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PUBLIC HEALTH

Hospital readiness

By Liz Kowalczyk, Globe Staff, 11/4/2001

   
 KEEPING SAFE

Articles:
How genuine is the risk?
Taking practical steps
Staying safe on the job
Handling new kind of stress
Talking with children
Is it just the flu?
What to do when in doubt
Hospital readiness
How the body fights back
Are there other threats?
Not all terror threats equal

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How to talk to your kids
5 signs you need help
What works, what doesn't
How anthrax is diagnosed
Inside a bacterial invasion
In case of emergency...
Identifying a mail threat
Safety resources

Compare cold & flu to other bioterror threats:
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Botulism
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More anthrax coverage

Massachusetts hospitals and public health agencies leapt into action so quickly after Sept. 11 that it was almost as if the terrorist attacks had happened here. An emergency bunker was open around-the-clock. Nurses tracked and reported available beds every two hours. And the Civil Air Patrol stood ready to fly 500 units of blood into the wounded city to the south.

In the end, New York City did not need Massachusetts' help. But the rapid response was a good test of what the state's medical and public health system was capable of and prepared for - and a sobering reminder of what needs to be done.

As bioterrorism becomes a reality of American life, most of us want to know whether our health system is ready. Can my doctor tell the difference between anthrax and the flu? Will the hospital find a bed for me if thousands of Massachusetts residents also are sickened? Are there enough lab workers to diagnose my illness quickly? And will I get the medication I need?

Fortunately, Massachusetts is home to some of the best hospitals in the country, and its doctors are familiar with a wide range of illnesses. Public health and emergency officials have been planning for disease outbreaks for a decade and say they are confident they can handle a small attack that injures up to several thousand people and is of short duration, meaning a couple of days.

However, they also are beginning to grapple with the system's limits. If terrorists pull off a prolonged or widespread biological or chemical attack, patients could overwhelm the medical system as communication breaks down, hospital beds fill up, and blood testing backs up at labs. For example, the state's public health lab can test 2,000 to 3,000 human or environmental samples a day for anthrax or other biological agents. Beyond that, said Ralph Timperi, director of the state lab, officials probably would have to mail samples out of state for testing, but they don't have a detailed plan for shipping them or receiving large numbers of complex results quickly.

If a large scale attack does occur, one with more than 5,000 victims, state officials would count on the federal government to swarm in with extra medical personnel, medication, and lab workers. But that crucial help could be delayed if other cities were hit at the same time.

''We're fairly well prepared for an initial response to any sort of incident,'' said Dr. Frank Friedman, an emergency room physician at New England Medical Center and chairman of the Boston teaching hospitals' emergency medical services committee. ''It's sustainability we're worried about.''

During a biological attack, which would probably be carried out secretly and discovered slowly, doctors and nurses will be the front line. Most have never seen or treated a person with anthrax, smallpox, or a viral hemorrhagic fever. But during the last three weeks, Massachusetts hospitals and public health officials have organized dozens of training seminars, held conference calls on recognizing infections, and sent e-mails on how to treat patients.

Doctors in private offices outside the cities, who are not closely connected with hospitals, do not have as much access to crucial and up-to-the-minute information.

Some health officials worry about holes in their knowledge. Partners HealthCare, the state's largest hospital and physician network, is trying to remedy this problem by e-mailing diagnosis and treatment guidelines to the organization's doctors and asking them to alert health officials to any suspicious cases.

If there were an anthrax attack that was scattered over time and sickened a small number of people, Massachusetts medical officials say they would have enough hospital beds, ventilators, and antibiotics.

Richard Serino, chief of Boston Emergency Medical Services, would not say how many doses of antibiotics are available in the city, but he said there is enough at the major teaching hospitals ''to treat several thousand infected people'' for the first few days of an outbreak.

If there were a chemical or nerve agent attack, which probably would occur rapidly with immediate injuries, ambulance workers would be the first to see patients. So the city has stocked enough atropine and 2pam, two common antidotes to nerve agents, on ambulances to treat 50 patients each. And there are enough drugs in Boston's stockpile to treat 1,000 people, Serino said.

The only supply of a potential treatment for smallpox, a vaccine that must be given within a couple of days of exposure, belongs to the federal government and would have to be shipped to Boston.

To treat patients with inhalation anthrax, the deadly form of the disease that destroys the lungs, Boston has 1,000 ventilators on hand. But no one is tracking the stockpile of drugs or ventilators statewide, and even in Boston it's easy to see the limits.

''If someone flies a crop-duster over Downtown Crossing at 5 p.m., you could easily have 1,000 injured,'' Friedman said. ''It's certainly possible to overwhelm the system.''

And while saying the system overall is well prepared, the assistant commissioner of public health, Nancy Ridley, contends community hospitals need more training and better decontamination facilities.

Hospital executives say they worry that they could run out of beds. After years of budget cuts and hospital closures, most facilities are 95 percent full year-round. During the attacks in New York City, Massachusetts hospitals freed up 1,200 beds by cancelling elective surgeries, moving out patients who could go home early, and obtaining state waivers on staffing ratios.

But Partners' chief executive, Dr. Samuel O. Thier, said he is concerned about a lack of coordination among hospitals statewide, particularly since there is no computer system to track beds. This would be important if Boston's teaching hospitals need to move patients to community hospitals to make way for more casualties. Information on empty beds was communicated by phone during the attack in New York, but Thier contends that during the Houston floods last June, the phone system broke down.

''If something is knocked out, you have to ask what's the backup? What's the second backup?,'' he said. ''Boston is still in better shape than almost anywhere else. What we don't need is panic. But we can't be Pollyannas about this.''

This story ran on page 11 of the Boston Sunday Globe's Common-sense Guide to Keeping Safe on 11/4/2001.
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