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The following was originally published in response to a classroom forum:

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To the best of my knowledge, there are not any facilities or agencies within Harrison County equipped or prepared for the early detection of biological terrorism, beyond the normal expectations of doctors and associated clinicians performing general diagnostics and evaluations of symptoms. Our hospital laboratory can process a variety of tests, however many samples are processed at larger metropolitan facilities; I would have to assume that certain biological agents would be amongst these. I will say that I have heard from reliable sources involved in the local medical community that when an initial need for testing occurs, our laboratory evaluates the need for materials and procedures necessary to conduct the tests in house.

Reporting procedures are likely unclear, with respect to alerting the public. Normal procedures of health concerns eventually reach the public in the form of an article published in the weekly newspaper, a memorandum passed along to school-children and discussion on the local radio station’s Monday through Friday morning hour-long talk show. Within recent history our E-911 dispatch center has gained the ability to contact citizens that have opted into an auto-dialing program for notification of varied public concerns; our medical community has not yet had a need to pass along a message to dispatch, though the opportunity exists. All agencies and organizations within the community know that it is possible to contact the broadcast media in Lexington in order to relay the message on their televised newscasts and social media channels. I believe that the medical community knows that notification of the local EM, dispatch center, and government officials are required; whether this would be practiced as policy dictates is unknown—to my knowledge there has never been a drill or exercise related to a bio-terror incident. There have, however been notifications to the public in years past concerning MRSA—notification came in the form of an article in the local paper and memos from the local board of education.

Reporting to higher medical authorities are routinely practiced per policies and regulations; there are, however, frequent hiccups—according to my sources—in the order to which these procedures are to be carried out.

I do know that there are plans in place for possible bio-terroristic events, with the expectation that the event would take place in a different area, and that our community would have to take preventative action. In late 2002, early 2003, our nation became concerned about the possibility of the terroristic release of the variola virus—smallpox—into the population. The entire medical and EM community responded by planning for such an instance, developing plans for distribution centers and prioritizing sectors of officials and the public for inoculation should the President order the release and distribution of the vaccine. In a three-part informational column then Public Health Administrator of the Wedco District Health Department, Dr. Julie W. McKee, described the plans for Harrison County (Barnes, 2003). In the plans, McKee stated that Wedco would initially be responsible for its own staff as would Harrison Memorial Hospital; following the inoculation of respective medical staff, Wedco and HMH would proceed to inoculating members of local emergency services and government. Once the local medical and emergency communities were supplied, two named locations would be opened, staffed by Wedco and HMH personnel, for the purposes of reaching the general public. Fortunately, the need never came; unfortunately—to my knowledge—the plan was never tested.

I do know that this specific plan did bring about discussion amongst emergency services personnel, with many of the agency leaders asking their respective personnel whether they would receive the vaccine should the voluntary inoculation take place—I had been asked if I would partake. Though I cannot remember my exact response, I wouldn’t doubt that I made a joke about the federal cataloging of citizens through smallpox vaccination that had been dreamed up in The X-Files.

Similar plans are in place for other vaccination possibilities—I had heard that the local hospital had established a plan based on the aforementioned smallpox plan during the 2009 H1N1 scare. It would be safe to assume that similar plans would be applied for other incidents, with modifications to include the addition of other vaccination stations—most likely separated by school or voting district.

References

Barnes, B. (2003) Health Officials Plan for Threat of Small Pox. The Cynthiana Democrat. Retrieved October 30, 2012 from: http://harrisonema.com/2003/01/29/officials-plan-for-threat-of-small-pox/

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I have no clue if I referenced the articles properly, considering I pulled the three of them from a single page that I published seven years ago… When I re-published the articles I failed to note the exact date of publication; additionally, the Cynthiana Democrat does not offer an online archive for articles prior to December 2007…

The following was written in response to a classroom forum:

There are many reasons as to why anyone classified amongst the “worried well” might seek care during a disaster situation; the most common reasons likely being connected to some incarnation of fear, misinformation, ignorance, or a combination of these elements. If we were to take an individual off the street and poll them on how they would respond to a given scenario, we might find that their response is one that differs from what we—varying members of the emergency community—would necessarily expect or recommend; this is simple ignorance of the proper methods, procedures or actions. The individual would, however, likely supply some sort of response based on the level of knowledge they possess of the given scenario, or some similar situation, referring to their simplest and most basic training in life—which, in this case, would likely be to seek immediate assistance from a professional.

