Population Vulnerabilities, Preconditions, and the Consequences of Disasters

In a perfect illustration of our nation's proclivity for postevent crisis response and our resistance to longer term planning and system investment, the nation put a rush order on developing a massive bureaucracy designed to fast track new systems for preventing and responding to terrorism and large scale natural disasters. FEMA and many other agencies were incorporated into the new Department of Homeland Security, billions of dollars were appropriated and, seemingly, a substantial focus on disaster prevention and management was emerging in the aftermath of the attacks on the World Trade Center in New York City. What actually materialized, however, in the frantic push to create new systems, has, so far, failed to provide credible, cost-effective, evidence-based systems of disaster preparedness and response. Overall, I suspect that the government efforts spurred on by the attacks of 9/11 represent not only an extraordinary level of spending, but also a lack of accountability that is virtually unprecedented in recent US history. In fact, after watching—and working among—the efforts to respond effectively to the disasters precipitated by Hurricanes Katrina and Rita, and the subsequent flooding of New Orleans, it is clear that much needs to be done in all aspects of this field. But perhaps no challenge is more pressing than coming to grips with the realities facing families whose "disaster risk profile" is exacerbated by vulnerabilities that include long-term income fragility, social marginalization, or chronic illness

Are our children terrorist targets?

Are U.S. children potential terror targets? While such a notion is almost impossible to contemplate, evidence increasingly suggests that U.S. intelligence efforts must be alert to this horrific possibility and that schools and first-responders should have appropriate emergency plans

Children as Potential Targets of Terrorism: Conference Report

The working group was an assembly of top thinkers who through their professional and personal endeavours stand poised to consider the implications of children as explicit targets of terrorism and provide directions for research and policy. The group was structured to be a small, select convergence of high-level persons situated in a forum of free discussion. An underlying objective of the group is for participants to be a resource for each other as well as select communities including policy makers and media. The group will convene periodically as issues emerge and research directions develop. The meeting was structured around four conversations: Veracity of the threat; Prevention and Preparedness; Health System Response; and Psychological Consequences. This meeting report will follow the order of the speakers

Overcoming barriers to health care access for medically underserved children

Many children in the United States face serious challenges in seeking appropriate medical care, including lack of insurance coverage, linguistic and social barriers, geographic isolation, and localized shortages of health personnel. This article reviews the New York Children's Health Project (NYCHP), outlining the planning and implementation of a mobile service delivery model for pediatric care that can be adopted to help underserved children elsewhere in the United States

Are We Ready Yet to Deal with Large-Scale Disasters?

What seems to be abundantly clear, however, is that the United States is still not where it should be in terms of the general response capacity following major disasters, whatever their cause. Part of the problem is unchanged from last year. We will have not defined what we mean by "prepared" whether we are speaking of this concept on a national or local level. Not that this is in any way easy. The concept of preparedness or readiness is understood to be arbitrarily determined, so that it is always possible to under or over-prepare for future disasters. No two major events are exactly the same and the consequences can encompass a relatively wide range. That is precisely why it is essential for appropriate officials - particularly on the federal level - to establish criteria for what it means for the nation and for communities to be sufficiently prepared. That definition should take into account the major threats that the U. S. faces, guidelines for appropriate planning on a regional basis and, ultimately, an arbitrary decision with respect to much will be spent on preparing

Katrina, Rita, and the Failure of Imagination

Americans have had to deal with disaster preparedness for decades, anticipating events such as industrial accidents, power plant meltdowns, natural disasters, and nuclear attacks. Since September 11, 2001, the nation has spent unprecedented resources, created new federal, state, and local agencies, and greatly intensified efforts to prepare for catastrophes. But when Hurricane Katrina hit, we were unable to respond in an organized and comprehensive manner. Hurricane Rita gave us a chance to correct some of our mistakes. But there was a series of additional flagrant missteps. It is obvious that we need to reexamine our most basic assumptions about planning for catastrophic events

Preparedness—A Reminder for the Public

What should citizens do – or not do – at a time when threat levels are raised and we are painfully reminded that living with a certain level of risk is a reality of our times? Of course, this isn’t a question of terrorism, alone. We are also concerned about natural disasters or sever flu pandemics that are also capable of putting many people at great risk

Homeland Preparedness for Major Terrorism in 2006: Not Yet Ready for Prime Time

This year will represent a turning point for preparedness and homeland security in the United States. With Michael Chertoff firmly in place and making his own mark as the new Secretary of Homeland Security, the anticipated reauthorization of the federal bioterrorism bill and many other new perspectives and strategies on the table, changes are likely to be seen across the board. That’s a good thing and the new Secretary seems off to a strong start. The nation clearly needs more resources and smarter strategies if we are to make the progress we need. The fact is that four years after the attacks of September 11, 2001, the country remains far less prepared for terrorism and catastrophic disaster than we should be. Even in the case of understanding and meeting needs among first responder agencies, much of what is being done is shockingly random. In any given State, for instance, fire districts are using designated Homeland Security funds for widely variant purposes. One particular district may decide to use these dollars to purchase personal protective equipment; an adjacent district may go for a new truck, communication equipment or refurbishing the firehouse. None of these decisions may have any relevancy to a master response plan for a region. Such a master plan, in fact, is not likely to even exist. Consequently, stations and districts are on their own, a situation that causes legitimate concern about the real level of disaster readiness in many communities

Terrorism and preparedness: What September 11 and its aftermath mean for physicians

In the aftermath of September 11, the people and government of the United States confronted a new reality--so too did the health care community. The attacks revealed a number of vulnerabilities with respect to the health care system's infrastructure and ability to respond to terrorism. Although September 11 represents an unprecedented disaster in the United States, one would shudder to imagine the repercussions if biological or chemical agents, radioactive material, or nuclear weapons had been employed. The truth is, September 11 could have been much worse. Yet in the 3 1/2 years since the attacks, arguably little progress has been made

Bioterrorism

Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not carefully monitored. It is well known that children may exhibit different effects of biologic agents. Here are some examples: • Smallpox: Lack of immunity in children, whereas some adults who were vaccinated as children may still possess some degree of immunity. • Trichothecenes: The data show that children maybe more susceptible. • Melioidosis : Children manifest unique parotitis. • Anthrax: Recent and older data support the concept that children are less susceptible to the effects of anthrax