Medical Resources

AAEM Representative Attends NDPO Conference

by Lawrence Isaacs, MD FAAEM

After just attending the National Domestic Preparedness Organization Health and Medical Conference, given August 1-2, 2001, on behalf of AAEM, I wanted to give members an idea what it was about and the goals of the NDPO.

The National Domestic Preparedness Organization (NDPO), organized the conference to let emergency responders know what the government is doing about the very real threat of an attack using weapons of mass destruction (WMD). The NDPO is actually a partnership of six federal organizations who, by being a part of this, will share information and aid in developing effective programs to lessen the possibility of a terrorist attack. Additionally, it will help develop an organized response if/when one was to occur.

The NDPO's federal partners include: The Federal Emergency Management Agency (FEMA), Department of Health and Human Services (HHS), The Federal Bureau of Investigations (FBI), The Environmental Protection Agency (EPA), The Department of Defense (DOD), and the Department of Energy (DOE).

Presentations were given from fairly high-level people from many agencies, including the VA, the CDC, the USDA, and Uniformed Services University Casualty Care Research Center (USUHS-CCRC), all of which have something to do with either prevention or response to an attack. Not having a military background, I've never heard so many acronyms being used in my life.

I learned several things from the 16 talks. First, the government is full of bureaucracy and acronyms. Second, it is also taking these threats very seriously, and they realize that emergency physicians should play a large role in the medical aspects (two of the speakers were EPs). Furthermore, I learned how to begin the response if it was my Emergency Department that was "lucky" enough to be the first to recognize an event.

NDPO is also developing the Common Communications Link (CCL), which will be the tool for information sharing and communications concerning WMD. It will also publish a monthly newsletter using the CCL. The CCL will be Web-based, and the idea is to have an electronic link between the federal agencies and emergency responders.

There is something called the National Pharmaceutical Stockpile (NPS). The NPS is a system of several warehouse locations which have stockpiles of antibiotics (mostly ciprofloxicin, and doxycycline) which can be delivered anywhere in the continental U.S. in twelve hours. If you're wondering why mostly ciprofloxacin and doxycycline, they are the treatment for Anthrax, considered the most likely biological agent.

One "push-package" delivers medications and related supplies for 270,000 adult ciprofloxacin and 2.5 million doxycycline acute and prophylactic courses for the treatment for Anthrax. The NPS also has a supply of dressings, vaccines, and airway supplies including ventilators. The problem is that there aren't many places that are organized to unload and distribute the medications, and this is something they are hoping the cities and states will develop.

The MMRS (Metropolitan Medical Response System) is a program run by the Department of HHS to give cities contracts to develop a local and statewide response to a terrorist attack. The idea is to get a unified local and state response that can easily coordinate with any federal aid being delivered. There are 72, mostly medium-sized, cities which have received contracts under the MMRS since 1999.

We also heard from the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)- a place I would never want to be a patient. This is the site that stores and works with bugs like the Ebola and Marburg viruses. They know a lot about organisms that may be weaponized and if one was going to send a specimen of highly contagious and deadly organisms, this is one of two places in the U.S. it would go (the other, the CDC). USAMRIID also works on vaccine development, and its TAML (Theater Army Medical Laboratory- a joint venture with the Army) could be sent to the location of an attack since it is the best mobile laboratory for infectious disease diagnosis in the U.S. It is also a resource for information on decontamination and treatment.

In case of any radiation questions, the place to contact is the Radiation Emergency Assistance Center/Training Site (REAC/TS), located in Oak Ridge, TN. They are the leaders in radiation injury and treatment. REAC/TS also has a mobile team that can be anywhere in the world and staffs a telephone consultation service 24/7. They have consulted on 1284 calls since June 1976, have seen 212 patients and have been sent to ten countries. They are also doing international radiation training, and are the people to call for a cytogenic dosimetric evaluation.

The Environmental Protection Agency (EPA) has a 30 year-old program called the National Response System (NRS). They are partnered with the Coast Guard, and are the ones to contact in a large HAZMAT situation. Contacting them will get you on-scene HAZMAT coordinators and removal managers. The U.S. Department of Agriculture reminded us that animals may be the first to die in a biological attack, and they can help determine if your food supply is contaminated. They are also a resource for emergency food supplies. The Department of Justice has a program called Office of State and Local Domestic Preparedness Support (OSLDPS). OSLDPS is a good resource for those of you, like myself, who are involved in disaster planning. The office does exactly what its name implies; it gives technical assistance in these matters to cities and states. You can ask them questions by mail, phone or e-mail.

The bottom line was the Federal Government realizes it's time to get itself and this country organized. They also realize that we are part of the community of first responders and need practical and easily accessible information. They also want to let us know that we need to meet them half way on this, and that there needs to be institutional, local and regional plans to respond to a WMD event. If there isn't, there will be a lot of cipro and doxycycline sitting on runways.

Contact information:
NDPO: www.NDPO.gov
CDC: www.BT.CDC.gov
REAC/TS: link through www.DOE.gov
EPA: www.epa.gov/ceppo
Uniformed services University: www.Usuhs.mil/ccr
Dept. of Justice: www.ojp.usdoj.gov/osldps/.

Editor's Note: AAEM Member, Lawrence Isaacs, MD FAAEM from Temple University, Philadelphia attended this conference on behalf of AAEM. Dr. Isaacs can be reached at Director of Emergency Medical Services, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA 19140. His email address is Isaacsls@gateway.net