Mission failure: emergency medical services response to chemical, biological, radiological, nuclear, and explosive events.

INTRODUCTION Only 4% of the United States Homeland Security funding for public safety terrorism preparedness is allotted to emergency medical services (EMS), despite the primary threat from a mass-terrorism chemical weapons attack (MTCWA) being personal injury. This study examines the preparedness of the EMS to respond to, treat, and transport victims of such attacks. HYPOTHESIS It was hypothesized that US EMS agencies lack the necessary equipment to mitigate large-scale morbidity and mortality from a MTCWA. METHODS Seventy after-action reports from full-scale, chemical weapons exercises conducted in large cities across the US were examined by the Office of Domestic Preparedness, Chemical Weapons Improved Response Program to ascertain if EMS responders had personal protective equipment sufficient to operate at the scene of a MTCWA. RESULTS Of the 50 after action reports that mentioned EMS personal protective equipment, only six (12%) EMS agencies equipped their staff with personal protective equipment. CONCLUSIONS Results indicate that EMS responders are not prepared to safely respond to MTCWAs, which may result in a significant loss of life of victims and responders.