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D D o o m m e e s s t t i i c c P P r r e e p p a a r r e e d d n n e e s s s s
Page 1
An Alternative Health Care Facility:
CONCEPT OF OPERATIONS FOR THE OFF-SITE TRIAGE,
TREATMENT, AND TRANSPORTATION CENTER (OST
3
C)
Mass Casualty Care Strategy for a Chemical Terrorism Incident
Prepared by:
Health & Safety Functional Working Group
CHEMICAL WEAPONS
IMPROVED RESPONSE PROGRAM
March 2001
Cleared for public release, distribution is unlimited.
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U.S. ARMY SOLDIER AND BIOLOGICAL CHEMICAL COMMAND
Aberdeen Proving Ground, Maryland 21010
SBCCOM
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Alternative Health Care Facility
- ii -
Disclaimer
The findings in this report are not to be construed as an official Department of the Army
position unless so designated by other authorizing documents.
The use of trade names or manufacturers' names in this report does not constitute an
official endorsement of any commercial product. This report may not be cited for
purposes of advertisement.
Disclaimer:
The opinions or recommendations expressed in this document are a consensus of the
Chemical Weapons Improved Response Program (CWIRP) Health and Safety
Functional Group and do not necessarily reflect the official position of the U.S.
Department of Defense.
Page 3
Executive Summary
- iii -
The United States Domestic Preparedness Program, instituted by the FY97
Defense Authorization Bill (PL 104-301, September 23, 1996) was established to
increase America's domestic response capabilities to a nuclear, biological, or chemical
(NBC) attack. In an effort to successfully identify issues related to weapons of mass
destruction (WMD), the Department of Defense (DoD) delegated responsibility for
executing this legislation to the U.S. Army Soldier and Biological Chemical Command
(SBCCOM). In combination with the DoD's expertise in WMD, SBCCOM created the
Chemical Weapons Improved Response Program (CWIRP) that would network with
civilian responders to identify key response issues.
One of the most prevalent issues identified by the CWIRP, was a community's
inability to care for an overwhelming number of chemically contaminated patients. Even
when emergency responders successfully decontaminate and triage large numbers of
patients at the scene, it is unlikely that area hospitals are prepared to receive these
patients and treat them within the boundaries of the existing health care system.
Jurisdictions need a plan to carryout victim triage, decontamination, treatment,
transportation, and hospitalization in a time critical manner that improves patient
outcome. Thus, planners must avoid intentionally overwhelming the health care system
and may need to redistribute existing resources to positively influence patient outcome.
In response to this issue, the CWIRP developed an alternative health care facility,
herein referred to as the Off-site Triage, Treatment, and Transportation Center (OST
3
C or
Center). This facility will supplement a community's existing health care system in
managing the overwhelming number of casualties, both actual and psychosomatic,
following a terrorist incident. Specifically the OST
3
C is meant to care for those patients
who have been triaged "Minimal" at the scene, those patients who are worried that they
might have been exposed, and those who self-refer to the Center.
The
Concept of Operations for the Off-Site Triage, Treatment, and Transportation
Center
was written to assist planners, administrators, responders, medical professionals,
public health, and emergency management personnel better prepare for and provide mass
casualty care. This document presents the philosophy of care for the OST
3
C as well as
operational planning considerations. The OST
3
C Concept of Operations is meant to be
flexible and modular. The intention of this document is to provide jurisdictions with a
basic understanding of the OST
3
C so that they can customize the concept to fit their
specific needs and incorporate their version of the Center into the larger response effort.
Emergency planners must undergo a certain amount of preplanning to execute the OST
3
C
concept, practice that plan with supporting agencies, and evaluate and refine the plan
before implementing it in an actual disaster. Some jurisdictions may not enact the
OST
3
C concept but will recognize the need to provide for and plan for some or all of the
critical aspects identified within this document.
The intention of this document is to provide jurisdictions with a basic
understanding of the OST
3
C so that they can customize the concept to fit their
specific needs and incorporate their version of the Center into the larger response
effort.
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The authors gratefully acknowledge the following agencies that have generously
given their time and expertise to the development of
The Off-Site Triage, Treatment, and
Transportation Center Concept of Operation
. In particular, SBCCOM would like to
thank Ms. Irene Lumpkins, Director of Field Health Services, Baltimore City Health
Department, for her contribution and support in developing this concept and for her
chairing the Health and Safety Functional Group.
