A disaster response program should include many elements if it is to be successful in dealing with the effects of a WMD attack and restoring public order. In the United States, several agencies at the federal, state, and local levels have been assigned to handle contingencies such as natural disasters, chemical spills, and nuclear mishaps. The Federal Response Plan, a signed agreement among 27 federal departments and agencies, and including the American Red Cross, provides a mechanism for coordinating delivery of federal assistance and resources to augment state and local efforts in major disasters or emergencies. This plan, however, does not describe an integrated, comprehensive blueprint for crisis/risk communications in the event of a large-scale disaster such as a WMD attack. It should be noted that in the 1918 pandemic of influenza, there was a severe lack of mortuary services and facilities, which must also be provided for by the plan.

To help fill the gap, research and analysis on communication and awareness campaigns, and training and preparation, are needed (see Chapter 9). However, it is essential that all federal agencies involved in response develop, through a panel of outside experts, a plan for analyzing data, developing a response, coordinating the response with other agencies and the Office of Homeland Security, and communicating with the public.

Development of Treatment Protocols

In most cases, there is insufficient research and information on which to base a sound public health protocol and medical response in the event of a biological attack. We cannot, for example, answer the following questions with confidence: How long should individuals continue antibiotic treatment after exposure to biological agents? How long after exposure will vaccination be effective? What other types of interventions will increase survival rates and decrease spread of the disease?

Sound protocols are a necessary prerequisite for communicating information about appropriate postattack responses to the public, physicians, and public health officers. The anthrax attacks of 2001 illustrated the lack of preparedness in this area.

Recommendation 3.13: Develop protocols for public health responses to bioterrorist attack. OHS should develop a plan for achieving this objective, and HHS, through its various agencies, should support the necessary research.

Development of Decontamination Protocols

At present there are few data on which to base decontamination procedures, particularly for biological agents. A review of the literature shows that dose-response information is often lacking or controversial, and that regulatory limits



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