NCSL Brief: Terrorism and the Health Workforce

(This is one of a series of briefs written by NCSL, "Protecting Democracy: States Respond to Terrorism.")

Terrorism and the Health Workforce

By Kristine Goodwin

Even before September 11, state legislators were worried about the current state of the health workforce, with shortages reaching crisis levels in certain geographic areas and among certain professions. Already high on legislators' radar screens: shortages among nurses, pharmacists and nurse aides. Add to that an overburdened hospital system--with emergency rooms unable to treat everyone needing care--and the challenge before the public health system is daunting.

The September 11 attacks and the subsequent anthrax cases beg the question: How would an already stretched-thin workforce and a shaky public health infrastructure respond to a disaster involving mass casualties? A terrorist attack, such as those in New York City and Washington, D.C., requires a skilled and prepared workforce, including epidemiologists, infectious disease experts, and emergency room and critical care personnel. These people work within a broader public health infrastructure that requires epidemiologic surveillance and investigation, laboratory analysis, information and communications systems, and coordination of essential equipment and treatment.

State and Local Actions

Some states and localities already had taken steps to improve their medical readiness, and others have stepped up their efforts since September 11. In addition to education and training activities for emergency providers, state lawmakers are considering ways to bolster their public health infrastructure and improve the coordination of federal, state and local resources. But the price tag for getting states up to speed is high and comes at a time when states are grappling with budget shortfalls.

· Lawmakers in Colorado established a committee in 2000 to develop a "public health response to acts of bioterrorism, pandemic influenza, and epidemics caused by novel and highly fatal infectious agents and to provide expert public health advice to the governor in the event of an emergency epidemic." In short, the committee is charged with making difficult decisions about public health and safety in a time of disaster, and advising the governor on issues ranging from quarantining patients to disposal of corpses and infectious waste. The committee also can advise the governor to order physicians and hospitals to transfer or stop admitting patients.

· Florida Governor Jeb Bush issued an executive order in October that establishes a Regional Domestic Security Task Force, joining emergency management and public health officials to coordinate domestic security efforts among local, state and federal resources. The governor also ordered the Department of Health to improve its communication capabilities, stockpile necessary pharmaceuticals, and develop and staff a statewide epidemic intelligence service, similar to the Centers for Disease Control and Prevention (CDC).

· The West Virginia Virtual Medical Campus-a joint venture involving West Virginia University, Electronic Data Systems and the West Virginia National Guard-will prepare emergency medical technicians, hospital emergency department personnel, and fire and law officials to respond to disasters and terrorist acts. Using a computer system to link with first responders, the virtual campus educates and trains workers. In a terrorist disaster, it would link them to specialists who can provide immediate information about how to protect people in the area.

· The New Jersey Domestic Security Preparedness Act of 2001 established a state domestic security preparedness planning group and task force. The bill appropriated almost $9 million for counterterrorism, emergency management and public health activities. The nine-member task force, with help from the planning group, will coordinate and supervise all domestic preparedness.

· In California, where the governor predicts a $13 billion shortfall in 2002, some public health and law enforcement groups are backing a quarter-cent sales tax increase to fund preparation for terrorism threats.

· In Texas, Governor Rick Perry announced the formation of a Task Force on Homeland Security that will involve state legislators, the Texas health commissioner, public safety officials and others. Their mission is to assess the state's ability to respond to threats and to coordinate efforts among federal, state and local sources.

Federal Actions

More than 20 federal agencies have a role in preparing for or responding to the public health and medical consequences of terrorist attacks. Federal agencies have been working closely with states and localities since September 11, providing public health assistance and funding. The Bush administration asked Congress to appropriate $1.5 billion to prepare against bioterrorist attacks. Of that, $300 million would be used to prepare state and local hospitals, health departments and laboratories. The Department of Health and Human Services announced the availability of $35 million in grants for public and not-for-profit entities in Connecticut, New Jersey, New York, Pennsylvania, Virginia and Washington, D.C. Among the eligible are hospitals, durable medical equipment suppliers and skilled nursing facilities.

The CDC is responsible for detecting, diagnosing, responding to and preventing illnesses caused by bioterrorism. Among its post-September duties are educating health departments and providers about symptoms and treatment, and providing frequent news updates.

How Prepared Are U.S. Hospitals?

Health care workers and the public health system are not prepared to respond to many casualties caused by weapons of mass destruction, according to some experts. A study published in the November 2001 Annals of Emergency Medicine provided a snapshot of 30 hospitals in four states--Maryland, Pennsylvania, Virginia and West Virginia--and the District of Columbia. Among the findings:

· None of the respondents are fully prepared to handle a biological incident, and three-quarters of those hospitals reported that they are not prepared at all.

· Just 10 percent of hospitals--all urban--reported that they could manage 50 to 100 casualties at once.

· No hospital reported that its pharmacy stockpiled drugs for disasters caused by weapons of mass destruction.

· There are "significant gaps in knowledge and skill content areas" among hospital workers in the following areas: mass decontamination, mass medical response, awareness among health care professionals of different weapons, health communications, and facility security.

Selected References

National Health Policy Forum. Preparing for a Bioterrorist Incident: Linking the Public Health and Medical Communities. Washington, D.C., October 1999.

U.S. General Accounting Office. Bioterrorism: Public Health and Medical Preparedness, GAO-02-141T. Washington, D.C., October 2001.

Williams, J.M., et al. "Hospital preparedness for weapons of mass destruction incidents: an initial assessment." Annals of Emergency Medicine 38, no. 5 (November 2001): 562-565.

Contact for More Information

Kristine Goodwin
NCSL--Denver
(303) 856-1525, ext. 210
kristine.goodwin@ncsl.org

Other NCSL Resources:

Other NCSL Briefs "States Respond to Terrorism"

NCSL's Protecting Democracy Page

NCSL's 2002 Legislative Session Home Page

NCSL's Health Page