“Many of the individuals that we educate within this school would find themselves key players in a response to any type of terrorist incident,” says Dean Harold Jones, Ph.D. “For example, clinical lab scientists would be very involved in trying to determine what type of biological agents were used and the levels of exposure that individuals have suffered. Many of the possible agents create difficulty with breathing, which involves respiratory therapists. Physician assistants and others in emergency-room settings would likely be the first to see a wave of symptoms.
“And people in health information management, who deal largely with data, would have to manage significant flows of information in a brief period of time to allow clinicians to make the right kinds of decisions. So there are many, many connections.”
SHRP’s course offerings continue to reflect that new playing field, says Patsy Greenup, Ph.D., associate professor of clinical laboratory sciences: “Since 2002 we’ve offered a course in biological and chemical weapons that’s open to all students across campus, and we’ve attracted even more students from outside SHRP than from inside. We’ve also offered a course in emerging and re-emerging infectious diseases. Another course that’s been submitted for approval is Bio- Crimes and Microbial Forensics. We taught an undergraduate Honors Program version in the recent term, and fall is our target date for the first graduate-level course.
“The big project we’ve been working on is writing the proposal for a certificate program in Homeland Defense and Security,” she continues. “We’re identifying courses that already exist on campus, and working with faculty in Public Health and in Social and Behavioral Sciences to include their classes in the program, as well as developing new courses that would be added.”
To say that the program is still evolving would be an understatement, according to Greenup: “When we started working on this a year and a half ago there were no certificate or degree programs in the U.S., but now they’re blossoming. I saw an article recently with the headline ‘Homeland Security 101 is Hot Topic.’”
Primary and emergency-care providers have a new resource in the Web site [www.bioterrorism.uab.edu], which offers online quizzes, a quick-reference database on diagnosing threats that range from anthrax and botulinum to West Nile virus, and links to continuing medical education.
“While it’s important to recognize any act of bioterror as soon as possible,” says one of the site’s creators, health-administration professor Norman W. Weissman, Ph.D., professor and L.R. Jordan Chair in Health Services Administration, “that’s made more difficult because the symptoms frequently mimic far more common conditions. Our bodies can only show symptoms in so many ways—fever or headaches, for example—so it’s important to help sensitize physicians to making judgments that distinguish an ordinary case of the flu from, say, avian influenza or bioterrorism.
“If the nation were on high alert, health-care providers would potentially be more suspicious of those kinds of events—otherwise, diagnosis is done on the basis of probability, of what it’s most likely for a certain patient to have. And our site is a reminder of possibilities that we should have in the back of our mind in order to recognize possible terrorism as early as possible, whether it’s by a specific blood test or by ordering an X-ray earlier to diagnose anthrax.”
A special “hot topics” section on the site’s home page carries timely updates on illnesses that are not yet high-profile, such as tularemia, which takes the forms of typhoid, pneumonia, or meningitis, and whose bacteria generally occur among animals in nature but could theoretically be grown in a laboratory and spread in aerosol form by a bioterrorist. The site’s popularity keeps growing; it’s already registered millions of hits from users around the world.
Health-care administrators, though they don’t directly see patients, nonetheless would play a crucial role in any response to an act of terrorism, says Howard W. Houser, Ph.D., professor of health services administration:
“These days our focus is a lot broader, including disease threats that are man-made as well as those that come from nature,” says Houser. “The context is that health administrators are generally educated for ‘normal’ operations—routine day-to-day events—and for what we might call, for lack of a better term, ‘routine disasters’ such as a plane crash, a train wreck, or a tornado. In those cases, the response is intense and instantaneous for the duration of a single incident. Every hospital is required to have a disaster plan and to practice it regularly.
“A bioterrorism threat of anthrax or smallpox, by contrast, has the potential to spread and can totally disrupt normal operations. For example, it raises the crucial issue of staffing. In the case of an infectious disease, what about staff members who either become victims themselves or fail to show up for work because they fear spreading the disease to their children or other family members? Is it possible to have plans for secondary staffing in place?
“Most people today under the age of 30, for instance, have no smallpox immunity at all. And in situations such as the recent SARS outbreak in China, we saw that anywhere from one-fourth to one-third of victims were the health-care workers themselves. That vulnerability raises many questions, and one of our major jobs is to prepare students in administration for anticipating these types of management problems in a crisis.”
During the 2001 terrorist attacks in New York City, emergency workers learned the hard way that their old communication systems were woefully inadequate for such large-scale disasters. Helmuth Orthner, Ph.D., program director and professor of health informatics, is part of a team that’s finding ways not just to update old systems but to create a new generation of emergency medical services that capitalizes on such breakthroughs as satellite communication, wireless Internet, and high-definition video.
With the help of a prestigious three-year grant from the National Library of Medicine, a branch of the National Institutes of Health, the group is testing such concepts as uploading patient data from a moving ambulance to a trauma center, to help the emergency room staff prepare their treatment plan. “There are many practical issues involved,” says Orthner, “not just how much data can be uploaded and sent, but how the information can best be identified and secured so that it meets standards of the Health Insurance Portability and Accountability Act.”
Other research is exploring the possibility of piggybacking emergency communications on existing systems such as “wi-fi,” or wireless local computer networks, and the OnStar emergency notifier that’s built into many new automobiles.
“Manufacturers of wi-fi systems provide filters to prevent unauthorized use,” Orthner explains, “but we believe it’s possible for a user who’s not ‘authenticated,’ such as an EMT team, to go straight to certain sites without compromising that bandwidth’s privacy, in the same way that payphones can dial 911 without requiring coins. We think the public might support the use of their secure sites, if they’re assured it’s only going for emergency support.”
Likewise, Orthner sees the increasing availability of high-definition television cameras and monitors, along with rapidly increasing bandwidth of a new generation of cellular phones, converging to allow emergency workers to transmit high-resolution video of ill or injured patients, in real time, from remote sites or ambulances to a central trauma facility. “With high-definition camcorders coming onto the market for $4,000 to $5,000, compared to the previous prices of more than $100,000 for professional models, the possibility of transmitting on-site pictures becomes a very interesting proposition,” Orthner says.
Other initiatives involve the use of GPS (Geo-Positioning System) technologies to automatically feed location information of ambulances to the Geographic Information Systems (GIS) in the disaster coordinating center. The GIS displays the location of all ambulances on street maps, allowing quicker and more accurate assessment of the geographic distribution of ambulances and their deployment.
The 20th-century breakthrough of nuclear medicine, now used routinely in hospitals and physicians’ offices, creates another set of concerns when radioactive material might be stolen by terrorists intent on making a “dirty bomb” that uses an explosion to scatter deadly chemicals or disease viruses. Fortunately, says Michael Thompson, NMT, professor of medical physics, almost all of the radioactive materials used by nuclear medicine have very short half-lives, which means that their radioactivity decays in a very short period of time, typically within a few hours.
“For the departments that do keep other radioactive substances on hand,” Thompson says, “we’ve worked closely with the university’s Radiation Safety office to ensure effective safeguards to keep the material out of sight and under lock and key. Most of those materials are behind at least three different sets of locks, with effective procedures in place to prevent any misuse.”
“Terrorism is a subject that cuts across a tremendous number of areas in health education,” says Dean Jones, “and that makes it important for us to coordinate our efforts educationally— especially in a curriculum that’s already extremely compacted to begin with—so that we prepare individuals for whatever role they might play in crises of the future.”