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Palo Alto Online

Publication Date: Wednesday, December 19, 2001

Bioterrorism response plan is in place Bioterrorism response plan is in place (December 19, 2001)

Stanford Hospital provides blueprint for everyone else

by Don Kazak

In the wake of the Sept. 11 terrorist attacks, Stanford Medical Center officials have been working to put a plan in place to deal medically with a bioterrorist attack.

That plan is not only in place, but it's ready to be used by other hospitals around the country.

Dr. Eric Weiss, assistant professor of emergency medicine, said the hospital has received calls from hospitals around the country. The plan is on the hospital's Web site and available for any institution to download. Weiss is also chair of the medical center's Bioterrorism Planning Task Force, which put the plan together.

"We initially focused our efforts on the local community, but then realized our work could benefit the greater medical community," said Dr. Philip Pizzo, dean of Stanford's School of Medicine.

It was an extensive effort. Stanford already had emergency plans in place to deal with mass casualties, such as the devastation caused by a massive earthquake. But when the anthrax episodes occurred in the wake of Sept. 11, Weiss said planners realized their measures to deal with the casualties of bioterrorism weren't as effective.

As a result, more than 50 people from 30 departments at the medical school and two hospitals worked on the plan, including psychiatrists and psychologists who examined the anxiety-provoking nature of bioterrorist incidents.

Another valuable component to the Stanford plan, Weiss said, was the ability to work with pediatric specialists from Lucile Packard Children's Hospital, because children often need a different sort of care from adults.

The plan has already been shared with Kaiser Permanente's Santa Clara Medical Center. "We reviewed the plan and thought it was a good product," said Eric Koscove, chief of that emergency department.

"We want to make it available to anyone who needs it," Weiss said. "They can download it and adapt it to meet their needs."

The plan assumes that biological attack by terrorists could result in outbreaks of anthrax, smallpox, botulism, plague or tularemia, a bacterial disease found in rodents. One of the scariest is smallpox because there is no treatment for it.

"Persons who received one or more smallpox vaccinations before the disease was eradicated worldwide have little or no immunity and virtually every living person in the world is now susceptible to the disease," the plan states. In addition, there is only a limited supply of smallpox vaccine available in the U.S.

Stanford Hospital runs disaster drills six times a year, twice a year as part of countywide drills. The most recent, on Nov. 15, wasn't a simulation of bioterrorism attack, but did hypothesize an accident releasing deadly ammonia. The procedures to protect the emergency room were similar to what the hospital would do if it were dealing with a bioterrorism attack, including patient triage outside the ER.

"The key to rapid intervention and prevention is to maintain a high level of vigilance," the plan reads. "To minimize the number of casualties, early identification that an outbreak is from an unnatural source is essential."

Some of what doctors and nurses would go through during such an outbreak was evident during the Nov. 15 drill, when a team of nurses and physicians provided triage outside the emergency room entrance. The plan was to prevent the "victims" from spreading the ammonia into the emergency room, turning the medical staff into victims themselves.

To that end, the Stanford Hospital ER is also using a system that helps emergency room doctors and nurses identify unusual patterns of illness that may in fact result from bioterrorism. The Biothreat Active Surveillance Integrated Information and Communication System (BASIICS) helps monitor ER patients by studying their signs and symptoms, feeding data off-site via phone lines.

The BASIICS system installed at Stanford in early November is expected to be put into nationwide use shortly. -- E-mail Don Kazak at [email protected]


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