The nation's public health system is scrambling to address the recent anthrax contamination that has killed at least four, infected more than a dozen others, shut down Congress, halted mail delivery to the White House and put an already jittery populace further on edge.
And with the current U.S.-led military actions in Afghanistan antagonizing terrorist groups around the world, there are fears that evildoers soon could unleash other biological weapons much more lethal than anthrax-smallpox, pneumonic plague and botulism, for example.
"The threat of bioterrorism is now a reality," says Mohammad Akhter, M.D., executive director of the American Public Health Association. "Public health departments nationwide are not fully prepared to handle these growing bioterrorist attacks. The demands to investigate these latest anthrax cases are rapidly outpacing our ability to act."
The Sept. 11 terrorist attacks on New York and Washington also changed the rules for emergency response, jolting healthcare professionals everywhere to the realization that they must be prepared for things never seen before.
Seattle's Virginia Mason Medical Center had to deal with riots surrounding the 1999 World Trade Organization conference, as well as with a measles outbreak and an earthquake earlier this year.
But in an Oct. 8 memorandum to employees, CEO Gary Kaplan, M.D., and Chairman Mike Roma wrote: "Our Emergency Operations Center goes into operation flawlessly, and the team involved is well trained and experienced. So we are in great shape to deal with known events. Many have asked about other events, however, such as biological and chemical terrorism."
The executives did not have an immediate answer.
A recent study by the National Association of County and City Health Officials suggests that 24% of local public health agencies do not have any plan to respond to an act of bioterrorism and that only 20% have a "comprehensive" strategy in place.
The APHA has called on Congress to appropriate $10 billion over the next five years--including $1 billion immediately--for public health officials to respond to bioterrorism.
The organization wants all practitioners who treat patients during a biological or chemical attack to have protective gear and be immunized against the diseases they are likely to encounter, says Richard Levinson, M.D., associate executive director.
"If they are out on the front lines, they need to be protected," Levinson says.
Research firm Frost & Sullivan estimates that three weeks of treatment of a large-scale outbreak of anthrax or smallpox in an average city would cost $36.4 million for vaccines and $24.3 million for antibiotics.
Rick Rutherford, manager of the Baltimore-based American Urological Society's practice management division, suggests that the Sept. 11 death toll could have been higher had the World Trade Center and the Pentagon not had emergency evacuation plans for occupants. "Sadly enough, it's a wakeup call for others to develop a plan."
On Sept. 11, a number of physicians in New York went to St. Vincent's Medical Center, close to the World Trade Center, to offer their services. But many did so by leaving their own practices unstaffed and their own patients waiting, says David Gans, practice management resources director for the Medical Group Management Association.
Gans, a retired Army Reserve officer, notes that the nation's emergency preparedness system is fragmented among various federal, state and local governments and private-sector organizations, including emergency medical services, law enforcement agencies, state National Guard units, charities and religious groups.
Now, with the advent of bioterrorism, there are new players in emergency response, including public health agencies, pharmaceutical companies, building inspectors and the Department of Defense.
"As the stakeholders change, the management system changes as well," Gans said last month at MGMA's annual conference in San Antonio.
Jeanan Yasiri, administrator of service initiatives for Dean Health System in Madison, Wis., says it is important to have a response plan ready before disaster strikes.
"You're going to have the benefit of a clear head" for when something does happen, she says. "Unless you have a plan, you really don't know how to react."
Yasiri recommends that medical groups perform exposure audits of the possibility of certain types of crises occurring in their service areas, how they will react to such occurrences and to whom they will need to communicate information, such as staff, the police, the media and specific patients.
"The work is truly an investment on your part that will be a sort of insurance policy," Yasiri says.
Without a clear roadmap for communication, practice managers become more vulnerable to lapses in judgment and run the risk of cracking under pressure in the public's eye, thus losing their credibility in a time of crisis.
Rutherford says managers occasionally forget about their own staff when they publicize readiness plans. "It's important to develop a training program because your program won't be effective if your employees don't know what to do," he says.
Prior to joining the urological society in early 2000, Rutherford managed a nine-physician practice in the coastal town of Wilmington, N.C. He survived four major hurricanes during his six-year tenure.
"Every time a hurricane came through Wilmington, my practice was a little better prepared than the last time because we learned from our mistakes."
In devising prevention and response strategies, Rutherford advocates planning in reverse, starting with recovery, moving on to surviving the immediate aftermath of a disaster, then addressing what he calls "pre-covery" issues--ways to prepare before an incident.
"Reverse planning helps to keep the task in perspective. It's very easy that in developing a plan, you get bogged down in details," Rutherford says. "You always need to keep in mind that you are in the patient caring business."
Rutherford also says it is critical to develop contingency plans at every step of the way.
"In any situation like that, chaos will prevail for a day or two," Rutherford says. What is most important is what happens after that initial period.
He advises practices to re-evaluate their fire and casualty insurance annually, since new equipment might not be covered and valuations of previously insured items can change.
"When you plan your damage control, you need to take the most serious risks first and act accordingly. You've got to remember that this is a working document. If circumstances change, will the plan still be appropriate?"
Online resources for disaster preparednessThe Centers for Disease Control and Prevention has posted bioterrorism-related information and resources at www.bt.cdc.gov.
Johns Hopkins University in Baltimore runs a Center for Civilian Biodefense Studies at www.hopkins-biodefense.org.
Pepid, an Evanston, Ill.-based developer of clinical software for emergency medicine, is providing free downloads of information on diagnosis and treatment of conditions related to potential biological and chemical weapons at www.biochemweapons.com.
The Federal Emergency Management Agency (www.fema.gov) and the American Red Cross (www.redcross.org) publish free preparedness guides for businesses.