Participating Agencies:
American Red Cross, Baltimore Chapter, Baltimore, MD
Baltimore City Department of Emergency Medical Services, Baltimore, MD
Baltimore City Department of Public Works, Baltimore, MD
Baltimore City Fire Department, Baltimore, MD
Baltimore City Health Department, Baltimore, MD
Baltimore City Office of Emergency Management, Baltimore, MD
Baltimore City Public School System, Baltimore, MD
Baltimore Mental Health System Inc., Baltimore, MD
Baltimore Police Department, Baltimore, MD
Baltimore Police Department, School Police Division, Baltimore, MD
Columbus Health Department, Emergency Response Division, Columbus, OH
Florida Department of Health, Tallahassee, FL
George Washington University, Washington, DC
Maryland Emergency Management Agency, Reisterstown, MD
Maryland Institute for Emergency Medical Service Systems, Baltimore, MD
Maryland State Department of Agriculture, Baltimore, MD
Navy Environmental Health Center, Norfolk, VA
Phoenixville Borough, PA
United States Public Health Service, Office of Emergency Preparedness, Rockville, MD
United States Public Health Service, Region III, Philadelphia, PA
US Army Medical Services Corps, Joint Regional Medical Planning Office, Ft. George
G. Meade, MD
University of Texas, Southwestern Medical Center at Dallas, Dallas, TX
Yellow Transportation, Baltimore, MD
SPECIAL ACKNOWLEDGEMENT
Patient Flow Concept Development
Philip Forbes, Directors Office, Washington DC Veterans Administration Medical
Center, Washington, DC
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The
Concept of Operations for the Off-site Triage, Treatment, and Transportation
Center (OST
3
C)
is the product of a multi-agency working group, including
representatives from government, military, public health, emergency management
institutions, fire, police, and emergency medical service agencies. The information
presented in this report represents a collaboration of multiple agencies from federal, state,
and local levels in conjunction with scientific technical studies conducted by the U.S.
Army Soldier and Biological Chemical Command (SBCCOM).
The process used to develop the recommendations in this report involved a
comprehensive review of related literature, a series of facilitated tabletop discussions, an
internal panel review by those who would likely staff an OST
3
C, and a full scale
functional exercise whereby an OST
3
C was stood-up in a local school. Additionally, an
independent panel, composed of representatives from other jurisdictions, that may likely
utilize an OST
3
C, also reviewed the concept.
The proposed OST
3
C patient throughput of 80-125 patients per hour, or 400 to
750 patients per six-hour period, is based on the experience of the full-scale exercise.
One hundred and sixteen people, who included law enforcement, decontamination
personnel, runners, medical support, administrative support, transport personnel, mental
health, and OST
3
C Officers, staffed the OST
3
C. The exercise was not specifically
designed to measure patient throughput but rather to test the concept in general.
Jurisdictions inclined to use the OST
3
C concept may use the proposed patient throughput
as a guide, but actual patient flow may differ. Patient throughput is most affected by the
number of staff, the capacity of the decontamination areas, the overall space of the
building, and the ability of officers to dynamically re-assign staff from slower areas to
busier areas.
The concept outlined in this report is neither mandated nor required for
jurisdictions to use when mitigating the consequences of a chemical terrorist incident.
Rather, it is presented to provide technical and operational guidance for those
communities and departments that choose to undertake planning and preparation for
responding to such events. We encourage you to review the data, understand the
implications, and consciously decide what response procedures you would perform.
Once you have made the decision that is best for your community, you should train and
equip your jurisdiction accordingly.
The authors have made every effort to ensure accuracy of the information
contained in this report. The opinions or recommendations expressed in this document
are an informal consensus of the working group participants and do not necessarily
reflect the official position of the U.S. Department of Defense.
This document has been approved for public release. The document may be
freely reviewed, abstracted, reproduced, and translated, in part or in whole, but not for
sale nor for use in conjunction with commercial purposes.
Page 6
- vi -
The use of either trade or manufacturers' names in this report does not constitute
an official endorsement of any commercial products. This report may not be cited for
purposes of advertisement.
U.S. Army Soldier and Biological Chemical Command
Attn: AMSSB-REN-HD-DI (Mr. William Lake)
5183 Blackhawk Road
Aberdeen Proving Ground, Maryland 21010
World Wide Web
http://www2.sbccom.army.mil/hld
Page 7
Foreword
- vii -
The following
OST
3
C Concept of Operations
presupposes that jurisdictions have
conducted standard emergency management planning. This concept is intended to be
part of a
larger disaster response plan and is not intended to function as a stand-alone
tool. Although community authorities may not use the
OST
3
C Concept of Operations
in
the manner it is presented, they will need to address many of the critical components that
the OST
3
C concept identifies.
