Hope reigns that bioterrorism won't occur, but if it does in the vicinity of Providence Medical Center, Kansas City, Mo., or Parkland Health and Hospital System, Dallas, infection control staff will be ready. Providence's drill tentatively is scheduled for July to test revised infection control preparedness in the event of a bioterrorist attack.

"Without a budget for it we've taken a lot of steps to prepare for weapons of mass destruction," says Nyla "Skee" Japp, regional infection control coordinator, Providence, and past president of ASHCSP. "We now have a complete regional plan for nuclear, biological and chemical attacks that wasn't covered in the original disaster plan. But we still have much to do before we are ready for the drill."

Money promised this year from state and federal sources could help provide such hospitals as Providence and Parkland with additional emergency training and with personal protective equipment, decontamination units, antibiotics and antidotes for biological and chemical weapons, she says.

"We don't have specifics yet on what biological threat we might use for our summer drill, but it will be a single-day event involving the fire department, police, emergency medical services, the county health department and the sheriff's department," Japp says.

"We probably will involve the federal agencies because we would be required to follow certain procedures with a biological or radiation disaster."

But will federal disaster preparedness money be enough?

Making ends meet

The federal Health Resources and Services Administration (HRSA) has allocated $125 million in 2002 for hospital bioterrorism preparedness.

The HRSA money is part of more than $1 billion to be used for state and local bioterrorism needs. Federal law requires state health departments to administer the HRSA program.

Hospitals are working with states to set priorities and to develop funding schedules. AHA representatives estimate the nation's 5,800 hospitals need $11 billion--$1.9 million per hospital--to prepare for mass casualties in the event of a biological, chemical or nuclear terrorist attack. The $125 million allocated this year from HRSA averages about $21,000 per hospital.

"There is a divergence of opinion on how funds should be used," says Matt Wall, associate general counsel, Texas Hospital Association, Austin. "The health department wants funds spent on coordination, communication, education and training. Hospitals recommend funds be spent primarily on personal protective equipment, antibiotics, decontamination showers and units."

Missouri will receive approximately $2.4 million in two funding stages, or about $15,800 per hospital. It is anticipated that Texas will receive about $8.4 million, or $16,500 per hospital. Funds range from $9.9 million for California to $441,000 for Wyoming.

"The health care funding for bioterrorism is just dreadful. I don't think our hospitals are funded adequately," says Barbara Sercely, infection control coordinator, Parkland.

"The rhetoric doesn't match the need," says Shirley Shores, manager for infection control, Parkland. "We need additional medications and equipment. We are already as prepared as any hospital in the country, but if you get a multitude of victims, there is only so much we can do without more funding."

Colorado hospitals will be receiving $1.9 million in federal funds this year and different ways of using the money are being researched, says Larry Wall, president, Colorado Health and Hospital Association, Denver, and chair of the state's hospital bioterrorism committee.

"It may be better to address preparedness on a regional basis rather than each hospital receiving a little bit," Wall says. "One way we may choose is to select one facility in each region and build its resources."

Regardless of the level of preparedness, infection control coordinators should work closely with emergency physicians to determine an appropriate response to a possible bioterrorist attack, says Stephen Cantrill, M.D., associate director of the emergency department, Denver Health Medical Center.

"Once a determination is made that someone has the plague as opposed to a common cold, you need to be able to take appropriate action quickly," says Cantrill. "Hospital staff must be ready."

But ready for what is the question. Hospitals don't have enough equipment to protect against a smallpox epidemic, Japp says.

"We have spoken with the state health department because we don't have the necessary numbers of ventilators, I.V. infusion pumps, hyberbaric chambers and external pacemakers," she says. "Most of the country is talking about upgrading the medical emergency network."

Japp says Providence now is spending additional money to train staff at bioterrorism conferences. "The additional federal money will help with supplies because hospitals have gotten to the bare bones with cost cutting."

Plan of attack

The one silver lining of bioterrorism preparedness is that infection control coordinators now feel as though they are more a part of disaster planning, Shores says.

"We are meeting new partners in the fire department, police and FBI, and we are much more involved with the emergency department," Sercely says. "The fact that we are all talking more will help us in regional planning for disasters."

Japp agrees. "It's great to establish these relationships because now we have a much greater appreciation for each other," she says. "Certainly, if something were to happen we would know who to contact and how to work through our plans."

But infection control coordinators are far more involved in bioterrorism preparedness than having the phone numbers of other agencies on speed dial.

"After 9/11, the response team [Kansas City Area Medical Response System, (KCAMRS)] felt it needed to add infection control coordinators and we were invited for specific insight to the biological hazards," Japp says. "The team didn't have that expertise before. We have been able to talk with them about specific organisms, patient decon tamination and isolation."

In the past, the county disaster team has prepared for chemical spills and pesticide exposures and accidents involving cars, trains, planes and buses, she says.

"We are required [by the JCAHO] to have two external and two internal drills a year," Japp says.

Throughout the next several months, KCAMRS will create a biological disaster scenario in which county, state and possibly federal emergency agencies will be involved, she says.

"This summer we will try to make our drill more than just Parkland and involve the other three hospitals on our campus," says Sercely. Parkland shares a campus with Children's Medical Center, Zale Lipshy University Hospital and St. Paul Medical Center.

During the last year, Parkland's infection control department has established a closer relationship with the FBI's Weapons of Mass Destruction Group and the Dallas-Fort Worth Hospital Council's subcommittee on bioterrorism, Shores says. "We have been in the groups before, but now there is more urgency, especially with the anthrax scare and bioterrorism threats. Infection control is becoming a more important partner."(omega)

Jay Greene is a freelance writer based in St. Paul, Minn.

This article first appeared in the May 2002 issue of Materials Management in Health Care

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