In 1999, forecasters believed Hurricane Floyd would hit Savannah, Ga., prompting state emergency officials to order an evacuation.
The storm veered, causing (by hurricane standards) minimal damage in Georgia. The evacuation became the real disaster. The interstate jammed. Evacuees abandoned their cars and tried to walk to safety with the little information they had.
Georgia physicians realized then they needed to better prepare for emergencies, says Walker Ray, M.D., president of the Medical Association of Georgia.
"So, the Georgia society began developing a disaster relief plan," Ray says. "They also began working with state and local officials to establish effective communication systems."
Planning has continued since the attacks of Sept. 11.
"If this is a war," Ray says, quoting a presenter at a recent forum, "then we are the warriors."
The mission of the MAG disaster preparedness team is to manage planning, reporting, public education and patient care in a crisis.
MAG officials also will look at state law and ensure that it allows for out-of-state physicians to treat Georgia residents in the event of a disaster, Ray says.
The California Medical Association's Bioterrorism Resource Center offers doctors and the public daily updates from the Centers for Disease Control and Prevention and the California Department of Health Services.
The group also compiled a letter physicians can distribute to patients to educate them about the risks of taking antibiotics if they haven't been exposed to a toxin.
The CDC began urging medical societies to join in the planning for a bioterrorism attack in March 2000, when a military researcher was diagnosed with the first reported case of human glanders in the country in 50 years. Glanders, like anthrax, is an animal disease. It was used as a biological agent in World War I.
The CDC's Ali Kahn, M.D., used that incident as a basis for his July 2001 editorial, "Ready or Not-Preparedness for Bioterrorism," in the New England Journal of Medicine.
Khan called for local, county and state medical societies to work with the states, develop community disaster plans and create physician communication systems in case of emergencies. The plans should specify which hospitals should receive what type of patients, and states should require physicians to attend bioterrorism courses as part of their continuing education, he encouraged.
At the federal level, government should keep a running total of available public, private and government hospital beds, says Kahn, who in 1999 also developed the strategic public health plan for the CDC.
"We've come a long way in three years since this program was envisioned," Khan says. A national network of laboratories now exists to test for biological agents, there is a national stockpile of drugs, and strategies are in place for real-time surveillance of outbreaks, he says.
Khan says he met on Nov. 19 with representatives from the AMA, the American Hospital Association, the American Association of Health Plans and leaders of other local and state public health groups for further planning.
"We have made tons of progress," he says, "but we do have a long way to go."
That's the message officials with the AMA want the public to get. And, they say, improving the nation's public health system is the only way to do that.
Saying that it's time to address bioterrorism head-on, the AMA and about 10 other healthcare groups placed ads in the nation's major newspapers last month urging Congress to shore up the public health system.
President Bush has asked Congress for more than $1.8 billion to better prepare the nation's public health system to fight bioterrorism.
The money would be used for stockpiling medicines, improving the early alert system and increasing and improving the disease surveillance system.
Congress has yet to act on the request.
After spending two weeks at Ground Zero, the CDC's Patrick Meehan, M.D., knows the importance of communications between healthcare and the government.
New York was one of two cities and nine states that received preparedness grants from the federal government.
Meehan, who directs a CDC division on emergency preparedness, says meeting the planning requirements from the Joint Commission on Accreditation of Healthcare Organizations is not enough.
"Hospitals do a great job with their internal plans, but they many not even know who to call in a disaster to get additional help or to know what's going on," Meehan says.
Physician executives should reach out and work with local, county and state public health agencies to be truly prepared for disasters, he says.
Joseph Conn and Elizabeth Thompson Beckley contributed to this report.