Emergency managers should conduct an all hazard approach when developing
disaster response strategies. Standard emergency management planning should entail
vulnerability and threat assessments, and resource analysis for all types of hazards, to
include chemical weapons of mass destruction. Planners should identify critical factors
that could affect the response efforts for each type of hazard and develop contingency
plans to mitigate these issues.
Education and communication are key factors of a disaster response plan. The
plan should be conveyed to the public using the most effective and appropriate resources
available. Generally, jurisdictions that focus on educating the public have a more
effective response and citizens exhibit less anxiety.
Catastrophic disasters require planners to coordinate response efforts on a broader
level than typical emergencies. Mutual aid agreements between surrounding counties,
regions, and states must be well defined so that city emergency managers know what
level of support they can expect. Moreover, city emergency planners must have a strong
understanding of the type of infrastructure they will create during a disaster to
successfully integrate the additional resources. In addition, disaster response efforts must
be documented in a particular fashion so that the jurisdiction is granted federal
reimbursement. A meeting with the respective state's representative, who is responsible
for filling out the application for federal support, will help emergency planners prepare to
capture necessary information.
When a disaster warrants the use of an alternative health care facility, like the
OST
3
C, then other services might be needed to support the response effort. These
services include but are not limited to, a Reunification Center, a Family Assistance
Center, casualty transportation services, and mass care shelters. A Reunification Center
functions as an information site and is the central location for people to reunite with
family members. A Family Assistance Center assists medical examiners/coroners in
confirming remain identity, and supports family members of those who died in the
disaster. Casualty transportation services may be beneficial, as patients will need to be
transported from over-crowded hospitals and taken to the OST
3
C, a Reunification Center,
or to their private residence. Mass care shelters provide housing if large numbers of
citizens are without homes due to the disaster.
Our society expects emergency planners and responders to be well prepared in the
event of any type of disaster. Concepts, like those that are described in the OST
3
C, can
facilitate a community's readiness posture.
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Foreword
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Executive Summary .........................................................................................................iii
Acknowledgements........................................................................................................... iv
Preface................................................................................................................................ v
Forward............................................................................................................................vii
Table of Contents ............................................................................................................. ix
1.0 Introduction ................................................................................................................. 1
1.1 Purpose
1.2 Mission
1.3 Background
1.4 Assumptions
2.0 Aspects Influencing Operational Methodology ....................................................... 4
2.1 Similar To A HazMat Response
2.2 Hospitals Will Not Be Able To Handle The Patient Surge
2.3 Re-Distributing Resources During a Disaster
3.0 Facility Requirements................................................................................................. 6
4.0 Organization and Staffing .......................................................................................... 8
4.1 Command: Management Personnel
4.2 General Staffing
4.3 Volunteer Staffing
4.4 Control: Communications
5.0 Scope of Practice........................................................................................................ 15
5.1 General
5.2 Ethics and Liability
6.0 Notification, Activation, and Deployment of Personnel......................................... 16
6.1 Notification
6.2 Activation
6.3 Deployment of Personnel
7.0 Patient Population..................................................................................................... 18
7.1 General
7.2 Unaccompanied Children
7.3 Special Needs Population
8.0 Tracking ..................................................................................................................... 20
8.1 Patient Tracking
8.2 Tracking Patient Belongings
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9.0 Critical Functions...................................................................................................... 22
9.1 Perimeter Security
9.2 Initial Triage/Registration
9.3 Gross Decontamination
9.4 Internal Security
9.5 Detailed Decontamination/Re-Dress
9.6 Re-Triage
9.7 Treatment
9.8 Out-processing
9.9 General Assistance
9.10 Reunification Center
9.11 Transportation
9.12 Temporary Morgue
10.0 Enhanced Capabilities ........................................................................................... 33
10.1 Law Enforcement Investigation
10.2 Victim Assistance
10.3 Pet Management
11.0 Site Shut Down ........................................................................................................ 36
12.0 Conclusion ............................................................................................................... 37
Figures
1 OST
3
C Incident Command System............................................................................... 9
Annexes
A OST
3
C Organizational Chart.....................................................................................A-1
B Performance Objective Matrix.................................................................................. B-1
C Critical Functions and Required Skill Sets ............................................................... C-1
D Patient Flow Diagram................................................................................................D-1
E Mass Casualty Decontamination Algorithm ............................................................. E-1
F Domestic Preparedness EMS Technician Course-Triage Section .............................F-1
G Antidote and Medication List....................................................................................G-1
H Acronyms ..................................................................................................................H-1
I References .................................................................................................................. I-1
Page 11
An Alternative Health Care Facility:
Off-Site Triage, Treatment and Transportation Center (OST
3
C)
Abstract
Given the potential for acts of terrorism it is now imperative that health care systems be
prepared to respond to a chemical weapons attack on a civilian community. An alternative
temporary medical care facility, herein referred to as the Off-Site Triage, Treatment, and
Transportation Center (OST
3
C or the Center) is envisioned to supplement the existing health
care system in managing the overwhelming number of casualties, both actual and perceived,
following a terrorist incident. It has been designed by the Improved Response Program (IRP)
under the auspices of the Department of Defense's Domestic Preparedness Program via a series
of exercises called Baltimore Exercises (BALTEX).
