View Full Version : Health Care Unprepared for Terrorism

August 25th, 2003, 12:40 AM
August 25, 2003


Ready or Not


More alarm bells. This time they're being rung by a bearded New York physician whose mature, low-key manner (bedside and otherwise) is the farthest you can imagine from alarmist.

Now 59, Dr. Irwin Redlener has spent many years delivering health care to poor and neglected children throughout the United States. Back in the 1980's he and the musician Paul Simon (in an outstanding collaboration of hip and square) created the Children's Health Fund, which turned specially equipped vans into mobile units that could be driven to wherever the underserved children were.

When the World Trade Center was attacked, Dr. Redlener immediately sent vans from the Children's Health Fund to the triage center that was set up on Manhattan's West Side. That sudden experience of the intersection of medicine and terror led to an entirely new mission.

Dr. Redlener is now one of the key individuals working on the urgent task of developing strategies to care for the sick and wounded in the event of another terrorist attack. He's the founding director of the new National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health.

At the moment our state of readiness is not good.

"My biggest concern," said Dr. Redlener, "is that now, nearly two years after 9/11, the hospitals and public health systems are absolutely unprepared for another major act of terrorism. There's been very little improvement from two years ago. No one's really even defined what we mean by preparedness."

Extensive steps have been taken to prevent the use of airliners in another Sept. 11-type attack. But Dr. Redlener noted that there is a wide range of potential acts of terror that front-line emergency organizations, hospitals and the public health system may have to cope with. "We need to be prepared for things like car bombs, or a terrorist attack on a nuclear power facility. We need to be prepared for the release of a chemical or biological agent in a public place a train station, an airport, a sports arena. We need to be prepared for sabotage of major infrastructural systems bridges, for example, and transportation and communications facilities.

"The health care system has to be ready to respond effectively to any of these emergencies. And right now it's not."

A series of recent studies have found that not just the health care system, but also critical organizations like police and fire departments and public school systems are dangerously unprepared.

A study commissioned by the Centers for Disease Control and Prevention and released just last week by the RAND Corporation found that most emergency workers in the 40 cities and towns surveyed "feel vastly underprepared and underprotected for the consequences of chemical, biological or radiological terrorist attacks."

A study prepared for an association that represents school safety officers found that while its members believed their schools were potential "soft targets" for terrorists, they did not feel the schools were prepared to cope with an attack.

Other recent studies have found that most urban hospitals do not have the medical equipment needed to handle the number of patients that would likely result from a bioterrorist attack, and that the federal government's ability to fend off such an attack may well be jeopardized by "a shortage of science and medical experts."

Dr. Redlener and his colleagues at the National Center for Disaster Preparedness are trying to help bring a greater sense of order and effectiveness to the current chaotic state of disaster planning in the U.S. They are trying to do this in a kind of think tank-plus atmosphere, combining intensive research with very practical tasks, such as the development and coordination of training programs, specialized curriculums and protocols. (The military has already done important work in this area and Dr. Redlener said those efforts should be more widely shared.)

Dr. Redlener met recently with the homeland security secretary, Tom Ridge, whom he described as a "very able and responsive" official, who is grappling with an almost overwhelming mandate.

"We need national standards and benchmarks for what should be done," Dr. Redlener said. "We need new ways of looking at these problems. This whole issue of preparedness could end up being the ultimate Achilles' heel for America." *

Copyright 2003 The New York Times Company