How can we respond to terrorists' threats?

Nov. 1, 2001
Armed with the knowledge of what can happen, what can be used, and what to do about it, there is no reason why a dental hygienist and others in associated health professions could not treat those affected.

Armed with the knowledge of what can happen, what can be used, and what to do about it, there is no reason why a dental hygienist and others in associated health professions could not treat those affected.

Editor's Note: Readers should be able to determine that Winnie Furnari wrote the Guest Commentary below well before September 11, 2001. For starters, there are no references to the terrorists' attacks on the United States. Yes, Furnari was a "responder" to the crises that developed after September 11. Because of the demands on her time, she was unable to update this article at press time in late September.

Are you prepared for a terrorist attack when it happens? The keyword here is when not if. Just how prepared are the United States, your state, your local community, and yourselves for when a nuclear, biological, or chemical (NBC) incident occurs? You would be very surprised, as I was, to find out what I learned in becoming an emergency first responder. No one should take the message of First Responder Ed as a "sky is falling," doomsday, anti-terrorist message. Its directive is to develop and provide information that can be used by health professionals to save lives during a "nuclear, biological, and chemical disaster incident." The goal is to empower health professionals to treat the general population so that when an NBC crisis does occur, chaos and anarchy will be minimized or avoided. This is a real threat and it is worldwide. It is a mistake to take a "it won't happen to us" attitude.

This is not as far-fetched as you may think it sounds. I met Dr. Rodney Leibowitz, CEO of First Responder Ed, Inc., when he announced his course to a group of dentists at a meeting. Always looking for the dental hygiene connection, I inquired about the possibility of dental hygienists being First Responders in this type of a disaster. He was enthusiastically responsive and told me it was not a "dentist thing," but that he wanted to reach all of the health professions. We spoke several times, and I was invited to the full-day, seven-credit course in New York City to see for myself. This course gave me the history, the probability, and the devastation caused by NBC crises, yet also informed me about how to be prepared. Health professionals need to deal with medical and emotional issues that will be the basis for the disruption and the loss of lives in the event of an NBC crisis. It will be up to the professional health community to establish a newfound level of preparedness to bring the loss of life to a minimum and to provide emotional and psychological reassurance to the victims and general public involved.

The course presented the major NBC items, their uses, treatments, and, most importantly, a prevention protocol. Dr. Charles Williams, an associate medical director for a Bryan, Texas, hospital and David Harville, a program coordinator at Texas A&M, presented the course. I knew some of the dentists who attended and met a pharmacist and a few corporate representatives.

The class clearly demonstrated the need for preparedness. Awareness becomes a weapon and education will be the tool to protect yourself, your family, and those under your care. How difficult would it be to penetrate so-called "secure sites" in this country? It is easier than you think. Gases can be pumped through vents and around cable, electric, and telephone wires.

An American in Ohio was able to purchase the anthrax bacteria online with a credit card. If a low-flying plane sprays anthrax spores over the land, people will remain healthy for a few days, but then many people will die without immediate doses of antibiotics. Where are they going to come from? Who's going to administer the antibiotics? Who will care for the many sick, as well as the many fatalities that can also be infectious? They must be properly taken care of. How will we be able to stop this stable spore-producing bacterium from reaching more and more people each minute? An exposure in another country can travel here effectively on the numerous aircraft that fly into the United States each day.

We are all health professionals. Why couldn't we be made ready to help our families, others, and ourselves when this occurs? An event of this nature would overwhelm our capabilities to handle it. Think anthrax or small pox can't happen? The U.S. Centers for Disease Control and Prevention in Atlanta recently received $155 million to begin a national bioterrorism preparedness program. In 2000, Cipro (ciprofloxacin) became the first antibiotic specifically approved by the U.S. Food and Drug Administration for use as an anti-bioterrorism drug.

An Associated Press report of July 29, 2000, quoted David Huxsoll, a microbiologist, as saying, "An anthrax outbreak in the Soviet Union and other terrorist activities changed the government's mind. Biological weapons are cheap and easy to hide," Huxsoll said. "Because of these characteristics, they have become the weapon of choice for smaller, economically vulnerable nations and terrorist groups." He added that governments cannot prevent all biological attacks, but they can learn to minimize the damage.