The OST
3
C will be capable of handling approximately 80-125 non-critical patients per hour (or
400 to 750 patients during a six-hour period). In addition to triage and treatment, patients will
also undergo a detailed decontamination meant to remove chemical contaminants. The patient
care endpoint is either transport to a higher level of care facility or discharge to home with self-
care instructions.
The goal of the OST
3
C is to provide care for a specific patient population and thereby improve
overall patient outcome for the community. By re-directing those who are triaged Minimal at the
scene, the psychophysiologic casualties who have no physical injury (anticipated ratio of
psychophysiologic casualty to actual casualties is expected to be at least 5:1), the non-critical
patients that show up at over-crowded hospitals, and the citizens who self-refer directly to the
Center, hospitals can focus on patients who require in-hospital services and the OST
3
C can
focus on patients who need basic symptomatic and supportive care.
The OST
3
C is an interim patient clearinghouse that will be disassembled once the flow of new
patients has diminished to the point that they can be handled by the existing health care system.
1.0 Introduction
1.1 Purpose
The purpose of this document is to describe an alternative health care facility concept
developed by the Improved Response Program (IRP). The information herein may be
used as the basis from which governmental jurisdictions, agencies, or health care systems
can develop an alternative health care facility as part of their own emergency response
plan.
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An Alternative Health Care Facility
2
1.2 Mission
The mission of the OST
3
C is to supplement the existing health care infrastructure by
providing triage, decontamination, treatment, and if necessary transportation to a higher
level of care, for victims of a chemical weapons attack or similar emergency.
1.3 Background
The threat of chemical or biological terrorist attacks against U.S. citizens is of national
concern. The Tokyo subway attack in March 1995 illustrated the likelihood of a
chemical weapons attack against a civilian population and the overwhelming impact
5,500 patients had on the existing health care system. This occurrence, together with
other more recent national and international terrorist incidents, heightens concerns about
the United States' ability to effectively manage incidents involving chemical agents.
It is the intent of terrorists to cause damage and confusion in an attempt to throw society
into a state of chaos. They are more tempted then ever to use weapons of mass
destruction (WMD) for an attack because of their
effectiveness in creating mass casualties and hysteria. It is
impossible to predict exactly which agents will be used,
how they will be disseminated, where they will be
employed, and which population will be targeted. The best
way to effectively mitigate the effects of a chemical WMD
incident is through comprehensive planning, training, and
preparation.
The Tokyo Sarin attack exemplified how even an educated civilized society responds to
an act of terrorism. The ratio of those who thought they were injured to actual casualties
was 5:1. Twelve people died as a result of the incident, less than 200 patients were
treated as hospital inpatients and approximately 1,000 others needed to be evaluated and
treated in the emergency department; yet more than 4,500 additional people sought
medical care.
The overwhelming number of casualties from a WMD incident will put a tremendous
strain on a community's health care system. Victims might leave the scene contaminated
and attempt to seek medical care on their own. They may arrive at their private
physicians' offices, managed care organizations, and local emergency departments
without the benefits of decontamination or triage. They could contaminate their own
homes, their loved ones, and anywhere they may go from the incident site.
The Off-Site Triage, Treatment, and Transportation Center (OST
3
C) supplements the
existing health care system in managing the overwhelming number of casualties, both
actual and psychophysiologic, following a terrorist incident.
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An Alternative Health Care Facility
3
Most hospitals will have difficulty coping with the sudden onslaught of patients and the
need to decontaminate those victims arriving from the scene. In order to cope with these
large numbers of patients, communities should be prepared to activate pre-planned mass
casualty plans.
