Doctors urged to focus on terror readiness

The recent elevation of the U.S. alert status means physicians should check plans to handle and possibly detect a terrorist attack.

By Victoria Stagg Elliott, AMNews staff. March 3, 2003. Additional information

Last month's announcement that the Homeland Security Council would raise the country's terrorism alert status to orange, the second highest level, left many wondering what it meant to them personally.

Attorney General John Ashcroft suggested that Americans continue about their business but with more awareness.

But for physicians -- who may have a significant role in responding to, or even detecting, a terrorist attack, particularly if an infectious agent is used -- the announcement is asking for a little bit more.

Overall, doctors should increase their vigilance for unusual medical conditions and ensure that their links to local public health departments are in place so anything out of the ordinary can be quickly reported.

"We have got to make sure that we are in contact with our public health and state defense authorities to at least be aware of what the communities' response needs will be," said Warren A. Jones, MD, immediate past president of the American Academy of Family Physicians.

Physicians in solo or small practices should review emergency plans for their offices and employees and, in some instances, be familiar with those of their vendors to ensure that their offices will be equipped with necessary supplies.

Duct tape has many uses.

In the hospital setting, the orange alert has prompted a review of response plans and preparations for the possibility of mass causalities.

Physicians and other health workers are also encouraged to be aware of procedures for incidents involving radioactive or chemical weapons. Plans are being put in place for drawing in extra staff to expand facilities' surge capacity. Off-site supplies that might be needed during an attack are being readied to roll out at a moment's notice. Defenses against computer viruses are being beefed up, and those who may be needed in emergencies are developing closer relationships with their pagers and cell phones.

Despite such efforts, experts are quick to point out that much of what is being done in response to the heightened alert is also appropriate preparation for any emergency. Infections should be dealt with in similar manners, no matter what the source. Duct tape has many uses. Extra water can get people through hurricanes and other natural disasters.

"My management of a child with meningitis is going to be no different than my management of a child whoI think has smallpox," said Joseph Hagan, MD, chair of the American Academy of Pediatrics' task force on terrorism. "The management, in terms of notifying public health, will be the same because they're both reportable."

Physicians should realize that patients may request additional doses of their regular prescription medications. The homeland security office advises people to have at least three days of basic supplies on hand in the event of an emergency that could interrupt supply lines or cause them to be housebound. But most physicians are quick to say that now is not the time for their patients to stockpile any medications outside of their regular regimen.

There has not been, thus far, a rush on prescription medications, but signs of patients' increased anxiety are becoming evident.

Many terror response plans are also appropriate for other types of emergencies.

"We are going to see a tremendous increase in anxiety as a symptom," said Dr. Hagan. "Anxiety as a comorbidity is going to be as prevalent again as it was in the week following Sept. 11."

Despite the activity generated by the elevated alert status, some bioterrorism experts are questioning the effectiveness of the color-coded system, saying it is not specific enough to generate a meaningful reaction.

"It is not helping one bit to have vague, poorly defined warnings coming out. It's inviting cynicism. We can't afford to have our national policy end up as a 'Saturday Night Live' routine," said Luther Rhodes, MD, chief of the infectious disease division at Lehigh Valley Hospital in Allentown, Pa.

The United States was last on orange alert for the two weeks following the first anniversary of the Sept. 11, 2001, attacks.

ADDITIONAL INFORMATION:

Code Orange

What physicians need to do in response to this level of alert:

Increase vigilance for out-of-the-ordinary medical conditions.
Confirm links with public health agencies.
Review emergency plans and, when appropriate, consult vendors or suppliers regarding their plans.
Manage patient requests to have additional doses of their regular prescription medications on hand.
Consider that patients may be suffering from additional stress.

Weblink

Statement from the Dept. of Homeland Security on emergency preparedness and terror readiness (http://www.whitehouse.gov/news/releases/2003/02/20030207-10.html)

Transcript of the announcement by Attorney General John Ashcroft, Homeland Security Secretary Tom Ridge and FBI Director Robert S. Mueller III raising the security threat level (http://www.whitehouse.gov/news/releases/2003/02/20030207-6.html)

HEALTH & SCIENCE