasanoff, S. The Bhopal disaster and the right to know. Soc Sci Med. 1988;27(10):1113-1123.
8. Lepkowski, W. Bhopal, Indian city begins to heal but conflict remains. Chem Eng News. 1985;63(48):18-32.
9. Broughton, E. The Bhopal disaster and its aftermath. Rev Environ Health. 2005;4(1):6.
10. Chander, J. Water contamination: a legacy of the union carbide disaster in Bhopal, India. Int J Occup Environ Health. 2001;7(1):72-73.
11. Shrivastava, P. Bhopal: Anatomy of a Crisis. Cambridge, MA: Ballinger Publishing; 1987:184.
12. About HSE. Health and Safety Executive website. Accessed October 6, 2015.
13. Belke, JC, Dietrich, DY. The post-Bhopal and post-9/11 transformations in chemical emergency prevention and response policy in the United States. J Loss Prev Process Ind. 2005;18(4-6):375-379.
14. LaForte, JM. The vulnerability of transporting hazardous chemicals specific to the semiconductor industry.
15. Bjerklie, DG. Diagnosing the risks. Time.,9171,1000931,00.html. Published October 8, 2001. Accessed July 14, 2011.
16. United States Congress. O.o.T.A. Transportation of hazardous materials, OTA-set 304. Congress of the US. Washington, DC: Office of Technology Assessment; 1986.
17. Fleet Owner. DOT and railroads take aim at D.C. HazMat ban.
18. Hazmat rail ban could have ripple effect. DC Velocity. Published July 1, 2006. Accessed June 9, 2010.
19. Office of the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs/Nuclear Matters. Specialized radiological monitoring and hazard assessment capabilities. 2.a DTRA HPAC. Accessed October 6, 2015.
20. Oak Ridge National Laboratories. LandScan Global Population Database. Oak Ridge, TN: Oak Ridge National Laboratories.
21. Basic questions regarding acute exposure guideline levels. OSHA website. Accessed July 13, 2011.
22. Bonnett, CJ, Peery, BN, Cantrill, SV, et al. Surge capacity: a proposed conceptual framework. Am J Emerg Med. 2007;25(3):297-306.
23. Burkle, FM Jr. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions. Emerg Med Clin North Am. 2002;20(2):409-436.
24. Smith, GP II. Triage: endgame realities. J Contemp Health Law Policy. 1985;1:143-151.
25. Kosashvili, Y, Daniel, LA, Peleg, K, et al. Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted? Injury. 2009;40(7):727-731.
26. DeLia, D, Wood, E. The dwindling supply of empty beds: implications for hospital surge capacity. Health Aff (Millwood). 2008;27(6):1688-1694.
27. Hick, JL, Hanfling, D, Burstein, JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44(3):253-261.
28. Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, part 1: Community emergency response. Acad Emerg Med. 1998;5:613-617.
29. Bell, WC, Dallas, CE. Vulnerability of populations and the urban health care systems to nuclear weapon attack--examples from four American cities. Int J Health Geogr. 2007;6(1):5.
30. Dallas, CE, Bell, WC. Prediction modeling to determine the adequacy of medical response to urban nuclear attack. Disaster Med Public Health Prep. 2007;1(02):80-89.
31. Peleg, K, Kellermann, AL. Enhancing hospital surge capacity for mass casualty events. JAMA. 2009;302(5):565-567.
32. Kaji, AH, Koenig, KL, Lewis, RJ. Current hospital disaster preparedness. JAMA. 2007;298(18):2188-2190.
33. Hick, JL, Barbera, JA, Kelen, GD. Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3(S1):S59-S67.
34. Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, part 2: Hospital response. Acad Emerg Med. 1998;5:618-624.
35. US Department of Labor. OSHA best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substances. OSHA website. Published January 2005. Accessed October 6, 2015.
36. Horton, DK, Berkowitz, Z, Kaye, WE. Secondary contamination of ED personnel from hazardous materials events, 1995-2001. Am J Emerg Med. 2003;21(3):199-204.
37. Quarantelli, EL. The future is not the past repeated: projecting disasters in the 21st century from current trends. J Contingencies Crisis Manage. 1996;4(4):228-240.
38. Assistant Secretary for Preparedness and Response. Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response; 2012:1-72.
39. Thompson, J, Rehn, M, Lossius, HM, et al. Risks to emergency medical responders at terrorist incidents: A narrative review of the medical literature. Crit Care. 2014;18(5):521.
40. Horton, DK, Orr, M, Tsongas, T, et al. Secondary contamination of medical personnel, equipment, and facilities resulting from hazardous materials events, 2003-2006. Disaster Med Public Health Prep. 2008;2(02):104-113.
41. Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: A conceptual framework. Acad Emerg Med. 2006;13:1157-1159.
42. Schultz, CH, Koenig, KL. State of research in high-consequence hospital surge capacity. Acad Emerg Med. 2006;13:1153-1156.


Medical Surge Capacity in Atlanta-Area Hospitals in Response to Tanker Truck Chemical Releases

  • Curtis Harris (a1), William Bell (a1), Edward Rollor (a1), Tawny Waltz (a1), Pam Blackwell (a1) and Cham Dallas (a1)...


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