Staying Alert Staying Alert (October 12, 2001)@24:subhead:

By Diana Reynolds Roome

Knowledge is often the best antidote to fear. For that reason, if no other, knowing what to expect and what to do in the case of an unusual emergency, such as a chemical or biological attack, may be the most effective way to increase our own sense of security during uncertain times.

"We've all had to think about this possibility," says Liz Bauer, clinical manager, emergency services at El Camino Hospital. "One of the first things I thought of when I heard about the terrorist attacks on September 11 was, okay, what do I need to do to mobilize and get ready for a problem here?"

Bauer's question to herself is being answered not only by the hospital, but by the health and emergency communities at large.

"We've been planning for chemical and biological warfare for the last two to three years," says Dr. Martin Fenstersheib, Santa Clara County public health officer. "Before September 11, this wasn't at the top of our priorities, but now we have a need that's being recognized. It's a tremendous opportunity to educate everyone."

El Camino Hospital has been educating its staff for a long time, as part of emergency preparedness protocols that all hospitals must have by law. "Every employee completes a complete safety education curriculum every year," says Keeley Blanchette, director of community relations.

Courses cover emergency management, triage, fire safety, dealing with hazardous materials and airborne pathogens, and even radiation poisoning. The entire staff of the hospital, whether medically trained or not, is equipped to offer useful skills and work as a team.

Partly because of the likelihood of earthquake, everyone is kept current on emergency procedures as a matter of course. Paper drills are regular events, though until now they have not focused on bioterrorism. During drills, every member of staff has to write an account of what he or she would do in the event of a hypothetical occurrence - which in Bauer's case, would be an intensification of her usual routine.

Fortunately, there are extra facilities and supplies available to the emergency department in the case of a full-scale alert. Four fully protective suits would allow medical personnel to work with patients without danger of contamination. As first responders, it is essential for medical personnel to protect themselves. There are also isolation rooms and scrub-down showers for people suffering chemical exposure. (The used water flows into a holding tank so that it will not contaminate the regular water supply).

The city's emergency services routinely prepare for the possibility of events such as toxic spills, airborne pathogens, or even radiation leaks. Because of the risk of earthquake and the city's proximity to major highways, rail lines and an airfield, Mountain View has always strived for a high degree of preparedness, though until recently terrorist attack has been low on the list of possible scenarios.

"Mountain View is not a high profile target," says Lynn Brown, coordinator for the city of Mountain View's office of emergency services, whose department works closely with Public Health. "I don't want to be Pollyanna-ish and say nothing can happen here, but I don't want to tell people to dig a bomb shelter in the back yard either. In my opinion, there's a greater risk from conventional weapons, a pipe bomb, or something like a tank full of anhydrous ammonia spilling on a motorway."

For the latter, or a localized chemical attack, there are hazardous materials teams trained to deal with such events. A widespread chemical attack, or biological warfare, would have to be prepared for and dealt with very differently.

"In a biological event, the first responders are medical clinics and doctors' offices. The new role for them is to provide early recognition," says Fenstersheib.

Santa Clara County's 4,000 physicians are receiving a "Zebra package" of information, including guidelines to be distributed to patients in English, Spanish and Vietnamese. These answer common question about gas masks, vaccinations or antibiotics. For example, gas masks are only effective when fitted properly and provided with the correct filter for each specific chemical or biological agent, which makes them impractical.

Smallpox and anthrax vaccines are currently unavailable, though anthrax is not contagious and responds to antibiotic treatment if detected early enough. Preventive antibiotics are not recommended.

"There's no magic pill that could be taken for many types of diseases, no one remedy that fits all problems," says Bauer. A run on certain antibiotics which people want to keep at home "in case" could cause a shortage, if the time came when it was really needed.

Indiscriminate use of antibiotics can cause mutation of bacteria, which might then develop resistant strains. The U.S. Government's Department of Health and Human Services has stockpiles of emergency response medications and equipment, the nearest in San Jose, which can be mobilized in the event of an outbreak. The county health services communicate with California's Department of Health on such recommendations; the state health department in turn communicates with federal agencies such as the DHHS and Centers for Disease Control.

Anyone suffering from unusual symptoms is advised to do what they would ordinarily do: see their doctor. Physicians are instructed to report suspicious illnesses or unfamiliar symptoms at once. A health surveillance system, which is now being finalized, allows physicians to feed information about syndromes they are seeing into a single public health organization that can detect blips, spikes or unusual patterns.

Though dealing with anything as unpredictable as biological or chemical sickness is best left to the professionals, Brown believes that there is much preventive work that can be done by individuals. All citizens should prepare their homes for hazards, whether natural, technological, or intentional.

Everyone should have a family plan for earthquake, fire, flood or toxic spills, and though the details would vary, some elements would remain essentially the same. Water, food, a radio, batteries and other essential supplies should always be kept on hand. A neighborhood support plan multiplies the effectiveness of each individual's or family's preparations.

"If people can come together as neighbors, especially if a few have had training, this helps everyone, including city services," says Brown. "Normally, if something happens in one neighborhood, all services will go there. But in a citywide emergency, people may have to help themselves for a while. They should be prepared for 72 hours without services

However, he adds, they should never feel out of touch, as the emergency alert system will break into radio and TV programs to make important announcements. Also, in a worst-case scenario, police would drive around, seeking out localized areas that need urgent help.

Brown has recently appeared on the KMVT cable station, discussing some of these safety issues with the city manager, police chief and fire chief, among others. He also teaches a class in basic disaster readiness that normally runs twice a year, the second beginning in October. This fall's class already has a waiting list, but Brown is only too happy at the prospect of teaching an extra class to accommodate the overflow.

Among other things, his classes teach effective damage assessment, search and rescue, gas shutoff, and first aid. In case of airborne toxins or bacteria, shelter-in-place strategies would be important: closing all doors and windows, and possibly sealing them.

If a community approach is the most effective way to stay safe, this community so far seems bent on helping out rather than asking for help.

"Our main calls after the terrorist attacks on the east coast were for giving blood," says Blanchette. "Our lab received hundreds of phone calls."

"Though we don't want to rest on our laurels," says Brown "We're in pretty good shape here in Mountain View."
The Santa Clara County Public Health department has set up an Information Line to answer questions at: 408-885-3980. For information on Mountain View City emergency plans: www.cimtnview.ca.us, link to fire department, then to emergency preparedness. To find out more or sign up for the emergency preparedness class call Lynn Brown, officer of emergency services: 650-903-6825. You can contact the Centers for Disease Control at www.bt.cdc.gov, or phone1-800-311-3435, or e-mail questions at: [email protected]