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Letter
Preparing at the Local Level
for Events Involving Weapons of Mass Destruction
Suggested citation for this article: Hoard ML, Williams
JM, Helmkamp JC, Furbee PM, Manley WG, Russell FK. Preparing at the
local level for events involving weapons of mass destruction. Emerg
Infect Dis [serial online] 2002 Sep [date cited];8. Available
from: URL: http://www.cdc.gov/ncidod/EID/vol8no9/01-0520.htm
To the Editor: The use of hijacked airplanes in the attacks on
the World Trade Center and the Pentagon on September 11, 2001, clearly
illustrated the immediate and massive destruction that can result from
a well-orchestrated, long-planned, and purposeful terrorist act. Weapons
of mass destruction (WMD) events (i.e., biological, nuclear, or chemical
attacks) present different challenges than other incidents involving mass
casualties (e.g., chemical spills, transportation mishaps, or natural
disasters). Persons involved in a biological weapons attack, for example,
may take days to develop symptoms and seek medical care (1);
a large geographic area may be affected, or persons may travel long distances
and unwittingly infect others, including hospital personnel (2).
Furthermore, traditional hazardous materials and emergency medical procedures
may be inadequate to respond to a WMD event (3-5). As
events of September 11 and its aftermath make clear, medical public health
systems were not optimally prepared. An effective response to a WMD event
focuses on two key areas: joint efforts between the medical community
and public health agencies and better trained and coordinated first responders
(i.e., law enforcement, public safety, hospital personnel, and public
health officials) (1-3).
In early 2001, telephone interviews with West Virginia county health
directors (CHDs) or their equivalent were conducted to ascertain the level
of collaboration between their departments and local hospitals in regard
to WMD preparedness and a coordinated medical and public health response.
Forty-four (90%) of 49 CHDs completed the interview. One of the 49 responding
CHDs is responsible for a six-county area, thus accounting for the state’s
55 counties.
Fewer than half (20 of 44) of the respondents have provided contact information
to local hospitals, and barely 20% have reciprocal information. Twenty-one
percent were either unaware of a policy for WMD preparedness or reported
that it was being handled by another agency. Although 72% of CHDs had
attended WMD training, only 14% of the training was in conjunction with
hospitals. While nearly two thirds rated their communication with hospitals
as moderate to strong, a similar proportion stated they had no protocol
for communicating with hospitals about a WMD event. Eighty-six percent
of CHDs reported that no new collaborative efforts were directed towards
the early identification of new or emerging infectious diseases possibly
related to bioterrorism. However, approximately one third of the CHDs
thought they should take initiative in this matter. Over 60% indicated
that primary responsibility for identifying biological agents rested in
another agency or was not the sole responsibility of the CHD. Further,
20% indicated they were weak or untrained in this area and thought that
development and implementation of policies, procedures, and training were
needed. While 93% of CHDs felt joint training with hospitals would be
beneficial, particularly in defining their respective roles in a WMD scenario,
many cited manpower and scheduling constraints for such joint training
sessions. Overall, CHDs reported weak relationships with area hospitals,
but thought that development or improvement of policies and procedures
through regular meetings and training would help prepare and plan for
a WMD event.
The results of this survey suggest that before September 11, West Virginia
CHDs and local hospitals had little collaboration in preparing to respond
to a WMD event. Despite the recent terrorist activities, local health
departments and hospitals may still be reluctant to spend resources in
preparation for events with a low probability of occurring, such as WMD
incidents. The local health departments and hospitals think that other
pressing programs will be jeopardized (6–8). Many federal
and state initiatives are under way to enhance the public health infrastructure
and its preparation and response to bioterrorism. Improving on programs
to meet daily operational challenges, as well as those presented by a
WMD event, must include the expertise of local health departments and
hospitals and encourage the creation of innovative, cost-effective preparedness
programs at the local level (9,10). Future research
should be conducted in areas of resource education and training, allocation
and sharing, personnel, and policy. This research will indicate if existing
programs should be improved and if new programs should be instituted.
Marna L. Hoard, Janet M. Williams, James C. Helmkamp, Paul M. Furbee,
William G. Manley, and Floyd K. Russell
West Virginia University, Morgantown, West Virginia
References
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