To the Editor: The article by Tan and Fitzgerald1 raises numerous concerns. The authors report that their recommended personal protective equipment (PPE) conforms to standards "in a hospital environment where the chemical vapour concentration will not be high". At the same time, the authors acknowledge data indicating most patients from a disaster will present to the local hospital by private transport (ie, without triage, decontamination, or prehospital care). These two considerations are incompatible and further ignore the possibility of the hospital as a direct terrorist target. The authors' assertion that their three decontamination lines "allow mass casualties, as well as trolleys and equipment, to be decontaminated quickly, efficiently, and in an orderly fashion" is simply not evidence based.

Of greater concern, the authors report "major considerations were policies and plans [referring to the hospital External Disaster Committee] and the emergency department response". Although this bottom-up approach to disaster planning is typical, it pays inadequate attention to interdisciplinary issues of proper hazard identification and management, environmental health, syndromic surveillance, and field outbreak investigation. Readers seeking robust emergency department templates are better referred to other sources for guidance.2,3

Of greatest concern, the authors report "our recommendations are similar to systems in the US and Israel, but much less intensive, as the threat of a terrorist attack here is perceived to be much lower". The three references cited for that statement date back to 1994, with none more recent than 1999. Moreover, the logic of the unreferenced threat assertion confuses hazard and risk. Although the absolute probability of a given hazard may be low, the risk attending that hazard encompasses vulnerability of the exposed population. With weapons of mass destruction, the conditional probability of catastrophic public health consequences is high — one event is the only number you will ever need.

The current public health context of chemical–biological–radiological (CBR) incident management in Victoria is one of limited experience, performance improvement indicators, and budgetary support from public health authorities. Public health is at risk when authorities report that "faced with dozens of requests each day to attend sites to assess white powder, the stretch capacity did not exist and nor should it".4 As a result, the leading trauma centre in Australia extracts $20 000 from its existing operations budget to discharge its CBR responsibilities. This is not good enough. Nevertheless, the authors deserve credit for their initiative. Until cross-trained and disaster-experienced healthcare authorities reprioritise, this article shows the reader an excellent way to play a very weak hand.