The biological threats include anthrax, botulism, plague, TB, and others. Biological agents include bacteria, viruses, toxins, and Rickettsia. These can be disseminated pneumatically by aerosol in a dry or wet release, explosive in bomblets and munitions, and naturally by vectors, water, and food supplies. Many have a human-to-human transmission. Biological agents are easily obtained and the manufacturing of them requires just minimal investment and moderate education.

Chemical threats include saran gas, toxic waste from plants, and water supply contamination. These can be accidental or a terrorist release. The health professional should be able to identify the instrument, treat it, and assist the CDC in determining origins.

The five classifications of chemical agents are nerve, vesicants (blister), cyanide (blood), pulmonary (choking), and riot control (incapacitating) agents. These can be inhaled, ingested, absorbed, or injected. The myths about chemical agents are that they are difficult to disseminate and difficult to produce. Just two or three chemicals are needed for making several devastating nerve gas compounds. The chemicals needed for these instruments of mass disaster are readily available and the recipes can be purchased in books.

I watched a film of a monkey who died in 24 seconds from a nerve gas. We know chlorine/mustard gas was used in World War I and casualties were enormous. Nerve agents have been the dominant chemical weapons since World War II. In 1995, sarin nerve gas was released in a Japanese subway. In February 2001, Scotland Yard raided a house in London, discovering detailed plans that contained instructions on how to manufacture and deploy sarin poison. Chemical weapons represent a wide array of agents, which are significantly toxic with cataclysmic potential.

Nuclear disasters can occur as a result of power plant problems and radiation from portable nuclear devices.

Can a dental hygienist make a difference should a disaster occur? How exactly could these professionals be involved? We know that education is our first step toward preparedness. Armed with the knowledge of what can happen, what can be used, and what to do about it, there is no reason why a dental hygienist, pharmacist, optometrist, EMT, and others in associated health professions could not treat those affected.

First, there will be the medical issues that will be the basis for the disruption and loss of lives in the event of such an NBC crisis. You can accept the role of providing treatment. You can be prepared to assist with the diagnosis using descriptions of symptoms and a hotline to assist you. You can administer to patients and help them administer to themselves and their loved ones. You also can be instrumental in referrals.

I asked Dr. Leibowitz, "Dental hygienists in New York and other states do not have injections in their scope of practice. What if the recommended treatment involved injecting an anti-toxin, and I was educated, willing, and able to administer it?" In his reply, he explained that he expects to see a type of emergency clearance in a case of an NBC crisis. Those who are trained will be able to "legally" save lives under the auspices of an Emergency Responder. The need to save lives would be the first thing to consider and he believes that educated professionals will be allowed to administer treatment in a crisis under this umbrella.

Then there would be the emotional issues we can assist in — emotional and psychological reassurance to the victims and general public. Our dental offices spend years building a level of trust and confidence. Patients would be able to look to us for the help they may need. This allows us easy "panic control" with our "patients," rather than "mass chaos" with the public at large.

The good news for dental hygienists is that First Responder Ed, Inc., has developed a four-hour course for them. An interactive Web course is another option, and the course also will be available in several other formats: CD-ROM, videotapes, and audiotapes.

Future courses will include real-life scenarios and members acting as resources to educate all health professionals. There are plans to train lecturers to be able to deliver the message nationwide.

It may involve week-long training and I am anxiously waiting the opportunity to do this. I plan to further my education and preparedness on this topic. I will not be afraid of leaving my home, but I will be more aware and possibly quite prepared to administer to others in the case of an NBC incident.

The first response is often the last chance. The First Responder Ed, Inc. can be contacted at (212) 592-5678 or at 352 Park Avenue, New York, NY 10010.

Winnie Furnari, RDH, BS, is a past president of the Dental Hygienists' Association of New York. She can be contacted at furnari@frontier