The IRP, under the auspices of the Domestic Preparedness Program, through a series of
exercises entitled Baltimore Exercises (BALTEX), identified key response issues unique
to a chemical weapon of mass destruction incident. These exercises identified the need
for jurisdictions to formulate response plans that optimize their existing resources by
coordinating them differently during a disaster. One recommendation was to re-direct
less serious, potentially contaminated, and possibly psychophysiologic casualties to an
interim medical facility to avoid purposefully overwhelming the health care system.
In an attempt to manage a large number of casualties, the IRP developed an alternative
health care facility concept. This facility, referred to as the Off-Site Triage, Treatment,
and Transportation Center or OST
3
C, is a casualty clearinghouse that is capable of
handling between 80-125 non-critical patients per hour, or 400-750 victims during a six-
hour period. The OST
3
C facility can be replicated to meet the need to handle a larger
patient population. The duration of the OST
3
C is short-lived, as most chemical agent
casualties will not require extended patient observation or in-hospital patient care.
1.4 Assumptions
1.4.1 The citizens of the United States are subject to an act of chemical
terrorism.
1.4.2 A well-planned chemical agent release is likely to produce a significant
number of casualties that will overwhelm the current health care system.
1.4.3 Some chemical agents (e.g., mustard agent) produce delayed signs and
symptoms of contamination. Patients exposed to theses types of agents
are more likely to cross-contaminate those with whom they come in
contact.
1.4.4 Most chemical agent liquid exposures (e.g., nerve agent) will produce
immediate signs and symptoms. Those patients who have been exposed to
nerve agent and only present with mild signs and symptoms will likely not
die from agent exposure.
1.4.5 A terrorist attack involving a chemical WMD will have instantaneous
effects on the community's emergency response system.
1.4.6 Local hospitals can expect to receive contaminated victims directly from
the scene.
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An Alternative Health Care Facility
4
1.4.7 Potentially contaminated victims will self-refer to the closest medical
facilities and private medical care providers.
1.4.8 There will be a large number of ambulatory psychophysiologic casualties.
1.4.9 A mass casualty management system that rapidly integrates existing
medical resources will be needed to care for victims.
1.4.10 People will be reluctant to go to an alternative health care facility and will
still attempt to enter traditional hospital emergency departments.
1.4.11 During a large-scale chemical terrorist incident the standard of care may
temporarily change to provide the most effective care to the greatest
number of people affected.
1.4.12 The local health department will play a role in assisting hospitals by
supporting the activities of alternative health care facilities.
1.4.13 Most health departments have medical staff trained to a minimum of the
first responder level.
2.0 Aspects Influencing Operational Methodology
2.1 Similar To A HazMat Response
Responding to a terrorist attack, which involves the use of chemical agents, is similar to
a hazardous materials (HazMat) response, with the exception of the following:
*
There exists the potential for an extremely large number of casualties because of the
deliberate nature of a terrorist incident.
*
Since the incident is a deliberate attack, there is a
concern that secondary devices will be employed
targeting responders.
*
The entire incident is a crime scene requiring the
collection of criminal evidence and suspicious
victim belongings. The preservation of a proper
chain of custody must be maintained for all
evidence.
Managing a chemical weapons (CW) incident requires addressing all these concerns;
therefore those providing patient care at the OST
3
C need to be aware that patients could
be suspects and their belongings may be evidence.
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An Alternative Health Care Facility
5
As with a large HazMat incident or any multiple casualty incident, it is imperative for
the emergency response community to ascertain whether or not the hospitals in the area
will be able to cope with the sudden surge of patients. With appropriate training and
forethought these responders will be in a better position to evaluate the impact that will
be placed on the health care system.
2.2 Hospitals Will Not Be Able To Handle The Patient Surge
Traditionally in any type of HazMat incident, hospitals provide the bulk of
decontamination and treatment for victims. In a CW incident however, it is
questionable if hospitals will be able to handle the patient surge, as HazMat incidents
produce only a few casualties and CW incidents can produce a multitude of patients.
Most hospitals are not prepared to decontaminate a large number of potentially
contaminated patients. Such an influx of patients may threaten the integrity of the
hospitals and the safety of their personnel. If a few hospitals shut down in a particular
health care system, due to internal contamination, then the system may no longer be in
a position to care for the remaining casualties.
