9/11 Left Doctors Learning on the Fly

Health-care system undergoing upheaval

WEDNESDAY, Sept. 11, 2002 (HealthDayNews) -- Terror has become an uneasily accepted part of the American medical scene in the last year.

The assaults of September 11 -- and perhaps even more so, the deadly anthrax mailings that followed -- were as much of a thunderbolt to health-care workers as they were to the rest of America. Attacks that had been theoretical were now very real, and people on the first line of defense were suddenly thrust into an education on the spot.

National, state and local authorities now must include in their medical calculations the incalculable possibility that someone, somewhere, may use explosives or biological or chemical weapons to try to kill tens, hundreds or thousands of Americans.

So, we see officials in the Department of Health and Human Services (HHS) reconsidering smallpox vaccination. Routine vaccination ended in the United States in 1972, when the disease was declared to have been eliminated.

Initial plans were to vaccinate only a limited number of medical personnel. However, Jerome Hauer, HHS assistant secretary for emergency preparedness, said recently that as many as 500,000 medical workers could be vaccinated, with the vaccine eventually made available to anyone requesting it.

However, "we might be paying a little too much attention to smallpox," says Dr. Philip J. Tierno Jr., an expert in microbiology and immunology whose credentials include an appointment to New York City's special task force on bioterrorism.

"Smallpox is far from the perfect weapon," Tierno says. "Even if you have a case, there will be only one or two immediate secondary cases, and you have a four-day window for people to be vaccinated and made safe."

Anthrax is a different story, Tierno says. His book, The Secret Life of Germs: Observations of a Microbe Hunter, was published just before the anthrax scare. It describes how a disgruntled military lab worker could spread the germ with a crop duster. Aside from the method of spread -- anthrax-laced letters were used to kill five Americans -- "almost everything I wrote about has occurred," Tierno says.

"I was reluctant to believe that anything like that could happen," says Tierno, who adds he wrote "tongue in cheek" and was "rudely awakened by the delivery of anthrax by mail."

Since then, "we are in a considerably better position now to defend ourselves," Tierno says. He is on the staff of Mount Sinai Medical Center as well as New York University Medical Center, and notes that both institutions have put disaster plans into place and formed standing committees to keep those plans up to date.

"We have been so inundated by material from departments of health that there is a saturation point," Tierno says. "Also, there has been organized delivery by all the medical societies that could be involved. Even the dentists got together to see what they could do in the event of bioterrorism."

Action was needed, says Dr. David Ghilarducci, a hazardous materials expert at Michigan State University. His study of 156 trauma centers around the country well before the World Trade Center and Pentagon attacks found that only 6 percent had the equipment needed for safe decontamination in case of a biochemical attack. Only 36 percent of staff members had training for such an attack, and only 58 percent of the centers had ever done a hazardous materials drill.

Ghilarducci is doing a follow-up survey to see how much has changed. "Anecdotally, we can say that two hospitals here in Kalamazoo are doing well in terms of awareness and equipment, but basic infrastructure things are hard to change," he says.

A survey by HHS and the American Academy of Family Physicians shortly after September 11 found those physicians needed more information about a response to terrorism. Three-quarters of the doctors surveyed said they were unprepared to recognize bioterrorism illnesses, and 38 percent rated their knowledge about the diagnosis and treatment of those diseases as poor.

HHS has responded by allocating more than $1 billion in grants to states and metropolitan areas for training, disease surveillance, epidemiology networks and hospital improvements. The Centers for Disease Control and Prevention (CDC) has set up a network to give more than a million public health and emergency workers quick information on any unusual outbreak of disease, and it's expanding the network to reach every county health department.

"I think we are quite well prepared" for a biological, chemical, nuclear or other terror assault, CDC Director Dr. Julie Gerberding said at a recent news conference. Among other actions, the CDC has increased its laboratory capacity so it can analyze 150 chemical compounds that could be used by bioterrorists.

The CDC is monitoring 911 calls, poison control centers and even veterinary clinics, since animals can be the first to feel the effect of a new infectious agent.

Basic medical supplies to help people injured in a terrorist attack also are a matter of concern. The need for blood after last year's attacks was met by a spontaneous wave of donations that more than met the immediate need. In fact, congressional auditors said yesterday, more than 200,000 units of blood had to be thrown away in the weeks after September 11, an amount that is five times what typically expires before it can be used and far higher than what blood banks acknowledge.

However, there could be no such public response to the need for skin transplants for burn patients. As a result, says Ellen Heck, administrative director of the transplant services center at the University of Texas Southwestern Medical Center at Dallas, "a lot of skin was sent across the country."

And it was sent on the ground, because all airlines were grounded in the days after the attack. Two Texas transplant technicians volunteered for a 1,300-mile, 24-hour drive that transported 70 square feet of skin, preserved by dry ice and packed in three containers, to the Pentagon for treatment of burn victims.

That trip "made FEMA [the Federal Emergency Management Agency] aware of the need to move tissues as they do blood," Heck says. She headed a committee of the National Association of Tissue Banks that developed a plan for future emergencies.

There will be 18 tissue banks in the first line of emergency response, with more in a second wave if that is needed, Heck says. The control center will be in Washington, with a backup center ready in case of need. Skin for burn victims will be the primary concern, but corneas for eye injuries and bones for crush injuries are also included in the plan.

So it is that September 11 is having the same transforming effect on the American health-care system as it has on almost every aspect of life in this country.

What To Do

Learn more about preparing for bioterrorism from the Centers for Disease Control and Prevention and the Center for Civilian Biodefense Studies.

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