The movie "Smallpox" that aired on the FX cable network January 2 gave us a glimpse of what may happen when terrorists launch their biological weapons attack on our nation. Though difficult and frightening to watch, that show gave us an opportunity to prepare. What can we do as individuals, offices, and professionals to defend our families, friends, and patients? As dentists we love "kits", self-contained conglomerations that contain all of the tools, materials, and technical information needed to successfully complete a task. I wish that such a kit existed for a bio-attack. For now, though, we can build a only a starter kit. Here are some suggestions for how you might do that.

Piece #1: Gather Essential Information

Begin by reading When Every Moment Counts by Senator Bill Frist, the Senate's only physician. This book gives a basic framework of the problem, the weapons, and what we can do at home and during our daily lives. Dr. Frist provides a host of Internet sites for further information.

The second book that should be read is Living Terrors by Michael Osterholm, Ph.D., M.P.H. This 1999 book tells us what we need to know to survive a biocatastrophe. It delineates what has been done and what more has to be done to survive.

The third book is Biohazard by Ken Alibek. Dr. Alibek was the head of the largest covert biological weapons program in the world. This book will give a complete new perspective of what is possible and what is awaiting us. You will be amazed that what you heard from the press does not jibe with the information in this book.

Next, become familiar with the Incident Command System. When a mass disaster occurs and government declares a disaster, the normal regulatory systems and hierarchies are replaced with one that is designed to direct and regulate a response in the area of the disaster. This military-style system governs during the disaster and its aftermath. In order to be part of the response, you will need to be part of the system. Working with your local police, fire, first-responders, and Department of Health will bring you into contact with the people who are part of this system.

The Minnesota Department of Health web site has good information on preparation at www.health.state.mn.us. Click on "Terrorism and Natural Disasters" current issues and overall planning information.

Piece #2: Gather Essential Supplies

Develop a list of essential supplies you should have on hand. Divide the list into supplies that are stable for storage and those that are not, i.e., those that have to be rotated from time to time. Determine the best area for storage, keeping these items together with boxes or tubs for transport. Keep all information guides together for home, office, and use in the field. Mark your calendar appropriately to drill and to replace/replenish your supplies.

Piece #3: Develop a Plan

Develop a plan for your office, home, and for you personally. Make sure your plans include all information you need in case of attack, including contact information at your local response organization. Make sure you have copies of the plans available for office staff, family members, and for yourself. Review and practice plan drills on a regular basis. A source for materials and planning assistance is the American Red Cross, at www.redcross.org.

Piece #4: Make Yourself Known

Make yourself known to others involved in mass disaster defense. Meet and train with them. Time and again, in mass disasters, being known by the people in charge will gain you access to the disaster area where your expertise will be an asset to the disaster response. Unless you have written credentials recognized by the Incident Commander, Incident Security, or are known, your preparations to serve will be wasted. The "first responders", including the American Red Cross, police, fire, and sherriff, will have plans in place for dealing with all kinds of emergency situations. Perhaps the best place to make your first contact is with your county health officials. They will know about your county's organization for responding to a terrorist attack. Very likely you will find that your county has a group or groups that meet regularly to formulate an operations plan that will interface with state and federal officials. Ask to be placed on their e-mail list.

A Sobering Scenario

The FX movie "Smallpox" showed how panic can set in, yet as you read this, most likely in a calm environment, this scenario feels unlikely, perhaps even absurd. This is where I suggest we consider that, for example, during the recent flu vaccine shortage, we had many people upset and angered by the long lines and the nagging possibility of not receiving a flu shot. There was no immediate danger; very few cases were reported. Now overlay upon this an outbreak from a bioweapon that has either no vaccine or a limited supply of medicine to control it. This, I believe, is a much more upsetting situation. Unlike the flu, which has a standard course most years, this will present as more of an unknown to the general population. Panic can very easily set in. Remind yourself of the anthrax problem we had in 2001. Fewer than a dozen people died, yet there was a very significant disruption in our lives. Congress actually shut down. This from an agent that is not communicable. With a communicable bioweapon that is released in multiple locations, it is very likely that the disease will be spread over a vast area of the nation.

Minnesota Status Report

How prepared are we in Minnesota? Dr. Frist speaks to this issue in his book. Early in December there was a preparedness ranking of the states based upon 10 criteria. Minnesota was in the top six.1 Even at that, we have a long way to go.

In a terrorist attack, how prepared we are is very important, but how the general population views our preparedness will affect how the population behaves during and after an attack. Dr. Roz Lasker headed a research team from the Survey Research Center, Institute for Social Research, University of Michigan, that studied the public's reaction to a smallpox outbreak and a "dirty bomb" explosion (radioactive materials in

the bomb).2 The public's reactions to instructions from the authorities were as follow:

1. Only two-fifths of the American people would go to the vaccination site in the smallpox outbreak.

2. Only three-fifths of the American people would shelter in place for as long as told in the dirty bomb explosion.

3. Two-fifths of the American people would be seriously worried about what government officials would say or do, and those who do not have a lot of trust in the system would be only half as likely to cooperate.

4. Three-fifths of the American people would have serious worries about the smallpox vaccine. That is twice as many people as would be worried about catching smallpox.

5. Worries about side effects from the smallpox vaccine would make one-fifth of the American people afraid to follow instructions to go to the vaccination site.

6. Three-fifths of Americans would be reluctant to follow instructions in a smallpox outbreak.

Could there be a widespread panic as in the movie? Without the cooperation of the general population will many more Americans die? I would say yes to both questions.

Dr. Lasker's group gave advice to planners. The pubic's concerns must be addressed and more realistic approaches for response need to be developed. Information, before and during a crisis, is always better received from people who are trusted. We as dental professionals are near the top of the trust list in the eyes of our patients. We will play a very important role in any biological attack. My advice is the motto of the Boy Scouts of America: be prepared.

Piece #5: Support Legislation by Minnesota Department of Health

During the legislative session, the Minnesota House and Senate will be acting on three bills introduced by the Minnesota Department of Health and the Minnesota Department of Administration. The passage of these three bills is crucial to the success of any response to a mass disaster whether it be a terrorist attack or a widespread infectious disease such as pandemic flu outbreak. Some of the changes include:

1. Clarification of liability and worker's compensation protections for volunteers working under appropriate supervision.

2. Authorize professionals licensed

in Canada and Washington D.C. to assist in a Minnesota emergency as the Governor requests.

3. Extend "Good Samaritan" style liability protections to all responders in worst-case situations where the capacity of the health care system has been exceeded.

4. Isolation and quarantine provisions to limit the spread of disease while providing support to persons affected by the quarantine order including job protection.

Your support for these bills will be very important. If it becomes necessary to enlist the help of everyone to contact his or her local legislators, the MDA will alert you with talking points for use with your lawmakers.

The Minnesota Department of Health is asking for support from all the health care professions in order to ensure our best response to a bioattack. Your families, friends, and patients are counting on us. Let's help us all and be ready!

References

            1.         Ready or Not? Protecting the Public's Health in the Age of Bioterrorism 2004. Trust for America's Health: December, 2004.

            2.         Lasker, RD: Redefining Readiness: Terrorism Planning the Eyes of the Public. The New York Academy of Medicine: 2004.