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A significant number of large corporations in the United States already had complex disaster plans in place when the "War on Terror" began, and most included a bioterrorism component. But as recent events suggest, not all possibilities had been anticipated by these plans. So, as mystery continues to shroud the cause of several deadly anthrax cases, companies across the country are going back to the drawing boards — and occupational health professionals are helping them.
"This has been a dominant part of my life for the last several weeks," says William B. Patterson, MD, MPH, FACOEM, chair of the medical policy board at OH+R in Wilmington, MA, noting "more interest on the part of all employers." (OH+R’s clients include Phillips Medical Systems, AGFA, several large hotel chains, and the U.S. Postal Service.) "We’ve had one very large employer so concerned about bioterrorism that they’ve paid our physicians to come into their worksites and provide one-hour employee education and question-and-answer programs," Patterson reports. "We’re developing the ability to have nonphysicians go in as well; it’s an advantage of being part of a large company that we have the resources that can pull it all together in a professional way."
"Some corporations had plans set up that they thought were good, but as a result of these recent events, everybody is reassessing," adds Charles Prezzia, MD, MPH, FRSM, general manager, health services and medical director of USX/US Steel Group in Pittsburgh. "The whole anthrax issue has to be interpreted within the context of bioterrorism, which is now a very real threat. People are looking at the whole aspect of communications and emergency response on a corporate level, as opposed to the plant level."
"What I see is a heightened awareness for both security and health care," says Virginia Lepping, RN, MBA, COHN, executive vice president of Providence Occupational Health Services in Granite City, IL. "One company I spoke to today said it has tight security when it comes to trade secrets, but now it is more concerned about disgruntled employees, and controlling and knowing everyone who comes into the facility and the purpose for their visits."
OH+R, which has 42 offices in nine states, is currently running employer seminars in all of those areas that are labeled "terrorism and disaster preparedness" programs. These programs are implemented in partnership with local hospitals and organizations or departments of public health. Typically lasting about two to three hours, they are presented to audiences of around 200. "We are getting excellent employer response," says Patterson.
The programs, whose main focus is to train managers, stress two main issues — what needs to be done to prepare ahead of time for disaster and terrorism, and what you need to do in the first 10 - 15 minutes if there is a disaster. "Mostly, this involves making decisions such as whether to evacuate, and if so, how to do it in a controlled way so as not to lose the ability to account for everyone," notes Patterson. "Do you need to isolate people? Do you need to turn off the HVAC [heating, ventilation and air conditioning] system to prevent the spread of spores? Do you send in your HazMat team, or is it too dangerous?"
In addition to educating staff about the scientific basics of bioterrorism, the program covers chemical events. It also stresses preventive measures. "This includes what we do in the mailroom, where we generally follow the recommendations of the [Centers for Disease Control and Prevention (CDC)], and we also stress issues like reminding employees not to carry suspicious letters into the hospital," Patterson notes.
The OH+R program also includes a component on stress. "We point out some very good critical incident stress management materials on the ACOEM [American College of Occupational and Emergency Medicine] web site, as well as on the CDC’s," Patterson says, noting that "a lot of what we present is in the pubic domain, but we bring to the table the ability to synthesize the information and put it on a level for managers, not physicians. We bring perspective to the information and then we add our own input."
The multidisciplinary panel also conducts a Q&A session, lasting anywhere from 30 minutes to one hour. "Typically, the panels will have one or two infectious disease/public health experts, and former military personnel experienced in chemical and biological warfare," says Patterson. "A number of the programs have also had local emergency medical services representatives or fire department administrators who can really talk to employers and tell them what they need to know. And of course, there are occ-med professionals. My own view is that occupational health physicians have the most experience with risk communication and equipment decision making, and are in an ideal position to engage in this kind of discussion," adds Patterson.
