Md. emergency agencies improve ability to respond to big attacks

Networks developed to spot bio-terror, cope with surge of victims

War On Terrorism

October 09, 2001|By Joel McCord | Joel McCord,SUN STAFF

Nineteen months after being found "generally unprepared" to deal with attacks designed to inflict large numbers of civilian casualties, Maryland emergency and health officials say they are better positioned to respond quickly, though still not completely ready.

Since starting to worry about "weapons of mass destruction" three years ago, the state has developed networks for spotting a potential germ-warfare attack and for coping better with the flood of sick or injured victims that might result from a terrorist attack.

Some of the precautions recommended by emergency planners, though, may take longer to accomplish because they require "significant investment of public and private funds," says James R. Stanton, director of planning for counter-terrorism efforts at the Maryland Institute of Emergency Medical Services.

The planners' work has taken on added significance since the attacks Sept. 11 in Washington, New York and Pennsylvania, and because of the potential of new terrorist strikes after the United States began bombing in Afghanistan on Sunday.

A study, released in February 2000 by the emergency medical services institute and the state Department of Health and Mental Hygiene, found that any incident that would produce casualties in the thousands is "not within the experience or planning horizons of the health and medical community."

The health system could probably handle an incident that producing several hundred casualties, but "when you hit 800 to 1,000 casualties, we begin to be overwhelmed," says Stanton.

Yet he says no one county or state in the nation is prepared to deal with an incident "similar in magnitude" to the attack on the World Trade Center in New York, where the city has begun issuing death certificates for the more than 5,000 people listed as missing.

In an era of managed care and after decades of eliminating excess hospital beds, it would be prohibi- tively expensive to have enough spare beds, staff and equipment on standby to handle such a surge of patients, Stanton says.

Instead, hospitals are developing plans to manage their space. For example, hospitals could treat patients in what normally are waiting rooms and lounges, set up decontamination areas in ambulance bays and discharge patients who don't need critical care.

That is how hospitals in New York and the Washington area handled the victims Sept. 11. The moment they received word of the attacks on the World Trade Center and the Pentagon, they began emptying beds.

But the expected surge never materialized.

"There were not mass casualties because of the swiftness of it," says Susan Waltman, a senior vice president of the New York Hospital Association.

"People either made it out and could walk to emergency rooms on their own, or they didn't make it out at all."

Maryland hospitals, as well as those throughout the nation, are required to have disaster plans, and those plans include transferring patients to make room for large numbers of casualties.

"What we need to do is go back and look at what else we need to do to free up hospital beds as quickly as we will need to," says Nancy Fiedler, senior vice president of the Maryland Hospital Association.

Federal and state officials began overhauling plans for health and medical responses to terrorist attacks after the bombing of the Alfred P. Murrah Federal Building in Oklahoma City and the gas attack in a Tokyo subway in 1995.

In March 1998, the Maryland Emergency Management Administration formed the state Terrorism Forum with emergency medical services institute and the state health department to draft new plans.

The agencies have produced two reports since then, one in 1999 and another last year.

Among other things, the reports recommended creating statewide systems to detect illnesses resulting from bio-terrorism, to alert health officials about developing incidents and to disseminate information.

It also recommended building caches of emergency supplies and creating new training programs for health care workers.

Stanton says emergency care specialists have come up with a plan that contemplates attacks with four categories of weapons - conventional explosives, chemicals, biological agents and radiological agents - and have run drills and exercises on that plan in the last year.

The plan predicts that attacks with explosives and chemicals are far more likely than with biological or radiological agents.

An attack with explosives could produce a large number of people suffering burns, and although the Johns Hopkins Hospital has a well-known burn center at its Bayview campus in East Baltimore, "we have inventoried services available to us in adjoining states," Stanton says.

The state has also developed a public health monitoring system that attempts to spot disease outbreaks in Maryland or elsewhere throughout the country that could be related to biological agents.

The same system monitors hospital bed status and distributes the information to public health and medical officials throughout the state electronically.

Ambulances in the field likewise would be coordinated, alerting them to hospitals that are overloaded and sending the drivers to hospitals that have space.

In addition, state emergency planners can call for help from federal agencies that can provide stockpiles of medicine and set up field hospitals within hours.

The task, Stanton says, is to make sure local health and emergency care agencies coordinate with each other to implement the parts of the plan that have not been completed - to invest in public health laboratories that can detect disease outbreaks more quickly and to improve training for emergency medical services, law enforcement and public safety officials who would be first on the scene of an attack.

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