include unusual illness or injury in a community. Although medical organizations have historically not been recipients of pre-incident intelligence, this practice needs to change in light of recent concerns about chemical and biological terrorism.
The CDC now maintains a database of individuals and organizations possessing any of 36 biological agents (listed in Appendix D) with potential to cause a severe threat to public safety and health. The legislation does not require CDC to share this information with state or local health departments, however, and sharing has not been done in any systematic way. Although facilities willing to report to CDC that they are working with these agents are unlikely to be terrorist threats themselves, they may be targets of terrorists, victims of theft by rogue employees, or the source of an unintended release. All of these events will be handled better if the local medical community is aware of the possibility.
Of far more importance is the need for an institutionalized linkage between the law enforcement and medical communities. The response of even the most well prepared medical facilities will be markedly improved by advance notice from the law enforcement community. The latter understandably fear compromising ongoing investigations, but may not fully appreciate the substantial impact even very general information about possible incidents can have in facilitating a rapid and effective response by the medical community. Receipt of information concerning a possible mass-casualty event need not involve more than a few key individuals who can review the organization's seldom-used plan and begin to think about treatment options, where and how to obtain needed antidotes and drugs, make hospital beds and resources available on short notice, and ensure adequate staffing levels. Inclusion of these key medical personnel in anti-terrorist intelligence activity would no doubt be facilitated by their willingness to undergo training on the needs of the law enforcement community, especially procedures for proper preservation of evidence.
After-action reports on the Tokyo subway incident (Obu, 1996; Olson, 1996; Yanagisawa, 1996) provide an example of the value of communication between the law enforcement and medical communities as well as an example of a missed opportunity for communication within the medical community that might have made the medical response even more effective than it was. Japanese police had apparently been planning a raid on Aum Shinrikyo facilities throughout Japan, and for that reason the government had ordered medical supplies, including nerve agent antidotes, not normally stocked in quantity by hospitals (anonymous comments in Obu, 1996). One of the reasons for the raids was the suspected involvement of the Aum Shinrikyo in a previous toxic gas incident in the city of Matsumoto almost a year before the Tokyo attack (Morita et al., 1995). The release in that city in 1994 of what was subsequently identified as