Terrorism represents a profound threat to our communities. Terrorists, whether representing foreign governments, religious fervor, or individual anger, have the capacity to harm our cities with explosives and weapons of mass destruction.

The explosions at the World Trade Center in New York City, the Murrah Building in Oklahoma City, and Centennial Park in Atlanta dramatize the susceptibility of communities in the USA to a terrorist attack. The Sarin nerve gas attack in Japan, the stockpiling of chemical and biological weapons by Iraq, and the problems of controlling access to the former Soviet Union's highly radioactive military stores present special challenges to the medical community.

While fire, Hazardous Materials (HazMat), emergency medical services (EMS), law enforcement, and federal and military agencies prepare to meet the threat of a terrorist attack, all victims eventually will seek care from the local hospital. Hospitals represent an invaluable community, regional, and state resource, and are an essential component of society's response to natural and man-made disasters.

Hospitals provide the majority of medical care to victims after a disaster. It is imperative that hospitals develop the capacity to safely provide assistance to the affected community after a terrorist attack.

In most training programs for nurses and physicians worldwide, very little or any effort currently is extended to prepare graduates to recognize and respond to the demands of victims of a terrorist attack. Globally, there are few hospitals with the capacity to safely assess, decontaminate, and treat victims of a terrorist attack.

A broad range of training and educational programs must be developed to improve the ability of the nurses, physicians, and hospitals to meet this demand. This training will enable nursing schools, medical schools, and other areas of higher learning to train students in the medical consequences of a terrorist attack. Post-graduate training should be extended to all communities to share this important material. This training must necessarily focus on Weapons of Mass Destruction: explosives, chemical weapons, biologic weapons, radioactive materials, and nuclear weapons.

In the United States, a range of public and private efforts developed training for the medical sector. Virtually every community currently is assessing its capability to respond to a terrorist attack. Planning must take place at local, regional, and federal levels. Central coordination by federal agencies will speed the development and availability of this information. Federal and local officials must agree upon minimum standards of preparedness for the cities as well as the nation.

While every effort must be made to prepare the medical community, it is essential that this preparation not take place in a vacuum. ALL responding agencies must develop plans that will meet the needs of the community in times of crisis. This planning must be multi-jurisdictional to include fire, EMS, HazMat, law enforcement, military, and medical systems. These responders must learn to respond in a coordinated fashion utilizing plans that have been tested, exercised, and generally accepted.

Policies and procedures must be developed to prepare hospitals to deal with the medical consequences of a terrorist attack. Decontamination systems appropriate for the medical facilities and their communities also must be developed.

Tabletop exercises and realistic drills that involve community response agencies will: 1) Coordinate the community response to a mass casualty event; 2) Highlight deficiencies; 3) Develop lasting relationships between fire, EMS, emergency management, and hospitals; and 4) Enable a safe response to a vast range of hazards

Summary
Hospitals are a valuable disaster resource. Internal systems must be developed that will enable hospitals to offer a safe response to a terrorist attack. Every hospital must have the capacity to safely assess and treat at least one patient exposed to a hazardous material.

Key words: capacity building; coordination; disasters; education; hazards; hospitals; mass casualties; planning; preparedness; terrorism; weapons
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