To the medical professionals in this course—you have likely seen, responded, or worked on cases where a patient did not need treatment—or if they did, it could have came from a first-aid kit or a trip to the corner drugstore. Many of these patients may have been ignorant to the simplicity of their injury/ailment; some may have been knowledgeable—or would have been—had they not been influenced by the situation in some manner, triggering a flash of fear and confusion.

[Fear, confusion and other emotional responses can come at odd times and have quite an effect on our behavior. I had known a person that had broken their arm, and responded to it with an “Awe, cool!” mentality, chasing their siblings with a wildly flailing arm. Later in life, that very same person fainted from the sight of the pinkish skin he revealed on a finger after pulling back and ripping off a nail-cuticle. An odd tale–but one that shows how an individual can react differently to varying stimuli. In this tale, we can see how a single person may calmly respond and await treatment—arm flailing—or seek immediate treatment—cuticle—based upon their reaction to the event.]

To the parents of multiple children in this course—how many times did you rush your first-born infant or toddler to the hospital? Did you transport the child in your personal vehicle or await an ambulance? Did your next child make as many trips to the ER, or had you changed your perception of an emergency? Initial responses to a new situation, such as the care of a child are heightened, where there may not be a base of comparison or a personal knowledge-bank.

[Picture this one—your first-born infant is spiking a nice temperature. You do have knowledge that Tylenol can bring it down; you even have a bottle or two in the medicine cabinet; yet the sight and sounds of the baby in discomfort wipes your memory of this information. What do you do?—you likely respond by seeking a professional, either through calling a doctor, a family member, or by loading the babe in the car and driving to the hospital—and if you drove, it’s because you ‘knew’ that an ambulance wouldn’t come fast enough. Now, with the third or fourth kid, you simply mutter to yourself, grab a doser, and sigh when that sticky pink fluid drips down junior’s chin and all over that clean Onesie…]

With these examples of everyday possibilities to facing the “worried well”, we can understand how the numbers may grow in disaster situations—when people may be relatively fine or unharmed. Facilities must expect that there will be a greater influx of these patients as well as patients in true dire need of assistance. In order to prepare for these scenarios, the involved organizations must work to establish a triage system in which all patients can be evaluated and prioritized according to medical condition. Unfortunately, these efforts are only as effective in relation to the numbers of staff and personnel available, the size of any facilities involved, and the number of patients that arrive. Additionally, efforts will be affected by the communication between any agencies involved, whether any plans laid out are followed, and the unknowns involving the patients/public themselves/itself.

In communities where more than one hospital or medical center exist, multiple locations can be coordinated and organized for the receipt of the varying levels of trauma; clinics and related facilities may be used for low-priority trauma and first-aid, while larger hospitals are reserved for high-priority cases. Organizing, designating and publicizing such locations in such a manner would greatly reduce some of the headaches associated with a massive event; however, there would still be issues related to members of the public incorrectly identifying their injuries to either extreme, or bypassing a designated location out of personal preference. Staffing requirements and transportation may become an issue as well.

With regard to those persons who are more-or-less in a state of shock, suffering little to no injury at all, medical centers would need to respond with staffing persons able to handle the psychological aspects of disaster. Supplying a psychological support staff might be easier than it seems—as many of the patients are in a shock state and not necessarily psychotic, it would be possible to train additional staff in disaster psychology—support staff such as secretaries, housekeeping and maintenance, as well as staff from other supporting emergency services could be utilized to calm and speak with the patients.

In every aspect of the disaster situation, the medical community might benefit from establishing a medical reserve corps or nurses auxiliary; keeping in good contact with such reserves and inclusion of these additional resources in planning and exercises would be mandatory for successful operation and organization, however.