Access to hospitals in the wake of terrorism: challenges and needs for maintaining public confidence

The problem of surge capacity in the wake of a terror-related emergency has lead to a number of interesting proposals designed to mitigate the effects of crowds as well as deficiencies in patient care capacities. The most controversial of these is a proposal to close hospital doors in the wake of a mass casualty terror event. However, several specific challenges posed by mass casualty events make closing hospitals doors undesirable. These include the need for efficient movement of resources, maintenance of social order, and providing the moral reassurance needed by the general public in times of crisis. Importantly, these challenges are related to features of terrorist events that distinguish such events from circumstances of "normal" surge that might result in, for example, closure of emergency rooms.