If there's anything that Don Hermey, safety officer for Sarasota Memorial Hospital, would like people here to know, it's that Sarasota has been planning for bioterrorism long before the nation suffered its first anthrax attacks.
"There's a naivete that we're starting from the ground up," says Hermey, a certified safety and health manager who has been with the hospital for 12 years. "There have been emergency workers planning and orchestrating scenarios for plans that are ready to be implemented tomorrow. There's a lot of readiness already out there."
Sarasota formed its current comprehensive emergency management plan (CEMP) after hurricanes Hugo and Andrew, basing it on state and local guidelines from the Federal Department of Emergecy Management (FEMA). The plan assigns different response tasks to teams of law enforcement, fire/rescue and area medical services. It includes, but is not limited to public works, social services, local media, port authorities and amateur radio groups; even animal care and control are considered. Each agency is represented by a local expert, and Emergency Services oversees the entire operation.
In May 2001, FEMA amended those guidelines to include terrorism preparedness, but Captain Douglas Wolfe, of Emergency Services in Sarasota, says plans have been in place here for nearly two years.
Some go back even further, thanks to regulations issued by the EPA in 1991 that require any company dealing with hazardous waste to submit detailed records to area hospitals and emergency departments. Those reports prompted local officials to re-examine their response systems in cases of chemical contamination or spills.
"Initially, when we set up emergency response plans, the purpose was two-fold," says Hermey. "To deal with local area businesses, and to handle agricultural accidents. My biggest fear was always the errant crop duster that might spray the wrong field and contaminate farm workers on the ground."
Hermey says that Sarasota's status as a low-risk target for international terrorists presents a two-fold challenge. "You need to concern yourself, but if you overstep, you could be alarming people unnecessarily." He adds that biological or chemical accidents can happen anywhere, and not always because of terrorism. "Recently, a drunk man fired a single gunshot into part of the Alaskan pipeline, causing millions of gallons of oil to spew out. Yes, we're low-risk, but the consequences of not being prepared for everything could be devastating."
By eliciting the cooperation of as many different sectors as possible, emergency planners hope to adapt to any circumstance. "That's how New York's emergency team was able to recover so quickly after the World Trade Center attacks," says Wolfe. Even though their offices, which were located in one of the towers, were destroyed, they were fully operational again within 48 hours.
Keeping that in mind, Hermey doesn't want to limit Sarasota Memorial's emergency plans to any specific biological or chemical threat. His goal is to get the broadest types of equipment in place so the hospital can handle a range of situations. But being prepared for everything may not be realistic.
For example, Dr. Mark Magenheim, medical executive director for the Sarasota County Health Department, says Sarasota is not ready to handle major attacks from chemical nerve gasses like Sarin, which killed 12 people and injured more than 5,000 in a Japanese subway seven years ago. "The reality is that if we were exposed to chemical agents like that, there wouldn't be time to react," he says. Nerve agents can cause death in only seconds, and for many of the deadliest ones, there is no antidote.
And no one can predict with certainty what terrorists might come up with next. Like Wolfe and Hermey, Magenheim has had to take on some new tasks since Sept. 11. Along with the clinical work that still comprises his usual duties, he now holds workshops about terrorism for civic groups and schools and educates medical professionals about how to detect biological terror agents.
At least twice a week, representatives from the agencies involved with planning for terrorism meet to discuss new developments and adjust their plans accordingly.
While many in the public health field worry that smallpox poses the next big health threat, Magenheim believes "we're going to see a lot more anthrax." He speculates that the limited scope of the first attacks indicates a deliberate attempt to test the mail system's effectiveness in spreading anthrax. Now that whoever was responsible has seen how easily the spores can escape from ordinary envelopes and contaminate other mail that comes in contact with affected postal machinery, Magenheim thinks other, much larger attacks may follow.
He says that unlike anthrax, which is not contagious and can be manufactured with relatively little risk to its handlers, smallpox requires a human host who is willing to be infected with the virus and then go into public situations where they can infect others.
"This is no longer theoretical," says Magenheim, who worries even more about bubonic plague and ricin toxin. Like anthrax, both are naturally occurring substances, and both are available in research facilities throughout the world.
Despite the dire possibilities, Magenheim remains philosophical, even optimistic. He recalls a story that recently appeared in the San Francisco Chronicle about poet laureate Billy Collins, whose first readings in Washington were postponed for months because of anthrax testing at the Library of Congress. Undaunted by the delay, and unrattled by possible threats to his own health, Collins later proclaimed that the prospect of "death is what makes life fun."
Obviously, a few thousand postal workers might disagree with that remark, but it helps Magenheim keep in perspective the fear that has gripped the nation in the wake of bioterrorism attacks. "It makes us revisit our spiritual centers," he says. "These new risks give immediacy to thinking about the things we're going to say or do. We must weigh these risks against known preventable circumstances that we're at much greater risk for."
He points out that 450,000 Americans die every year as a result of smoking, 20,000 from the flu, and many others from traffic fatalities caused by failure to wear seatbelts. "As a nation, we would never accept 450,000 anthrax deaths," he says. "And yet we will accept it from things we have control over."
He urges people to get their flu shots, pay more attention to their surroundings and focus on all the things that are important. "Hug our kids," he says. "Tell them we love them and think about how we are living each day." Bioterrorism or no bioterrorism, "If we're living in such a way that we'd regret it if this were our last day, then we need to be living another way."
When toxic material strikes, the last thing you should do is head for the hospital.
When asked how many people Sarasota Memorial Hospital was prepared to care for in a single attack, safety officer Don Hermey declined to give a number. "In an average year, the emergency room sees 70,000 patients. I think we could do 500."
Hermey hopes such a scenario doesn't happen. In the event of a widespread biological or chemical attack, emergency management officials would prefer to quarantine people and not let them go to the hospital. The reason: cross-contamination.
Imagine for a moment that you've opened a letter in your kitchen and been contaminated by a foreign substance. Instead of calling 911, you panic, grabbing the letter, your purse and a jacket as you sprint for the door. On your way out, you sprinkle a trail of the toxic material throughout your house. Once in the car, more leaks out. As you near a heavily congested U.S. 41 on your way to the hospital, you squeeze under a yellow traffic light and T-bone a car going the opposite direction. Bleeding and unconscious, you're unable to tell the emergency workers who are trying to cut you out of the car why you were in such a big hurry to beat the light. A fireman reaches into the car, picks up the toxic letter and tosses it aside. The tow truck driver handles it as well. Once in the hospital emergency room, the staff comes into contact with your clothes and skin. An attending nurse searches your purse for contact information. No one takes note of the mysterious white powder spread around the room. It could have come from the accident you were just in. By the time they discover what it really is, it's too late. You've just contaminated at least 50 other people.
Hermey says that if you honestly believe you have been exposed to a biological or chemical threat, stay where you are. Call authorities and wait for a hazardous materials team to come to you.