October 5, 2001

VUMC vs. bioterrorism — Medical Center prepared for biological, chemical terrorism

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Kelley Work with Environmental Health and Safety helps a patient through the decontamination showers during a bioterrorism drill last year at Vanderbilt.(photo by Dana Johnson)

VUMC vs. bioterrorism — Medical Center prepared for biological, chemical terrorism

On Sept. 11, the threat of being a victim of terrorism on U.S. soil became a reality. Along with the sobering events of that day came the realization that terrorist acts will likely happen here again. Since that day, federal, state and local agencies have stepped up efforts to prepare for what may happen next.

One of the chief concerns of U.S. citizens is the possibility of some form of chemical or biological terrorism. Fortunately, the framework of a system already exists to address many possible scenarios. Several VUMC faculty and staff continue in their efforts to prepare the Medical Center for patient care after a chemical or biological attack.

“I think it’s the public’s opinion that when it comes to the U.S. medical community’s preparedness to care for victims of bioterrorism is that our pants are all the way down. In actuality, at this point our pants are only half-down,” said Dr. Ian Jones, assistant professor of Emergency Medicine. “We’re not as far behind as we could be, but we still have a long way to go to be ready.”

“Bioterrorism is certainly a possibility, but if there’s good news, it’s going to be harder for terrorists to pull off than people think,” he said.

VUMC’s department of Emergency Medicine, which includes both the Adult Emergency Department and Children’s Hospital Pediatric Emergency Department, will serve as a frontline in surveillance and patient care efforts should a biological or chemical attack occur in the Middle Tennessee area.

As one of the 120 top U.S. cities Nashville has been identified by the CDC’s Working Group on Hospital Infections Program and Bioterrorism to develop a Metropolitan Medical Response System (MMRS). Within the system, VUMC would assume a critical role in the event of a weapons of mass destruction event. Nashville’s involvement in the MMRS means a high level of awareness and preparation within its health care community.

Jones and Dr. Robin Hemphill, assistant professor of Emergency Medicine, are working together to form a plan to provide educational training on biological and chemical agents. “In addition to the many things VUMC has already done to prepare for mass chemical or biologic exposures, such as our state-of-the-art decontamination shower, education and training are ongoing,” he said.

In the coming weeks Jones and Hemphill will begin giving general overview lectures about the signs and symptoms of diseases associated with bioterrorism for VUMC’s faculty and other health care providers like area EMS personnel. Additionally, Hemphill is working with the School of Nursing on a multi-year Federal Grant to educate health care providers on how to best deal with causalities due to bioterrorism and other weapons of mass destruciton.

On the national level the Centers for Disease Control and Prevention is planning an early surveillance program that will gather data from hospitals all over the country via computer network. The program monitors spikes in particular symptoms or diagnoses indicating unusual patterns of disease. The CDC’s early surveillance program was under development before the terrorist attacks on Sept. 11. Since then the program has become a CDC priority. Vanderbilt is considering participation in the program.

Health care providers are in agreement that managing a large-scale biological or chemical attack will require the efforts of hospitals like VUMC working in concert with city, state and federal agencies.

“The community has, with the aid of federal grants, done a lot of disaster and terrorism response planning,” said Dr. William Schaffner, professor and chair of Preventive Medicine. “Most of that has emphasized criminal justice, trauma, chemical spills and the like. There has been a fair amount of that planning in those areas that has gone on and that’s good.”

Schaffner says the Tennessee State Health Department, in conjunction with municipal and county health departments, has conducted training exercises and that all agencies are in the process of obtaining a stockpile of critical antibiotics. “The antibiotics would be available as a backstop in the event something untoward happened,” he said.

“Within VUMC our preparedness to care for victims of mass trauma or chemical exposures is probably A-1. We have done many rehearsals, and the team in the ED, Trauma Unit, and Department of Orthopaedics has good experience on a day-to-day basis.”

When it comes to treating large numbers of bacterial infections, VUMC has already done several things to prepare. Hospital officials have assessed pharmacy inventory and have identified critical antibiotics in order to have a larger supply on hand. This will complement the larger inventories of the Metro and State Health Departments.

Schaffner says staff has conducted an inventory of personal protective gear—OSHA masks, gowns, gloves—to make sure an adequate supply exists.

“I would like to provide assurance that this seemingly simple equipment offers powerful protection against any of the agents that might be involved in bioterrorism,” he said. “If health care workers use this equipment regularly and correctly, they can be secure that they can pitch in, help take care of the sick, and keep themselves healthy.”

Schaffner likes to use himself as an example of the effectiveness of masks. Having spent more than 30 years as a physician specializing in infectious diseases, he has seen “innumerable” cases of communicable tuberculosis. Yet, thanks to his strict use of masks and adherence to other parts of the TB control program, he still has a negative TB skin test. “These devices work to great effectiveness. I cannot emphasize this enough,” he said.

Schaffner agrees with Jones’ assessment that there is still much work to be done. “We are in the process of planning more education about bioterrorism,” he said. “We hope to have several faculty members, even some residents, who develop educational modules for physicians, nurses and other health care workers. With our connections to the CDC, the latest information will be available so that we can be a source of information for other institutions, health care providers and the community.”

Several months ago, Hemphill and Terri Urbano, associate dean for Life Long Learning and director of the International Nursing Consortium for Mass Casualty Education in the School of Nursing, assumed leadership roles for VUMC’s participation in a concerted national effort called the International Nursing Coalition For Mass Casualty Education.

The coalition’s goal is to develop a curriculum and continuing education competencies so that nurses in the community, and in all parts of the health care system, can better respond to weapons of mass destruction or a mass casualty event. This International Nursing Consortium was developed primarily through the efforts of the the Dean of the Nursing School, Colleen Conway-Welch and comes from her foresight on the importance of this topic.

“What we are hoping to develop are core competencies for every level of health care provider whether it is physicians, nurses, or EMS professionals,” said Hemphill. “These different health professionals need a base knowledge that is updateable and refreshable. Our task is to figure out what those needs are and then implement them. We need to give people the best information they can use.”