Dr. Thomas provided an overview of the history and breadth of biological agents. It was noted that this is not a new issue. In fact, he participated on a Presidential Commission on the topic in 1983. Having said that, everything changed 9-11. People take risks everyday, in what they eat, in what they do (e.g. travel, etc.). Add to that biological warfare. Key impact of this form of terrorism is social disruption; it is psychological terrorism. There is a clear priority of agents about which there is concern. Among them is traditional nerve agents, anthrax and smallpox. They all have different toxicities, delivery vehicles, etc. More preparation is needed for biological and chemical terrorism.
Michele Bachus, Communicable Disease Program Coordinator, Fairfax County Department of Public Health provided insights into what their department has been up to. With Fairfax Hospital as a critical site, they have upgraded their function from "passive surveillance" to "syndromic surveillance," which may go on indefinitely. Physical presence in the Fairfax Hospital ER is coupled with review of chief complaints forms. These forms are fed into a CDC algorithm that determines how serious the threat may be. Three thrusts of late: detection, communication (including their web site) and treatment clinics (not much action). They have received many calls and are coordinating closely with CDC.
Kathryn Hughes from Virginia Hospital Center Arlington provided a brief summary of the challenges faced during the Pentagon crisis. Among the real blessings was an hour of advanced warning to clear the ER and discharge patients where possible as occupancy was 95% prior to the disaster. Call system did a great job of bringing in staff under the disaster format. Major challenge of coordinating with so many people. Staffing in ER was 26 times normal. A total of 44 people were treated. Virginia Hospital Center Arlington has since upgraded its disaster plans taking into accounty the experience of September 11. The hospital conducted major debriefings afterward. In addition, the hopsital itself was physically modified to be able to scale up for a bigger disaster.
Bob Fleshner, CEO for the Mid-Atlantic Region of United Health Care provided an overview of their role. He started by noting that the previous presenters had focused on the front lines. Payers were clearly secondary players in the process. United’s focus was twofold: 1- to inform and 2-to reimburse. They were careful not to cross over into the realm of provider as they do not practice medicine. Key was to get information to all of their people so that they could field calls appropriately. There were protocols for medical directors to follow. Also have funded research at a major center at the U of MN focused on bio-terrorism. They actively refer people to this web site.
Doug Goldstein concluded the presentations by emphasizing the need for Internet resources to be implemented and utilized among physicians and hospitals for purposes of education, communication and collaboration.