Book Excerpt: Bioterror

Most everyone can recall seeing a picture in the newspaper or video footage of the classic WMD exercise. Typically, a number of HAZMAT professionals are seen in space suits walking out of some building carrying a container. We all feel comforted to know that the government has an impressive effort for terrorism. The painful irony is that these exercises do nothing to prepare us for the eventual bioterrorist attack.

As I noted before, we have fooled ourselves into believing we're prepared to deal with bioterrorism because we have perfected our response to an event such as an explosion or release of a chemical agent. In real life, none of these players, including the FBI or other law enforcement officials, will be on the front lines when we recognize the results of the intentional release of a biologic agent. Moreover, that recognition will occur not over minutes to hours, but rather over days to weeks. In the end, it will be the emergency rooms, doctor's offices, and public health departments that will be the smoke alarms going off alerting us to the impending raging fire.

Despite this conclusion, we continue in this country to avoid preparing for bioterrorism through such activities as meaningful live drills and tabletop exercises (a type of make-believe exercise usually conducted in a single room). Why? Frankly, to unfold a bioterrorism exercise that is realistic means days to weeks of challenging health care workers, persons working in clinical laboratories, and public health officials with bits of information that appear to be unrelated. And it won't happen in a single clinic, hospital, or even geographic region. Most of all, no one will even know it happened. That's different from responding to a recognized crisis, even if you don't know why the building blew up.

For these reasons, very few communities have attempted to play out realistic scenarios involving the release of a biologic agent. Instead, we continue to fall back on exercising the classic chemical release to earn the comfort of knowing that our HAZMAT teams are in place. This is a serious mistake. We need to begin to organize, on a regional basis, plans for addressing head-on the complexities of a one-week to several-months scenario that could mean simulating the provision of antibiotics and vaccine to hundreds of thousands of individuals and direct medical care for an equal number of critically ill patients. These types of drills will take resources. Unfortunately, both the public health and medical care delivery systems are already stretched to the point of breaking by their efforts to provide the necessary resources for daytoday business. There isn't any flexibility in these systems to allow for the kind of exercises that will allow us to understand and address the serious deficiencies in our bioterrorism response protocols. In addition, state and federal planning efforts to date have generally neglected hospitals. While first responders, EMS, and law enforcement have become very energized about this issue, there has been very little attention paid to what needs to be done within the hospitals.

8. We're on Our OwnTogether.

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