9/11 Ten Years Later: Bioterrorism Preparedness, Then vs Now

An Expert Interview With James J. James, MD, DrPH, MHA

Janet Kim, MPH; James J. James, MD, DrPH, MHA

Disclosures

September 08, 2011

In This Article

Editor's Note:
It will soon be 10 years after September 11, 2001 (9/11). What progress has been made in healthcare and public health in regard to disaster preparedness and response? How have the public and private sectors been working together to ensure public safety? What does the future hold for the burgeoning discipline of disaster medicine for healthcare professionals?

Post-9/11, the American Medical Association (AMA) felt that they needed to have a credible presence in the area of preparedness and response. In December 2002, the AMA launched its Center for Public Health Preparedness and Disaster Response (CPHPDR). James J. James, MD, DrPH, MHA, a pivotal and well-known leader in the field, has served as its director since its inception. He brings more than 30 years of experience in the public and private healthcare sectors -- as a clinician, researcher, professional personnel manager, and program director -- to this challenging and critical undertaking. As director, Dr. James spearheaded the development of a number of key initiatives.

One of CPHPDR's monumental efforts to date is the development of a robust educational group called the National Disaster Life Support Educational Consortium. This group has developed, piloted, and put into use 3 courses -- advanced, basic, and core disaster life support -- which have been delivered to nearly 200,000 physicians, nurses, and other healthcare personnel. These courses are being upgraded to better integrate them and ensure that they are competency-based. It is hoped that an even larger audience is reached, with the goal of including these courses in the common core curriculum of health profession schools.

Another major effort was the development of a public health response office, where CPHPDR works with public health and medical groups in areas affected by public health emergencies and disaster events with the objective of advancing the science of disaster medicine in public health preparedness. One of the office's projects is the Health Security Card, which is supported by a grant from the Centers for Disease Control and Prevention (CDC). The Health Security Card is intended to provide a means for the public to ensure they will have, on their person, absolute identification and basic medical information should they be caught in a catastrophic event.

The most important future initiative for the CPHPDR is going to be defining a registry of the ready, willing, and able, where individuals who are willing to respond under certain conditions can be identified. Information about who they are, what they are, what they can do, and whether they have had special training in preparedness and response will be included in the registry. Because it is not an operational entity, the AMA itself does not deploy; however, the AMA would be able to support government and legitimate nongovernment agencies by providing them with ready, willing, and able volunteers when needed.

Dr. James spoke with Medscape about the post-9/11 era of bioterrorism, specifically anthrax and hurricanes, which is especially timely given Hurricane Irene's recent landfall and destruction along the East Coast of the United States.

New or Emerging Potential Bioterrorist Threats: How Prepared Are We Now?

Medscape: You are well recognized for having played a pivotal role in the investigation and response to the anthrax attacks of 2001. What are the new or emerging potential bioterrorist threats to our nation? Are we now more or less prepared to respond to such bioterrorist attacks?

Dr. James: When you look at new or emerging potential bioterrorist threats, you need first to consider whether the emerging biological threats are natural or from a bioterrorist-intended source. So much of the activity of preparedness and response was focused on and benefitted from what went on with SARS [severe acute respiratory syndrome] and H1N1. When you look at biologicals in that light, unfortunately, the potential spectrum of new agents is truly almost unlimited and that is what is so scary. The same holds true when you look at biologicals that are intentionally used in a terrorist mode. When you do that, you are looking at what we might call the classical agents, first and foremost of which is anthrax, as well as other [infectious diseases] such as smallpox and plague. It is one thing to prepare and deal with the classical agent. With current biotechnology, however, the original agents can be so altered as to, in essence, represent new agents, engineered to potentially evade the countermeasures that we might have. I think the real answer to this question is not so much what new agents are out there today but rather what is potentially out there through cultivation of existing things or by engineering new, more potent, and more resistant agents.

Are we more or less prepared? And prepared for what? If you don't know what you're preparing for, it is really difficult to answer in an objective sense; yes, we are more prepared, or no, we are not more prepared. We have come to look less at specific preparedness for a given event with a given agent and more at the agent's effects in terms of type of injury and type of casualty. If you are dealing with anthrax, for example, you are dealing with individuals with circulatory and pulmonary collapse. Other agents [elicit effects that] may be hemorrhagic in nature or may have other biological effects. Instead of looking at anthrax, we are now looking at the effects of circulatory and pulmonary collapse. One strength of this approach is that when we look at specific outcomes instead of specific agents, we are able to cut across and prepare for all potential scenarios.

In terms of being prepared, we need to do as much work as we can in (1) educating and training our workforce about what is potentially out there, (2) educating the public on how best to respond to anticipated and unanticipated events, and (3) in terms of stockpiling or resourcing, maximizing those things that we know cut across all scenarios. A perfect example of stockpiling and resourcing would be ensuring availability of respirators. You can see a need for [respirators] across many plausible disaster scenarios. Another thing to consider when discussing stockpiling and resourcing is countermeasure development that gets into the manufacture or development of new antimicrobials and antiviral agents. When we consider the whole area of countermeasure development, yes, we need antimicrobials and antivirals that are targeted to a specific agent. However, we also need more countermeasures that are capable of fighting a whole class of agents, rather than a very specific one.

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