A new breed of medical horror
Hospitals may not be ready for nerve gas, smallpox, or a radioactive bomb
Most terrorism experts agree that surveillance needs to be stepped up: Specifically, cities and states should gather data to look for odd patterns, such as an unusual number of school absences in one neighborhood--especially outside flu season. New York already has one such system. And just last week, officials in Baltimore were scrambling to get a Web-based operation going to allow area hospitals to report numbers of flulike symptoms as they turn up.
Overwhelmed? Hospitals do have some of the technology and medicine to treat many attack injuries. Nerve gas victims get atropine, a drug often used to treat heart attacks. Chemical-burn victims are treated like other burn victims, with pain medication and measures to prevent infection. Radiation victims are at risk for organ failure but can be treated with cancer drugs like interleukins. And those infected with dangerous bacteria get heavy-duty antibiotics.
A big part of effective medical response is guaranteeing availability of supplies. If, for example, all the hospitals in one city order anti-infection masks or drugs from the same vendor, and if they run low at the same time, that could cripple the supply line in a crisis. To avoid supply problems, the government has developed a National Pharmaceutical Stockpile with caches of vaccines, drugs, and medical equipment like syringes and face masks stored around the country. It was activated for the first time on September 11.
Blood supplies pose a similar problem. The recent terrorist events showed that nationwide, the American Red Cross's collection locations weren't staffed adequately to screen potential donors and process blood. Donors waited in lines five to six hours long. So the agency is now developing a "Mercy Corps" of trained medical volunteers available after a disaster.
If hospitals are not well prepared, it's partly a matter of simple economics. After a decade of cost-cutting and downsizing, gearing up for a terrorist attack has been the last thing on the minds of hospital chiefs. There's a reluctance to use space and money to build decontamination bays inside hospitals, bays that might rarely be used. "Administrators live in a `put out today's fire' world, not a `hope it never happens' world," says Lew Stringer, medical director of state emergency management in North Carolina. "And you can't blame them for that."
It's especially hard to cast blame when some experts say the most alarming scenarios are highly unlikely. Amy Smithson, an expert on chemical and biological weapons at the Washington-based Henry L. Stimson Center, thinks the threat of this kind of attack has been exaggerated. "I'm seeing a lot of people say things on TV that really irk me," says Smithson. "Such as, `It's easy' or `It's inevitable.' It's neither." Aum Shinrikyo, for example, had Ph.D. scientists, millions of dollars, and years to work on biological and chemical weapons. All its biological efforts failed, and its sarin attack--at the height of rush hour in the world's busiest subway system--killed 12 people.
Others disagree. Rice University chemist James Tour says he recently purchased through the mail for a couple of hundred dollars enough chemicals to kill 50,000 people. Still others say that the question of whether terrorists can obtain chemicals and make weapons is largely irrelevant. "The thing that actually scares me is sabotage," says Jonathan B. Tucker, a terrorism expert at the Monterey Institute of International Studies in California. A terrorist attack on a chemical or nuclear plant could create a Bhopal- or Chernobyl-like disaster.
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