Executive Vice President's Report Are We Prepared? Jeffrey Goldhagen, M.D. and Patricia Frank, RN

Those who are astute will realize that the picture above is not the usual one you'll see. I am pleased to relinquish my space this month to Dr. Jeffrey Goldhagen, Director of the Duval County Health Department, to discuss a crucial topic in the health of our community — disaster preparation. As this issue of Jacksonville Medicine was being finalized, Jacksonville appeared to be lucky enough to escape the destructive path of Hurricane Georges. But what about next time? What about other disasters like floods, fires, terrorists threats and bombs, or chemical warfare. Are we prepared?

-- Philip H. Gilbert, Executive Vice President

Hurricane season extends between June 1st and November 30th. However, hurricanes are not our only potential disasters. Recent floods, tornadoes and fires have cost lives and hundreds of millions of dollars in damages. As a City, we must be ready for all natural and man-made disasters. As a medical community, we have a critical role to play in preparing, maintaining a level of readiness and responding whenever necessary. We must also be available to other affected communities in the state.

In addition to the above, terrorism _ including chemical, biological and nuclear agents _ is an emerging threat to all American communities. The 1996 federal Defense Against Weapons of Mass Destruction Act, is an attempt by Congress to prepare 120 U.S. cities to respond to such a disaster. Jacksonville is among the first 27 cities to begin this preparation to train and equip a Metropolitan Medical Strike Team (MMST). Over the past year, local fire, police, hospitals, physicians and other public and private agencies have begun this effort.

This preparation of a MMST is not an endeavor to deal with the abstract. During the past few years there have been numerous incidents of terrorist threats and bombings, using weapons of mass destruction (WMD).

The Japanese saran gas attacks, the World Trade bombing and the tragedies of Oklahoma City, Kenya and Tanzania are among the most recent examples of terrorism. What is not widely known is the number of documented reports of groups and individuals possessing illegal biological, chemical and nuclear agents. The number of WMD attacks has increased 15 fold over the past 20 years! Chemicals such as phosgene, chlorine, and thiodiglycol are available commercially. Biological pathogens, such as anthrax and ebola can be obtained from nature, hospital labs and university research facilities, as well as cultivated in "home" labs. Radiological materials are found in many industrial facilities, research labs and on the black market from abroad.

Jacksonville needs individual physicians, the medical society, hospitals and
other health care agencies involved in all aspects of disaster preparation.

• We will need your cooperation in obtaining the location of every physician practice, hospital, pharmacy and other health care facilities in Duval County in order to geo map and code them for future use.
• Connection of each practice via email and fax will be necessary for immediate communication.
• Each physician should be aware of their responsibilities as professional staff at hospitals. We will need to coordinate such responsibilities inside and outside of these institutions.
• Physicians and physician practices need to be involved with planning for the care of their patients to ensure critical services will not be interrupted. This is especially true for patients with special needs, chronic diseases, the aged and those with limited mobility.

  Patients who will need to be in Special Medical Needs Shelters must be identified to the Emergency Operation Center (EOC) so that we can ensure early transportation and availability of shelters. We need your involvement with reporting such patients to the EOC.

  Home Health Agencies who care for your patients must be held accountable to continue their care in the case of emergencies. You must ensure that they will be available for your patients and that they are involved with the community response.

  Primary care physicians and those with relevant subspecialty skills will need to be available to help staff shelters.

• Physicians will be needed to participate with our Disaster Medical Assistance Team (DMAT) as it is developed. DMAT's are specially trained teams of health professionals who are prepared to respond to the medical needs of other communities if the medical resources of the affected communities cannot respond to their local needs.
• Physicians will be needed to participate on our Metropolitan Medical Strike Team (MMST). The MMST is a highly trained, readily deployable, fully equipped local response team organized and equipped to address WMD effects on human health. It will have specialized skills, pharmaceuticals and equipment that will enable it to assist in identifying a WMD agent, initiate victim decontamination, conduct medical triage and administer appropriate therapy prior to transportation to emergency and definitive medical care facilities.

In order to accomplish any and all of these responsibilities, you and your family will need to be well prepared for potential emergencies and disasters. The Health Department and City Emergency Response Team is ready and committed to work with you to ensure that you are prepared and able to participate with us.

Thank you in advance for your cooperation and consideration.

Jacksonville Medicine / October 1998

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