Though the terrorist attacks of 9/11 shook the United States from some of its complacency, 11 years later, our public health system and the public/private health departments of the United States are still incapable of coping with a major bioterrorist attack. Our health care system was not designed to deal with bioterrorism, our medical personnel are not trained or experienced enough to deal with bioterrorism and we have not devoted enough political muscle and money to redesigning, re-educating and restructuring so the health departments can effectively deal with this very real menace. The solution is the devotion of all those assets to new, empowered, well-funded, coordinated health departments comprising a highly effective public health system.
Addressing the proposed Model State Emergency Health Powers Act (MSEHPA) in 2003, the Louisiana State University Law Center concluded that the real problem in addressing bioterrorism is that our public health system is incapable of adequately responding to a bioterrorism threat, just as it is incapable of adequately responding to other public health threats. The LSU Law Center’s concern is apparently shared by influential scholars in the United States, as Harvard University devoted a Symposium to the future of our health care system, with a significant emphasis on our inability to address bioterrorism and the steps we must take to adequately answer that crisis. An important factor cited by multi-disciplinary scholars at the 2002 Symposium is the limited resources that must be devoted to both normal public health concerns and crises such as bioterrorist acts. In addition, our healthcare professionals are not commonly well-trained in handling crises such as bioterrorism and our infrastructure is essentially outdated for dealing with a massive bioterrorist attack that we might not recognize in the first place and might not be able to deal with on a sustained basis.
The methods for meeting the public health demands of a bioterrorist attack would involve new ways of looking at the problem. The Symposium scholars mention a “dual use” approach to public health care. This dual use would address both the normal health issues handled by our public health system and mass crises such as bioterrorism; this would deal with bioterrorism, which is admittedly high in the public conscious, but would also deal with other public diseases, hazards and catastrophes that also impact vast numbers of people. The approach would require concentrating funds on the dual use approach – compelling politicians to “put their money where their mouth is” and allocate sufficient funds for a deep and broad revitalization of our public health system. In addition, the dual use approach would require restructuring of our health systems at all levels, including local, state and federal health structures, ideally with uniform systems and responses to public health concerns, including bioterrorism. This would allow a more seamless approach to bioterrorism in which all levels of our public health system are “on the same page” in knowing/having ahead of time: the warning signs of a bioterrorist attack, the process and resources required to handle the attack; sufficient personnel, facilities, equipment and medicines for dealing with the attack. Another important piece of the dual use approach to bioterrorism would be a uniform approach to massive education/re-education of medical personnel through normal medical schools and required continuing education, so our healthcare providers, who are not normally taught about or experienced in dealing with bioterrorism, would receive the necessary knowledge and training if/when a bioterrorist attack occurs.
In sum, we can pass laws from now until Doom’s Day (which could come pretty quickly if there is a successful bioterrorist attack), but that will do nothing to increase our preparedness for dealing with bioterrorism or any other major public health crisis. Our health care system is not accustomed to or designed for dealing with bioterrorism; consequently, it is now incumbent on us to provide the political, financial, educational and structural tools necessary to revitalize and refocus our health care system so it can effectively deal with any massive public healthcare crisis, including bioterrorism.
How, then, can we deal with bioterrorism right now? One example is provided by proposed responses to Anthrax. During its 2002 symposium on the future of public health, the Harvard School of Public Health recalled several incidents that show anthrax to be a genuine bioterrorism threat: 1979 incidents of inhalation of anthrax in Sverdlovsk; the deliberate release of anthrax only weeks after the 9/11 terrorist attacks; additional incidents of anthrax being deliberately released in 2001. In addition, the U.S. Department of Health and Human Services published a 2006 report mentioning a 2004 anthrax incident in the Dirksen Senate Office Building. In addition, there are numerous reports of white powder being received by business and governmental officials. Consequently, there is a realistic possibility of an anthrax (or Ricin) bioterrorist attack in the future and the average individual should know how to respond if he/she receives mysterious white powder in an envelope.
