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acts of terrorism optimally and rapidly, their collective efforts will need some choreographing, and they will have to react instinctively and collaboratively as they do in other emergency situations for which they have been adequately trained.

Fortunately, medical and other first responders can acquire these essential instinctive and collaborative reactions for responding to an actual or threatened chemical or biological terrorist act by enhancing their existing skills, knowledge, and abilities for dealing with more conventional disasters. However, as unlikely a chemical or biological terrorist act is in any given locale, its potential impact makes it vital to the first-responder community, especially the principal decisionmakers, that such enhancement of existing capabilities also be sustained. Accordingly, this section of the report identifies relevant computer-related tools and pertinent health-effects information that could be used by medical and other first responders to train regularly or even use operationally. These tools will also decrease the need for frequent participation in large exercises that can be disruptive, logistically complicated, expensive, and unproductive.

Medical Vigilance and Dose Reconstruction

Extremely rare infections, chemical exposures, or alternatively, temporally or geographically unusual or uncommonly frequent adverse-health effects could serve as an early warning that there has been a covert release of a chemical or biological substance into a civilian population. Emergency care facilities are likely to be the sentinels for observing such effects in a population. Consequently, the medical community can actively contribute to the rapid identification of a chemical or biological release if they have at their disposal communication systems by which they easily can report confirmed or suspected, rare diagnoses to public health officials.

As mentioned in Chapter 5, Recognizing Covert Exposure in a Population, although epidemiological surveillance systems exist and public health authorities do compile some health-effects information (e.g., morbidity/mortality reports), the process is slow, somewhat isolated, and should be better networked so that data streams documenting rare events can be received, assimilated, and analyzed for trends far more rapidly. In fact, a computer network, combined with easily understood software, perhaps involving the Internet, and an approach that is similar to or is connected with the Program for Monitoring Emerging Diseases (ProMED) or the Global Infectious Disease and Epidemiology Network (GIDEON) could be designed for rapidly collecting diagnostic data from the medical community electronically, particularly from sentinel locations, such as emergency departments. These data could then be sent to a secure, centralized

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