Emergency prepardness contigency plans for hospitals

20 Jul 2005

Question No:  115  

Question

Name of the Person: Ms Indranee Rajah, MP for Tanjong Pagar GRC

To ask the Minister for Health what emergency preparedness contingency plans our hospitals have to deal with a mass biochemical attack and whether we have sufficient resources to deal with such a contingency.

Reply

Reply From MOH

We have various contingency plans to deal with biological and chemical attacks. The nature of the plan will depend on the scale of attack and the type of biological or chemical agent used. 

The risk of such an attack on the civilian population is low but real. It has happened elsewhere before. In 1995, Aum Shinrikyo, a Japanese cult, carried out a chemical attack using Sarin gas on the Tokyo subway lines. The attack killed 12 and injured over 3000 people, of which some 500 were hospitalized. 

More recently in 2001, a series of attacks through the use of anthrax-laced letters affected several locations in the US, including the Senate. This is a biological attack using a bacterium that causes anthrax. There were 22 victims, of which 5 died. It caused widespread anxiety among the population. 

Dealing with such attacks requires a total effort involving several Ministries as well as the private sector and Singaporeans at large. For the healthcare sector, biological and chemical attacks pose rather different challenges. Chemical agents such as nerve agents cause immediate injuries to those exposed. Survival is largely predicated on how quickly we can deliver treatment to the victims. If a large number of people are exposed, then there will be a large and sudden surge of victims needing immediate care in our hospitals. 

On the other hand, a biological attack will normally not yield immediate casualties. There would be an incubation period before the symptoms start to manifest and patients appear at the hospitals. Since many of the possible bio-terror agents are transmissible from person to person, if we are not able to identify and isolate the victims, the public would continue to be at risk of contracting the disease, long after the perpetrator has left the scene. 

Hence, we need a range of contingency plans to meet the various types of attacks. We have, for example, a contingency plan to deal with a chemical attack which results in up to 1000 casualties. For biological attacks, we have focused on a few bio-terror agents such as anthrax and smallpox. As a general principle of contingency planning, we need to make sure that the necessary system, infrastructure, equipment, and skilled manpower are in place. 

There are no perfect or comprehensive contingency plans. We just have to regularly review and update them in the light of new knowledge and experiences. We have learnt much through dealing with SARS. First, we now have a quicker system to mount a coordinated response that involves many government agencies, so that we can respond quickly to save lives and mitigate the impact to public health. Second, we have strengthened our infection control measures in the public hospitals. Third, we have enhanced our hospital infrastructure, with isolation rooms and fever screening areas to prevent cross infection. Fourth, we have acquired stronger capabilities in field epidemiology, infectious disease surveillance, contact tracing and quarantine which will all come in handy in any bioterror attack. Fifth, we have built up a stockpile of critical medical supplies including essential drugs, vaccines, antidotes and personal protective equipment. 

In addition, our public hospitals have expanded their contingency plans to deal with a sudden upsurge of patients in the wake of an attack. Current situation is much better than before, though not yet fully satisfactory. Our main limitations are in the capacity of the emergency departments and intensive care beds. We are expanding the physical capacity and training additional staffs in these areas. We are also building more de-contamination facilities so that healthcare workers can be protected when treating patients affected by chemical agents. 

As always, prevention is better than cure. That is why we are introducing measures to reduce the risk of an attack on Singapore. One such measure is in the control of hazardous substances. Administratively, we have tightened the control of access to dangerous biological agents. We now need the legal backing to such a measure. A Bill for this purpose is being drafted and I will introduce it to this house in a few months' time.

But prevention is not the job of the government alone. We can all play our part to be vigilant. And in the event of a bio-terror attack, Singaporeans can also help to bring the transmission of the disease under control by consulting their doctors when they are unwell and isolating themselves if advised to do so. 

Formulating contingency plans and exercising them are important parts of our national preparedness to deal with terror attacks. We will continue to refine our plans and enhance our capabilities to deal with emerging threats as they are identified.