Terrorism in America: Time for medicine to prepare

The Sept. 11 terrorist attack suggests that even more devastating weapons might be used against Americans and that doctors might be the ones on the front lines.

Editorial. Oct. 8, 2001.

The staggered, daylight attacks on the World Trade Center and the Pentagon were tailor-made for the cameras.

For the terrorists, it wasn't enough to murder thousands of innocent victims and hundreds of rescuers. They wanted something that could be replayed again and again, as a reminder of America's vulnerability and loss.

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Yet watching those images brings another even more disturbing realization. What the cameras recorded was destruction by what are only the most primitive weapons in the terrorist arsenal.

Fire, shattering force and men with knives -- except for the hijacked jetliners, this is technology a caveman could relate to -- are what brought down the World Trade Center towers and part of the Pentagon. It's also why the injuries and loss of human life, even as terrible as they turned out to be, were contained.

Chemical, biological and radiation weapons are at the other end of the spectrum in terms of technology and potential for mayhem. Experts have warned for years that these weapons are likely within the reach of a fanatic, tightly organized and well-financed terrorist organization. The terrorist network behind the Sept. 11 attack proved it was all that and something worse -- it already has acted to kill thousands.

What these terrorists are certain to know, from a more than ample public record, is that this nation is not adequately prepared to deal with all the dimensions -- especially the medical ones -- of a chemical, biological or radiological strike. Will they try such an attack before justice catches up with them?

Very few other terrorist groups have even attempted to cross that line. What understanding we have of the implications of such an attack come largely from the crude 1995 Tokyo subway attack using sarin gas, which was launched by a religious cult. The incident claimed 12 lives, but flooded emergency rooms with more than 5,000 panicked patients, most uninjured, but all requiring evaluation. (The Tokyo attack also contained a low-tech touch that the WTC terrorists would have appreciated: The sarin was released by puncturing the containers with the tip of an umbrella.)

Fears of a rogue nuclear bomb have largely subsided, but not worry about much more crude radiological weapons. Spent nuclear fuel rods blown apart by conventional explosives could create widespread contamination, exposure and the potential for panic the likes of which we have never experienced in this country.

Yet it is biological weapons, the pure perversion of medical science, that represent the most chilling terrorist threat. Unlike the events of Sept. 11, this would be a stealth strike -- a deadly bug perhaps sprinkled from the rafters of a crowded stadium or from a small plane over an unwitting city. Smallpox -- admittedly the least likely, because the only samples left in the world are supposed to be locked away -- is the biggest worry, followed by anthrax and a short list of others. A recent simulation of smallpox attack estimated that it would take less than two weeks to cause several hundred thousand cases, dispersed around the country.

Not all the predictions about the likelihood and effectiveness of these weapons are bleak. All are hard to develop and deliver. Government medical response teams have been created for each. More is being done to stockpile vaccines and antibiotics.

Nevertheless, the threat is real, and more must be done. The need for more attention extends from the individual doctor to the largest hospitals and government agencies. The AMA has been active in recent years in calling for such preparedness. For more information, visit the AMA Web site (http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response.shtml).

Especially in the case of biological attack, physicians will be at the very front lines. It is important that physicians get into the habit of reporting unusual symptoms immediately to public health authorities -- something most don't do now -- if such an outbreak is to be recognized, treated and contained. Meanwhile, more must to be done to outfit first-response units and hospitals to handle any of these events, from increased training, to necessary supplies and hardware such as decontamination and protection equipment for medical personnel.

All of this necessary extra effort is another part of the mobilization for this new-era war that we've now found ourselves in. But may we never have to put even the best preparations to the test.

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