A new breed of medical horror
Hospitals may not be ready for nerve gas, smallpox, or a radioactive bomb
`I just wish we had more patients," said Mark Smith, emergency chief at Washington Hospital Center, two days after the terrorist attacks. Smith didn't want more carnage; he did want to save more lives. But though his hospital was expecting a massive wave of injuries from the nearby Pentagon, the region's primary trauma center took in just 10 victims. Only as the day wore on did he begin to realize that the scarcity of injured meant most victims had perished at the scene.
Smith may yet see an attack, however, that creates dozens, hundreds, or even thousands of casualties. Intelligence experts believe that Osama bin Laden has been trying for years to obtain enriched uranium usable in a "dirty bomb" that could spread radioactivity over a city. He may have pursued bioterrorism agents like anthrax, smallpox, and the bubonic plague. And the components for nerve gas may be frighteningly easy for terrorists to obtain--though, like bioagents, very difficult to make into a weapon. "If I have indeed acquired these weapons," bin Laden has said, "then I thank God for enabling me to do so."
Are Americans at risk? The federal government thinks so. It has spent billions of dollars on antiterrorism measures since the 1995 sarin nerve-agent attack in Japan's subway by the Aum Shinrikyo cult. One hundred twenty cities around the country have received federal funds to develop emergency plans and conduct simulations of chemical and biological attacks. Some cities say they now feel fairly well prepared for a chemical disaster. But others aren't, and hospitals all over the country say they're not truly ready for biological attack, to say nothing of nuclear radiation. "We can deal easily with 10 severely injured people," says Anthony MacIntyre, an emergency physician at George Washington University Medical Center who was part of the Pentagon rescue effort. "We can't deal with thousands. No one is prepared for Armageddon."
Safety first. Released in a shopping mall, subway, or at a place like Disneyland, nerve agents like sarin, soman, or VX would hit people quickly and dramatically. Tests have shown that firefighters can protect themselves, if they use duct tape to seal their uniforms and wear their regular breathing apparatus. But police officers and emergency workers would have much less protection. And while some counties' fire engines have started carrying antidotes for nerve agents, most do not. So rescue forces are purchasing their own masks. "I'm not interested in sending my people out to become what we call `blue canaries,' " says Patrick Sullivan, sheriff of Arapahoe County, just outside Denver.
Ordinary people, not rescue workers, of course, would need the most help, and many--still contaminated--would find their way directly to the hospital. So hospital workers would have to diagnose and decontaminate. In chemical assaults with skin-burning agents, about 80 percent of the substances can be removed by shucking clothes. The rest can be taken off by a warm shower, and many hospitals have plans to turn their parking lots into emergency decontamination posts. Nerve gases and radiation poisoning are harder to identify, and if terrorists unleashed a clandestine biological attack, it could take weeks before health officials even realize there is a problem. Agents like anthrax and smallpox produce early flulike symptoms. A smallpox simulation called Dark Winter, played out at Andrews Air Force Base in Maryland in June, showed that a well-coordinated attack with smallpox or plague could kill hundreds of thousands of people.
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