Most U.S. hospitals found unprepared to handle chemical, biological attack

January 11, 2000
Web posted at: 10:24 p.m. EST (0324 GMT)

In this story: 3 out of 4 hospitals unprepared FBI declared 4 high level alerts in Dallas Pentagon needed in handling catastrophe RELATED STORIES, SITES

(CNN) -- Should a large scale biological or chemical attack be launched against U.S. civilians -- the United States has no practical contingency plan to handle it, according to a new report published in this week's Journal of the American Medical Association.

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Hospitals and other health care facilities are "poorly prepared" to care for victims of such an attack, the report said.

Terrorism experts say the probability of such an attack on any single U.S. city is low. However, they add, it's not so much a matter of if or when it will happen, as it is a question of where the attack will take place.

Terrorist activities that would affect a large number of civilians are of greatest concern. The JAMA study's authors looked at key elements of effective hospital response including decontamination and triage, medical therapy and coordination with public health agencies and emergency response personnel.

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Medical Correspondent Dr. Steve Salvatore looks at whether hospitals are prepared for a bioterrorist attack. Real 28K 80K Windows Media 28K 80K

"I think there is a general consensus among emergency planners and among the health care community in the United States that our health care preparedness for catastrophic chemical terrorism is not where we want it to be," said Dr. Joseph Barbera of George Washington University.

Five years ago, the Clinton administration spent $158 million to train firefighters, police and emergency medical service workers in 120 cities to deal with bioterrorism.

Experts say biological and chemical attacks shift a large part of the burden away from police and firemen to hospitals and health care workers.

"Our first obligation is to protect the facility, meaning the staff, our current patients, and our capability to take care of patients," Barbera said. "So we need to have immediate perimeter control and to redirect patients to where they can get what they need, which is decontamination."

Currently, about 25 percent of 6,000 U.S. hospitals are at some state of readiness for a chemical or biological incident, according to the American Hospital Association.

One such facility is New York's Presbyterian Hospital.

"We had to consider our proximity to areas that might likely be involved," said Dr. Neal Flomenbaum, head of the emergency department at New York Presbyterian Hospital. "The logistics of decontaminating large numbers of patients -- the likelihood that after a period of time, the ground floor of the hospital could be contaminated."

The hospital is stockpiling large quantities of antidotes and antibiotics in case of a bioterrorism attack.

"There's real reason to stockpile them in a central location," Flomenbaum said. "By central, I don't mean in one location for the entire country, but in cities, because the last thing you would want to do is have them widely available in the individual facilities and used inappropriately."

Parkland Hospital in Dallas also has a stockpile of drugs, including the antidote for sarin nerve gas, antibiotics for anthrax and medication to relieve suffering.

The Texas facility also has a bioterrorism response team and has trained the staff using simulated attacks. However, hospital officials concede they would be quickly overwhelmed.

"We could be dealing with 10 to 100 times what we've planned for," said Dr. Kathy Rinnert, a leader of one of the response teams.

Hospital officials said that since September, the FBI has declared a "Level One" terrorist alert -- the agency's highest alert level -- in Dallas four times

"While the frequency of risk is low, when an event occurs, the casualty numbers and the mortality -- the number of people that die -- will be very, very large," said Rinnert.

There has been only one successful biological attack in the United States. In 1984, the Rajneesh cult poisoned salad bars in Oregon with salmonella, sickening some 750 people.

"These are weapons that terrorists have had access to for decades and yet have shunned -- and I think they've shunned them for good reason -- that they are not very reliable. They are difficult to weaponize," said Bruce Hoffman, a terrorism expert with RAND.

A 1995 sarin gas attack in a Tokyo subway killed 11 people and set off alarms in Washington.

Last year, the Clinton administration doubled spending on federal efforts to counter such attacks, raising the figure to $1.4 billion.

The Defense Department set up a new command designed to help local police and disaster relief efforts -- drawing on the military's expertise in chemical, biological and nuclear weapons.

"The Defense Department is very adept at mobilizing and moving large numbers of people and great quantities of equipment and materials very quickly," said Brig. Gen. Bruce Lawlor, commander of the Joint Task Force. "In the event of one of these catastrophes, those kinds of skills are going to be very important."

Hoffman pointed out, however, that, "terrorists can still accomplish their basic aims of fear and intimidation just as well by using entirely conventional weapons -- the gun and the bomb."

Even those sorts of attacks apparently were successfully thwarted over the New Year's holiday. So while there is reason for caution, some analysts argue there's no need to go overboard against a threat that has yet to materialize.

Medical Correspondent Dr. Steve Salvatore, National Security Correspondent David Ensor and Correspondent Charles Zewe contributed to this report.