Stemming Terror By Sharing Knowledge

A patchwork of isolated agencies, the current national public health system has trouble meeting ordinary day-to-day public health needs, much less the added burden posed by terrorism.

To rebuild the system, the president and Congress have promised billions of federal dollars and often cited information technology as a key part of the solution. But willy-nilly purchasing of computers and software will not solve the problem, warns Elin Gursky, ScD '85, senior fellow at the Center for Civilian Biodefense Strategies. An information-sharing system with national standards is needed so that hospitals and health departments can exchange information seamlessly.

The system needs to be able to respond in real-time when, for example, hospitals report an unexpected disease or a sudden surge in patients. "We don't have in place an early warning system that can measure and instantly report an atypical public health event," Gursky says. "Even if we had [that], we don't have the next pieces: the connectivity, how you find the key people and disseminate the information to public health authorities and hospitals and tell them to gear up for X number of patients, [and] how you share this information 24/7."

Gursky is a member of the national Information Technology Infrastructure for Bioterrorism Summit Group. (The Center was a catalyst for the initiative.) The group of public health officials, hospital administrators, technology professionals, and others is working to design a network with common software standards that would allow medical and public health officials to immediately share the latest information on outbreaks, diagnoses, treatments, and available resources, such as antibiotics or vaccines.

The group, facilitated by the RAND Corporation, plans to create a blueprint for the architecture by this summer, Gursky says. "Our concern is that state and local health departments have the right guidance to use the dollars wisely," she says. - BWS

DETECTING DIRTY BOMBS


An early morning explosion rocks downtown Baltimore, shattering windows and injuring a dozen people. Police and fire crews respond within minutes to help the injured and cordon off the debris-strewn intersection for investigation.

But the real danger is just beginning.

Among the panoply of possible terrorist weapons that law enforcement and public health officials must anticipate and prepare for is the "dirty bomb," a conventional explosive packaged with radioactive material. The explosion disperses the material, which would be impossible to see or smell, spreading the hazardous radioactivity over a large area.

Asked for advice by Peter Beilenson, MPH '90, the Baltimore City health commissioner, Jonathan Links, PhD '83, has brainstormed a radiological terrorism preparedness plan for the city. Beilenson and another School alum, Jon Mark Hirshon, MPH '94, are implementing Links' recommendations. Says Links, a professor of Environmental Health Sciences: "It seems highly likely that what we're putting in place [now] will be part of the long-term solution."

The city is buying 50 handheld Geiger counters that Links will calibrate before they're distributed to police, firefighters, and emergency medical technicians. He will then teach them how to use the Geiger counters when arriving at the site of an explosion and what to do if radio-activity is recorded. Links is also advising the city on how to enhance existing radiological monitoring and protection of the city's water system.

Links has joined a Baltimore "Strike Team" that would respond to radiological events.
Detection of dangerous levels of radioactivity would initiate a cascade of emergency activities: Victims and initial responders would be evacuated and decontaminated, more accurate instruments would be brought in, and prevailing winds would be monitored. Links is part of an expert "strike team" that would respond to such emergencies.

"A lot of the initial planning stuff is uncharted territory," he says. Developing guidelines on the types of detectors needed, how to calibrate them, what the threshold for alerts should be, and other issues will make perfect dissertation fodder for Links' doctoral student, Ken Brenneman.

When not helping Baltimore City prepare for radiological terrorism, Links researches beneficial uses of radiation such as the non-invasive imaging in animals and humans using the sophisticated SPECT/PET imaging system. His work also involves other techniques such as X-ray fluorescence, which can be used, for example, to quantify the amount of lead in a person's bones. - BWS


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