Health System Response to Terrorism

Featured Article

The National Association of County and City Health Officials. Assessment of Local Bioterrorism and Emergency Preparedness. NACCHO Research Brief. 2001 October; Number 5. Available at www.naccho.org/files/documents/explanatory.html.
This brief answers the question of whether the United States is prepared for a bioterroist attack from the point of view of local public health agencies (LPHAs). LPHAs are the frontline agencies in responding to bioterrorism threats. They prepare jurisdictions for bioterrorism, including rapid detection of unusual health events, coordination with response partners and healthcare facilities, providing treatment recommendations and protocols to prevent the spread of infection and disease, doing "contact tracing" to assure that all individuals exposed to BT agents are reached for testing and treatment, and providing health information and resources to the public and the media. The nine-question survey was sent to 999 LPHAs in October 2001 and received a 53 percent response rate. Only 20 percent of LPHAs have a comprehensive response plan in place. LPHAs have made headway in preparedness for bioterrorism in the last few years. However, they have much more work ahead of them in order to acquire the capacities required to detect and respond to an act of bioterrorism as quickly as possible, to prevent the spread of disease and save lives.

Other Articles

American Hospital Association. Disaster Readiness Advisory #4. 2001 November 7. Available at www.aha.org/Emergency/Readiness/MaIncidentB1107.asp.
Provides guidance about emergency preparedness in light of September 11, 2001. In response, the American Hospital Association (AHA) developed a model readiness template for hospitals. Information on the Hospital Emergency Incident Command System (HEICS), an emergency management system that outlines a management structure, defined responsibilities, clear reporting channels, and a common nomenclature is provided.

Bloche MG, Gostin LO. A Health System Primed to Fail. Los Angeles Times. 2001 November 4. Available at www.latimes.com.
This article, by two professors of law and public health, provides a historical accounting for what they see as America's poorly funded, fragmented, and unprepared public health system. While public health was a priority for both legislatures and citizens from the 18th century through the Industrial Revolution and both World Wars, the successes and consequences of more recent public health campaigns has lead to diminished concern. Most recently, the AIDS epidemic of the 1980s and 1990s led to public-policy responses where the government intruded minimally on private lives and was often viewed more as a threat than a solution. The authors reveal the urgent need for new federal and state laws to organize public health, law enforcement, and emergency-management agencies, mobilize resources, and encourage or perhaps require information-sharing.

Centers for Disease Control. Update CDCHAN-00053-01-11-14-UPD-N Public Health Preparedness for Threats and Emergencies. 2001 November 14. Distributed by Health Alert Network, healthalert@cdc.gov.
This brief describes the seven high priority areas that public health agencies have agreed to focus on for preparedness for public health threats and emergencies: workforce, information systems, communication, epidemiology/surveillance, laboratory, policy and evaluation, and preparedness and response.

Connolly C. Bioterrorism Defense Plan Called Inadequate. The Washington Post. 2001 October 23: Page A11.
Public health officials gathered at the American Public Health Association's annual meeting criticized the Bush administration's proposal for improving the nation's ability to respond to bioterrorism and other public health crises. Many public health experts declared that the proposed spending of $300 million for local and state hospitals, laboratories, and health departments was insufficient to prepare the nation's public health agencies to respond to a biological response. Health and Human Services Secretary Tommy G. Thompson countered with indications that his agency is pursuing more funds and other options including adding potassium iodide, which is taken shortly after radiation exposure to prevent thyroid cancer, to the National Pharmaceutical Stockpile.

Disaster Management Center at the University of Wisconsin-Madison. Fred C. Cuny Memorial Continuing Education Series: Principles of Disaster Management. Prehospital and Disaster Medicine. 1998-present. Available at http://pdm.medicine.wisc.edu/continuingeducation.html
This is an on ongoing continuing education series, published in the journal: Prehospital and Disaster Medicine (PDM). The series began in 1998, and is still in progress. A different topic is covered in each issue. The series is dedicated to the memory of Fred C. Cuny, a pioneer in the field of Disaster Management. Below are the topics covered:

Fraser M, Fisher S. Elements of Effective Bioterrorism Preparedness: A Planning Primer for Local Public Health Agencies. Washington, DC: National Association of County and City Officials. 2001January. Available at www.naccho.org/files/documents/Final_Effective_Bioterrorism.pdf.
This Primer was created to assist local public health officials and their partners in identifying their public health and safety roles when responding to bioterrorism. Although targeted at local public health agencies, the public health response is one part of a larger response that will involve criminal investigation and other emergency management authorities at local, state and federal levels. This Primer is intended to help local public health agencies to coordinate their piece, and jointly plan response activities with neighboring local and state public health systems. The document does not lay out step-by-step instructions. Rather, it identifies the crucial elements local public health agencies need to consider in developing their plans. Additional resources are provided.

United States Department of Health and Human Services. Testimony before the Committee on Energy and Commerce, United States House of Representatives. HHS Bioterrorism Preparedness: CDC's Role in Public Health Protection. Statement of Tommy G. Thompson, Secretary, Department of Health and Human Services. 2001 November 15. Washington, DC. Available at www.hhs.gov/asl/testify/t011115.html.
In his testimony, Secretary Thompson outlines several areas of President Bush's $1.5 billion budget request to strengthen the U.S. government's ability to prevent and respond to bioterrorism. He addresses the administration's proposals for the National Pharmaceutical Stockpile; research on new vaccines and therapies; laboratory capability; surveillance, communications, and training; food safety; and security for CDC facilities.

United States Department of Health and Human Services. Testimony before the Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies, United States Senate. CDC's Public Health Response to the Threat of Bioterrorism. Statement of Jeffrey P. Koplan, Director, Centers for Disease Control and Prevention. 2001 October 23. Washington, DC. Available at www.hhs.gov/asl/testify/t011023a.html.
Director Koplan's testimony provides an update on the CDC's response to anthrax exposures, and the status of the bioterrorism preparedness program. During a concise history of the first anthrax cases during the days following September 11, Koplan identifies the actions taken by the CDC to diagnose anthrax cases, prevent subsequent contraction of the bacteria, and inform the public health community. CDC's Strategic Plan for Bioterrorism has been ongoing since 1998 and Koplan concludes that the CDC has made substantial progress in this plan resulting in an enhanced capability to prepare for and respond to a bioterrorist event. Current priorities include strengthened public health laboratory capacity, increased surveillance and outbreak investigation capacity, and health communications, education, and training at the federal, state, and local levels.

For Further Reference

Centers for Disease Control and Prevention Public Health Training Network Announcements. 2001 December. Available at www.phppo.cdc.gov/phtn/default.asp.

Landesman L. Public Health Management of Disasters: The Practice Guide. 2001. APHA.

Strongin RJ. Emergency Preparedness from a Health Perspective: Preparing for Bioterrorism at the Federal, State and Local Levels. 2001 October. Washington, DC: National Health Policy Forum.

United States General Accounting Office. Testimony before the House Subcommittee on Oversight and Investigations, Committee on Energy and Commerce. Bioterrorism: Review of Public Health Preparedness Programs. Statement of Janet Heinrich, Director, Health Care-Public Health Issues. 2001 October 10. Washington, DC: U.S. GAO. Available at www.gao.gov/new.item/d023149.pdf.

United States General Accounting Office. Testimony before the Senate Subcommittee on Public Health, Committee on Health, Education, Labor, and Pensions. Bioterrorism: Public Health and Medical Preparedness. Statement of Janet Heinrich, Director, Health Care-Public Health Issues. 2001 October 9. Washington, DC: U.S. GAO. Available at www.gao.gov/new.items/d02141t.pdf.

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