Mysterious white powder carrying the anthrax/ricin bacillus could result in “inhalation anthrax,” which is nearly always fatal without treatment. Due to the use of ricin in the past and the real threat of its use in the future, the U.S. Department of Health and Human Services commissioned a report outlining an effective response to both “overt” (e.g., white powder in an envelope) and “covert” (possible ricin poisoning, plus possible exposure, threat or clue) “ricin incidents”. The wisest course of action if one receives an envelope with mysterious white powder would be to immediately reclose the envelope without touching, tasting or smelling it. In addition, the receiver should not attempt to test the powder himself/herself: “Anthrax Home Detection Kits” may have been all the rage after 9/11 but in 2002, the White House finally released a statement that those kits are unreliable. Consequently, the guidelines set forth by the U.S. Department of Health and Human Services seem to provide the best course of action. Upon discovering mysterious white powder in an envelope, a person should leave the envelope and its contents alone, keep others away from the envelope and call 911 to request the assistance of a nearby HAZMAT team, (if one can actually reach a HAZMAT team by that route). If the 911 operator cannot put the powder discoverer through to a HAZMAT team, the person should request the local police and explain the discovery to them, so the police can contact HAZMAT. Upon arrival at the scene, the HAZMAT team must determine whether the powder is ricin, protect the possible crime scene and collect evidence from it, protect the receiver and anyone else who might have come into contact with it through preventive measures, and protect the public at large from the white powder. Consequently, the HAZMAT team will: screen the substance for ricin bacillus, take preventive measures for the safety of the person receiving the powder and for anyone else in the vicinity, question the receiver and others for any information they can give, survey the site for evidence, and assess the possibility of anthrax risk to the public. Whether or not the white powder tests positive for ricin, the HAZMAT team will collect evidence, as even sending a hoax letter is a crime.
If the white powder tests positive for ricin bacillus at the scene, the HAZMAT team will “notify: FBI, local law enforcement, the local health department, and local emergency management.” In addition, if the envelope was mailed, the CDC, HHS, DHS, NRC and USPS” must be notified. Whether or not the powder tests positive, it will be transported to an appropriate laboratory to confirm the field test results. If the laboratory results indicate ricin bacillus, the matter will require a response from the appropriate public health departments. In sum, the U.S. Government has established a uniform response to receipt of mysterious white powder in an envelope, which certainly does not include testing, tasting, smelling or touching by the powder’s receiver. Reliance on these guidelines significantly increases the likelihood that the powder’s receiver and others will not be harmed and the perpetrator will be caught.
DO’S AND DON’TS
DON’T test, taste, smell or touch any mysterious substance, including but not limited to white powder.
DO immediately reclose the package/envelope containing the substance.
DON’T rely on “Anthrax Home Detection Kits,” as officials have found them to be unreliable.
DO leave the package/envelope and its contents alone.
DO keep others away from the package/envelope.
DON’T touch or otherwise disturb anything in the area.
DON’T allow anyone else to touch or otherwise disturb anything in the area.
DO call 911 to request the assistance of a nearby HAZMAT team.
DO request the local police and explain the discovery to them, so the police can contact HAZMAT if you are not able to directly contact a HAZMAT team.
DO obey all instructions and answer all questions from the HAZMAT team so the team can successfully:
a. screen the substance
b. take preventive measures for your safety and for the safety of anyone else in the vicinity
c. question you and others for any pertinent information
d. survey the site for evidence
e. assess the possibility of a public health risk.
[Note from HandelontheLaw.com: This article is to be used as an educational guide only and should not be interpreted as a legal consultation. Readers of this article are advised to seek an attorney if a legal consultation is needed. Laws may vary by state and are subject to change, thus the accuracy of this information cannot be guaranteed. Readers act on this information solely at their own risk. Neither HandelontheLaw.com, or any of its affiliates, shall have any liability stemming from this article.]
Note from HandelontheLaw.com: This article is to be used as an educational guide only and should not be interpreted as a legal consultation. Readers of this article are advised to seek an attorney if a legal consultation is needed. Laws may vary by state and are subject to change, thus the accuracy of this information can not be guaranteed. Readers act on this information solely at their own risk. Neither the author, handelonthelaw.com, or any of its affiliates shall have any liability stemming from this article.