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The concern over terrorism has centered on biological attacks since the Sept. 11 attacks and the subsequent anthrax exposures by mail, leading the Joint Commission on Accreditation of Healthcare Organizations to call for a significant improvement in the health care community’s preparations. But while industrywide improvements may be needed, security experts tell Healthcare Risk Management that most hospitals and other providers can address the problem by shoring up existing policies.
No major revision or new policies will be necessary in most facilities, says Lee Matthews, CHPA, CPP, interim executive director of the International Association for Healthcare Security and Safety. The anthrax attacks in October caused a nationwide paranoia about any suspicious powders or mail deliveries, but Matthews points out that almost all of the reports turned out to be false alarms. And because anthrax is not contagious and is difficult to effectively spread, it should not be a major concern for hospitals, he says.
"There are some real concerns, but worrying about your facility getting attacked with something like anthrax is a waste of time. It’s just a distraction," he says.
Even treating anthrax exposures should not pose a major problem to hospitals, he says. The actual substance containing anthrax spores must be contained as a hazardous material, but existing hospital policies on hazardous materials should cover such an event, he says. Treatment for those exposed involves prescribing Cipro, a common antibiotic.
Biological warfare is a serious threat, Matthews says, and other types of pathogens could pose a serious threat to the population while also challenging the health care response. The most worrisome biological threats are those that would be contagious, such as smallpox, he says. An attack with those agents could overwhelm a hospital with patients and possibly cause a panic in the community. If the population panics, the hospital could be overrun by those seeking medications and treatment, even if they don’t need it, he says.
"In those situations, controlling access to your facility becomes one of the primary concerns," Matthews says. "When your community is scared and they see you as the solution, you have to deal with crowds knocking on your door."
The good news is that your health care organization should already have policies and procedures in place for dealing with all of those threats, he says. They may need to be improved and re-examined in the light of the terrorist threats, but you shouldn’t have to start from scratch. (For more on how to be sure your emergency preparedness plans will cover terrorism, see HRM, November 2001.)
While he urges a calm and reasonable response, he does say that health care risk managers should look into providing more education to their staff and physicians about the nature of bioterrorism. That is one point where his advice coincides with the concerns of the Joint Commission.
On a nationwide level, the Joint Commission is calling on Congress to improve the nation’s bioterrorism response capacity by developing system-wide, integrated community approaches to emergency management that are supported at the federal and state levels. And the Joint Commission wants it done quickly.
Joint Commission president Dennis S. O’Leary, MD, recently spoke at bioterrorism hearings before the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce, saying public health systems should be improved.
"We, as a nation, are not unprepared to deal with bioterrorism, but this country’s public health and medical care systems could be better prepared than they are today," O’Leary said. "We need to start addressing the identified needs with all due haste."
O’Leary said one of the first priorities should be training medical professionals regarding pathogens that may be used in bioterrorism, to make them aware of the symptoms they produce, knowledgeable about their routes of transmission, and alert to the possibility of their use.
A single, integrated system of response also should be created to effectively address a full range of diseases and rare events, whether of terrorist or natural origins, he said. O’Leary also called for community or statewide capacity analyses of preparedness that would include available medical facilities and delivery sites. A medical/public health surveillance system should be established to promptly detect naturally occurring epidemics as well as terrorist activity, he said, and issues relating to precious national supplies including vaccines and their disbursement need to be evaluated and resolved.
"If the system capabilities are appropriately upgraded, the medical care and public health systems will be able to respond effectively to massive disasters," O’Leary said.