Maintaining the current or routine patient load for a community is an important
consideration during a mass casualty incident. For example, there will still be people
who will suffer from heart attacks (possibly even more than normal, which occurred in
the 1996 Centennial Park bombing in Atlanta, (Nordberg, 1996)), medical emergencies,
motor vehicle collisions, traumatic incidents, etc. The health care system must continue
to accommodate the so-called "unaffected community."
In addition to the patients transported from the incident scene, the health care system
will be inundated with the following populations:
*
Large numbers of psychophysiologic patients.
*
Victims who have left the scene and seek treatment
on their own.
*
Friends and family members seeking information
regarding casualties.
In order to accommodate the patient surge, hospitals should look to initiate their own
disaster plans. Those disaster plans may include discharging patients that can be
moved to outlying facilities or to their respective homes. Other options may include
relocating some of the in-patient populations, who are stable enough, to a ward unit or
unused portion of the hospital. Further options may include transferring patients to an
alternate location outside the hospital to make room for patients arriving from the
incident.
Hospitals will not be able to accommodate the patient surge from a terrorist incident
involving chemical weapons of mass destruction. This was evident in the 1995 Tokyo
Sarin incident that resulted in over 5500 patients trying to enter the health care system.
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An Alternative Health Care Facility
6
2.3 Re-Distributing Resources During a Disaster
Ideally, hospitals should continue to provide care for those patients who need a level of
treatment that only a hospital is most suited to provide. Hospital resources even under
disaster conditions cannot be easily replicated, supplied, or staffed. The traditional
mission of a hospital may shift during a disaster from rendering care for the community
at large to rendering care for acute patients.
A more generally accepted premise in disaster management is to provide treatment for
triaged Minimal patients outside traditional emergency departments. Minimal
casualties require considerably less resources thereby making it easier to provide
appropriate care in non-traditional settings. Minimal casualties generally do not require
in-patient services, or extensive medical tests, nor do they demand acute care treatment.
Well before hospitals are taxed beyond their capability or when the health care system
is forced to handle a patient load beyond its designed ability, a jurisdiction should
establish a means to treat casualties outside the boundaries of the traditional hospital
realm. One example of an alternative health care facility is the OST
3
C.
Emergency managers must determine when opening one or more alternative health care
facilities is beneficial. Several factors influence when a community should set-up an
OST
3
C or when treating casualties outside the normal hospital setting is beneficial.
Such factors include but are not limited to:
*
The size/magnitude of the incident.
*
The geographic distance from the incident site to a planned alternative health care
facility site.
*
The need to care for patients within a reasonable period of time.
*
The expected surge of patients will likely occur within the first six hours of the
incident.
*
The length of time needed to stand-up an OST
3
C.
*
The optimal number of patients that can be treated per hour in proportion to the
number of staff available to operate each Center.
3.0 Facility
Requirements
An
ideal
OST
3
C
has the following resources. It can be established however, with considerably
fewer resources and adapted to fit a jurisdiction's assets and disaster plans.
*
Separate male and female locker rooms and showers.
*
Large open areas to support helicopter delivery of state and federal resources.
*
Spacious parking facilities.
*
Good internal access roads, allowing for emergency vehicle ingress and egress.
*
Electricity, preferably with generator backup.
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An Alternative Health Care Facility
7
*
Internal and external water supply (e.g., fire hydrant).
*
Access to sanitary sewer system.
*
Easily identifiable to the public.
*
Large enough facility to co-locate multiple services within one campus, (e.g., patient
decontamination/treatment, crisis intervention, law enforcement investigation, animal
decontamination).
*
Gymnasium or large room.
*
Bathrooms.
*
Heating/Air Conditioning/Ventilating System that can be sectored off to avoid cross
contamination.
*
Securable internal and external rooms.
*
Chairs.
*
Tables.
*
Areas to post information (e.g., chalk and bulletin boards).
*
Public announcement systems.
*
Cafeteria/food service facility.
*
Auditorium.
*
Copy machine.
*
Fax machine.
*
Hard-wired phone lines.
Examples of buildings that may have much of the recommended items or buildings that can be
modified to facilitate an OST
3
C include fitness centers, medical buildings, hotels, college
dormitories and campus facilities, motels, high schools, and middle schools. Even warehouses
and tents can be converted into an OST
3
C, providing a jurisdiction is prepared to allocate
extensive resources to set up such a facility. Of the aforementioned facilities, high schools and
middle schools contain much of the needed equipment and may be an optimal choice for many
jurisd