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Preparing for the Unthinkable

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As nervous New Yorkers stow gas masks in their desks and consider mooring escape boats on the Hudson, they're also obsessing over one (of many) worst-case scenarios: What if you can't get out in time? Would hospitals be able to respond to a bioterrorist attack?

Luckily, doctors have been worrying about the same thing. On September 25, emergency-room staff from 100 local hospitals met with representatives from groups like the Centers for Disease Control to discuss their readiness. The atmosphere was, understandably, a little tense. Kevin Chason, director of disaster management at Mount Sinai, says, "People were anxious to make sure their staff would be safe, that they wouldn't be contaminated."

To address that concern, "a segment of the staff would be designated to deal with patients coming in," says Lorraine Ensminger, a nurse manager at Beth Israel's ER. "They would be the front line, suited up in protective gear."

But the biggest challenge for emergency-room workers may be recognizing that an emergency has actually occurred. "The only way we would know about an incident in real time is if EMS or the city's command center alerted us to an unusual spraying," says Dan Wiener, chairman of emergency medicine at St. Luke's Roosevelt. "More likely, we wouldn't know until we spotted symptoms a week or two later. If five people came in from Columbia and they all had pneumonia with blood, we would think about plague. If we saw a vesicular rash in an adult who had already had chicken pox, we would suspect smallpox."

"The idea with smallpox is that some suicidal fellow would infect himself and walk around Manhattan spreading it," says Lewis Kohl, chairman of emergency medicine at Long Island College Hospital in Brooklyn. (Kohl's less concerned about chemical attacks: "Dealing with these gases is like putting a cobra in your pocket. Hopefully, it will kill them before they can use it.")

There are currently 10 million to 15 million doses of smallpox vaccine, and the CDC is working on producing more -- soon. "They expect to have it in an affected city in four to six hours," says Kohl. There's also an experimental antibiotic, cidofovir, but doctors caution against self-medication, because you can develop resistance.

Indeed, the most important prescription right now -- for both patients and hospital workers -- may be: Don't panic. "The chance of anything happening is low," says Kohl. "People are making themselves sick over this."


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