Prezzia also is a strong supporter of the multi-disciplined approach. "You have to get the relevant players from each department," he insists. "Within our corporation and within the occupational health profession, from my own perspective and from being with other medical directors, this situation calls for a cross-disciplinary approach involving medical, safety, industrial hygiene, security, legal, and human resources." Prezzia combines this structure with careful attention to how the information is presented. "In essence, you don’t want employees to panic, but you want to be sure they get the appropriate information," he says.
AT USX/USS Steel, that information includes how to evaluate a threat, who to notify, and how to respond. "We are extensively using our Intranet as well as e-mail notification," notes Prezzia. "Depending on what occurs, we need to have more rapid responses; this could include cell phones, pagers, any form of communication that is fast."
Prezzia and his staff are also helping employees empower themselves by continually updating relevant information about the CDC, Federal Bureau of Investigation, Postal Service, and Occupational Safety and Health Administration (OSHA) web sites. "We’ve also taken videotapes of CDC conferences and sent them out to our medical departments for research as well as to let them know what’s currently taking place," he explains. The company also is addressing the emotional impact of the anthrax attacks. "We have an employee assistance professional [EAP] here that reports to me," notes Prezzia. "We have on-site counselors at every significant plant we have, as well as an 800 number and on-line coverage through Ceridian."
The firm’s governmental affairs office in Washington, DC, was directly serviced by the Brentwood postal facility (where two employees died after exposure) and is located near the Pentagon, so the company’s EAP conducted a critical stress incident briefing. "With a critical stress incident we use small group debriefings, then one-on-one sessions depending on the event," Prezzia explains. "After the anthrax scares, we also had to have an assessment done by a reputable industrial hygiene group and respond to employee concerns in terms of prophylaxis."
Lepping has noted a call for improved communications by local firms in the last several weeks. "I’ve called around to a couple of larger companies," she says. "The medical center has an area-wide plan that incorporates bioterrorism, but we are identifying available resources and channels of communications. With local workplaces, we are making sure they have a communications plan set up with health services and fire departments in their areas." Companies that deal with hazardous materials may already have those communication links set up, she notes. "If something out of the ordinary occurs, be it symptomatic or just the observation of something unusual regardless of the source of the problem, these links would still be involved."
She’s also concerned about protecting staff. "We need security support for the nursing staff; if an area becomes contaminated, we want to make sure it is controlled until the authorities can reach it," she explains. In that vein, adds Lepping, OSHA will soon have some new resources available on its web site (www.osha.gov). "These will include a full set of guidelines on anthrax; protective equipment, how to instruct employees, and signs and symptoms," she says. "Outside of the military, anthrax is something the typical nurse in occupational health doesn’t come in contact with. That being the case, some of them need to be reintroduced to these diseases. We’ve done that with our ER and occ-health staffs, both nurses and physicians."
Interestingly, she notes, her group has not yet received specific requests from local firms to present on-site bioterrorism programs. "But we have had a lot of companies come in here for information, and we have a contract with the postal service, so we feel it is inevitable that someone will have that concern. That’s part of why we’re training our staff to recognize signs and symptoms — to support any employee coming in with them."
It is evident from these and other responses that not all employers have "gotten it" yet, says Patterson. "For example, a lot of factories and large buildings have not done adequate evacuation preparation," he notes. "What made the biggest difference in the World Trade Center was evacuation preparedness and effectiveness. There are certain basics every employer ought to follow, and it is our job to remind them of those basics."
[For more information, contact:
• William B. Patterson, MD, MPH, FACOEM, OH+R, 66B Concord St., Wilmington, MA 01887. Telephone: (978) 657-3826.
• Charles P. Prezzia, MD, MPH, FRSM, USX/US Steel Group, 600 Grant St., Room 2581, Pittsburgh, PA 15219. Telephone: (412) 433-6605.
• Virginia Lepping, RN, MBA, COHN, Providence Occupational Health Services, 2103 Iowa St., Suite D, Granite City, IL 62040. Telephone: (618) 798-3517].